Medicare Part D News

by Mary Loftis, Extension Associate

The articles below are Mary Loftis's Medicare Part D columns. For more information on any of these topics or activities contact Nebraska Extension in Burt County at 402-374-2929 or contact your local Nebraska Extension office.

Medicare Prescription Drug Plan Computer Help Sheet 2015


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May 4, 2017

mloftis2@unl.edu

402-374-2929

Medicare Basics Workshop

          Are you turning 65 in the next few months? Or are you over 65 and have decided to retire and will be losing your work insurance? These are excellent reasons to learn about Medicare. Getting started in the Medicare program can sometimes seem like a daunting task but once you know the basics, you can make good decisions regarding your future health care.

          The Medicare Basics Workshop will help explain the different parts of Medicare, the associated costs and the time frame to make decisions regarding Medicare. The Medicare Basics workshop will be held Thursday, May 25th in Blair at the Nebraska Extension office in Washington County at 597 Grant Street beginning at 7:00 p.m.

The workshop will be presented by Mary Loftis, Nebraska Extension Associate who is also a trained Senior Health Insurance Information Program (SHIIP) counselor for over 12 years. Just like the Nebraska Extension program, the SHIIP program provides information only. Absolutely nothing will be sold at this workshop and there is no charge to attend.

          Maybe you’ve already talked to human resources at work or even Social Security but you’re still a little confused you are welcome to attend. The more you hear the information about how Medicare works the better you will understand the program.

          Please call Nebraska Extension in Washington County at 402-426-9455 by Tuesday, May 23 to register for this workshop so enough materials will be available.

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April 20, 2017

New To Medicare Educational Program – Wednesday May 24

By Mary Loftis, SHIIP Counselor

If you are turning 65 in 2017 and/or are considering going off an employer’s insurance plan in the near future this “New to Medicare” program is designed for you.

The Senior Health Insurance Information Program (SHIIP) which is part of the Nebraska Department of Insurance, provides unbiased information to assist individuals as they reach this important point in their lives. I’ve been a SHIIP counselor for 12 years and have assisted hundreds of people explaining the different parts and costs of Medicare as they become eligible. In addition, I’ve helped many, many more Medicare recipients compare Medicare prescription drug plans each year.

          During this workshop we will discuss the different parts of the Medicare program, costs, eligibility and much more. There will be time for questions and answers, because any insurance related program always leaves you with questions…especially one as individualized as Medicare. The best news is that I can’t, won’t and don’t try to sell you anything. I work for Nebraska Extension and education is our business. Period.

          Anyone is welcome to attend no matter what county or community you live in. Bring along a friend, spouse or neighbor and any mail you’ve received that might be helpful to explain your questions.

          This free program will be held in the Washington County Extension Office meeting room at 597 Grant Street, Blair, NE on Wednesday, May 24 beginning at 7:00 p.m. Please call the Nebraska Extension office in Burt County at 402-374-2929 or in Washington County at 402-426-9455 to pre-register so enough materials are available.

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March 31, 2017

Fraud Article

By Carol Harrah – Nebraska SHIIP Training Specialist

 

Every year, healthcare fraud wastes billions of dollars in taxpayer funding and robs the most vulnerable patients of the resources they need to get well.

As anti-fraud programs gain momentum, fraudsters always look for new ways to slip through the cracks. Here are four types of fraud healthcare professionals should be aware of this year.

Unnecessary procedures

One of the most common ways that people defraud Medicare, Medicaid, and TRICARE is by billing those programs for unnecessary procedures. This scheme typically involves lying to a patient about their diagnosis or treatment needs in order to justify the highest possible billing level.

In January 2017, a Michigan neurosurgeon named Aria Sabit was sentenced to nearly 20 years in prison for giving patients unnecessary spinal surgeries solely to boost his own profits. He defrauded $2.8 million from healthcare programs, including Medicare and Medicaid.

He performed the unnecessary procedures as part of a kickback scheme with Apex Medical Technologies, which provided the spinal implants. Many of the patients this neurosurgeon treated were seriously harmed by the implantation of the devices.

Not only did Sabit hurt patients in Michigan; he had previously been suspended from his position at a California hospital.

Sabit's case is a clear demonstration of why healthcare providers should only be performing those services that are in the best interest of patients. To do otherwise can come at a steep cost to patients, as well as to the taxpayers that fund public healthcare programs.

Patient referral schemes

Healthcare companies sometimes develop an excessive focus on boosting profits and end up breaking the law. Though all hospitals need patients in order to continue operating, it is illegal to pay for patient referrals while enrolled while enrolled with public healthcare programs.

Tenet Healthcare paid over $500 million in 2016 to settle allegations that it bribed prenatal care clinics to refer Medicaid patients to Tenet hospitals-even if the nearest branch was very far from where the expectant mothers lived. The patients were told that in exchange, all of their childbirth and newborn care costs would be covered. Tenet raked in over $145 million from federal healthcare programs from this kickback scheme.

There are many ways healthcare facilities can commit kickback violations, but it's important for providers to know that it is illegal both to offer and to receive payments or gifts in exchange for patient referrals.

