CHA Blog

Several Health Insurance Counseling and Advocacy Programs (HICAP) have reported on a few Medicare Advantage plans that are back-billing their enrollees for past monthly premiums. Many of these plans did not bill beneficiaries for months or even years at a time and are now sending them a bill for a large lump sum. Beneficiaries receiving such bills are rightly distressed and have contacted their local HICAP offices for help.

If you are experiencing this problem or have clients who are: 1) file a grievance with the MA plan; and 2) file a complaint with CMS Region 9 Office and ask that you or your client be relieved of all payment responsibility and ask for a Special Election Period (SEP) to change to another MA plan.

CMS Region 9 Contact: Ayanna Busby-Jackson

Her email and phone number are: ayanna.busby-jackson@cms.hhs.gov; 415-744-3615.

We, along with other advocacy organizations, are collecting information on such cases to report to the Centers for Medicare and Medicaid Services (CMS). With enough cases we can strongly recommend CMS file sanctions against these plans and/or impact litigation.

Please email us with a summary of such cases.

The number of reported hospital errors increased across California during the last year, according to data from the state Department of Public Health.

While a 2006 state law requires officials to publicly report hospital errors, California’s DPH has not yet reported the information to the state Legislature.

California hospitals reported 1,538 serious and preventable events for fiscal year 2008-2009, up from last year’s reported 1,224 errors. About 90% of the reported errors are currently under investigation, according to a recent article from the Sacramento Business Journal, 1/8.

Health insurers and hospitals are working to reduce the incidence of preventable medical errors through new policies and procedures. Medicare has also chosen not to pay for preventable medical errors, and many major health insurance companies are following suit.

In addition, hospitals are enacting new safety protocols in an effort to prevent such events. One system gaining more attention from lawmakers stems from a unique and successful strategy used in Pittsburgh to improve the quality, safety, efficiency and cost of hospitals in the area. The system took its ideas from one of the most efficient companies, Toyota. While this approach, modeling after an industry, may seem a bit strange and impersonal, hospital after hospital in the Pittsburgh area saw and sustained dramatic improvements. This approach is now being considered for other hospitals throughout the country. To learn more, see the book, The Pittsburgh Way to Efficient Health Care.

Here’s a chart that outlines the types and numbers of medical errors in California last year.

Secretary of Health and Human Services Kathleen Sebelius and Assistant Attorney General Tony West will highlight the Obama Administration’s work to fight Medicare Fraud and release new tips and information to help seniors and Medicare beneficiaries deter, detect and defend against Medical identity theft. Medical identity theft occurs when someone steals a patient’s personal information, such as his or her name and Medicare number, and uses the information to obtain medical care, to buy drugs or supplies, or to fraudulently bill Medicare using that patient’s stolen identity.

The event will be webcast live at www.StopMedicareFraud.gov.

When: Thursday, 10/15/09 at 1:30 p.m.

See our website section, Medicare Fraud, for more info. You can also contact our Senior Medicare Patrol (SMP) project to report cases of suspected fraud at 714-560-0309.

ABC News highlighted California’s Senior Medicare Patrol project in their recent report on durable medical equipment (DME) fraud in the Los Angeles area. Julie Schoen, CHA’s SMP Project Director was interviewed along with a Spanish-speaking beneficiary who was tricked into a wheelchair scam. Tips for avoiding becoming a victim are clearly presented in this short clip.

Here’s the video:

Medicare fraud costs taxpayers billions

The two articles below in the Wall Street Journal and Silver Planet also highlight our SMP and provide good advice on how consumers can 1) prevent Medicare fraud and 2) report suspected fraud.

• How to Join the Fight in a New Crackdown on Medicare Fraud
• Volunteer Program Targets Medicare Fraud

See Medicare Fraud for more information.