Fraudulently compounded medications

Compounded medicines are an important option for patients with unique treatment needs or difficulty taking standard forms of medication. Many pharmacies that offer these types of prescriptions have been known, however, to orchestrate large-scale fraud schemes. Federal reimbursements for compounded medicines have risen astronomically in recent years, prompting the government to more closely investigate the authenticity of claims for those drugs.

One way that pharmacies defraud the government is by paying doctors to write needlessly expensive compounded prescriptions. A California pharmacy was accused of a compounding scheme, after bribing doctors to write $3,000 prescriptions for pain creams, when the patients' needs could have been met with $20 prescriptions.

Since Medicare and Medicaid are publicly funded, it is illegal to deliberately overcharge the government for any treatment, including pharmaceutical products.

Ambulance billing fraud

There are so many cogs in the wheel of our healthcare system, it can be difficult rooting out fraud in every corner. A recent settlement involving Medstar Ambulance shone a light on a less publicized type of healthcare fraud that can be seriously costly.

Medstar agreed to pay $12.7 million back to the government to resolve allegations that it had regularly billed for unqualified trips. The company was also accused of upcoding regardless of the actual severity of a patient's condition.

Given the frequency with which ambulances are used in healthcare, this is a type of fraud that is unlikely to go away anytime soon. Unfortunately, fraudsters may take advantage of a patient's vulnerability or inability to communicate in order to increase their profits at the government's expense.

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March 27, 2017

Debra Schroeder, Nebraska Extension Educator in Cuming County was honored Sunday, March 26 on her retirement after 40 years in Extension.

Deb has become a familiar figure to thousands of Nebraska residents through her innovative work with the Control Your Diabetes for Life program as well as her extensive 4-H programming.

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March 24, 2017

March Fraud Article

Detect Medicare Fraud by Checking Your Medicare Summary Notices

Medicare statements outline payments made on a beneficiary's behalf for Medicare covered services. There are two primary types of statements received by Medicare beneficiaries: Medicare Summary Notices (MSNs) and Explanations of Benefits (EOBs).

  • Beneficiaries enrolled in Original Medicare receive MSNs.
  • Beneficiaries enrolled in Medicare Advantage (Part C) plans receive EOBs.
  • Beneficiaries enrolled in Medicare prescription drug (Part D) plans receive EOBs.

MSNs and EOBs explain:

  • What service the health care provider billed for
  • The amount approved by Medicare for payment
  • How much Medicare paid
  • What the beneficiary may be billed for

Be on the Look Out for Fraudulent claims:

  • Review your or your loved ones' Medicare statements as soon as they arrive to ensure all of the services listed were actually received
  • Compare the statements to your receipts and records 
  • If you notice any mistakes, or have questions, call your provider or plan with your questions
  • If you still have questions or think a claim is fraudulent, contact The SHIIP hotline at 1-800-734-2119

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March 2, 2017

The Do’s and Don’ts of Dealing with Criticism

Anyone that has been diagnosed with type 2 diabetes knows the flurry of concern the diagnosis raised among family members, friends and colleagues.  You might even find yourself being criticized for “bringing it on yourself” or not living a healthy enough lifestyle to manage your condition.

Much of this criticism stems from a lack of understanding or the person’s fear for your health.  Nevertheless even when the intentions are good, criticism hurts. Successfully dealing with this criticism requires a carefully planned response. 

People often criticize from a point of ignorance.  Although their criticism might be out of concern for your well-being, clumsy efforts can end up being more hurtful than helpful.  If the criticism comes from someone who you are unlikely to see again, it can be easier to shrug off a careless remark.  Often, these people realize their comments were ill-phrased and inappropriate right after they speak. Try not to take it too personally. 

However, don’t be as quick to ignore criticism that comes from those who love you and mean you well.  Look more deeply into their comments to identify the underlying message, because it will be coming from a place of love.  Just because they have been clumsy in their delivery of the message doesn’t mean there isn’t something you can take from it.  Once you understand the key message, paraphrase it back to them to illustrate a more considerable way to express their concerns.

Most importantly, it should not be dismissed if it comes from knowledgeable experts or those who also live with Type 2.  There are people around you from whom you can learn a great deal and who want to share their knowledge with you---take that opportunity.

Since criticism is something that you cannot ignore, Debra Schroeder, Extension Educator, will help you prepare yourself for it.  She will share dos and don’ts for dealing with criticism.   

Good control with diabetes requires both diligence and willingness to try new strategies.  Learn new strategies by attending “Control Diabetes for Life.”  The March 13 session will focus on Make Your Commitment to Self-Management. 

Set a goal to take control of your diabetes.  Aim for lower blood glucose levels to feel better now and stay healthy for years to come.  Monday, March 13, topics to be addressed include: “Commit to be Fit”, “What’s New in Diabetes Care”, “Fiber and Protein in Your Diet”, and “The Dos and Don’ts of Dealing with Criticism”.  These sessions are designed to supplement the education that you receive from your local diabetes education team and not a substitute for diabetes classes through your local health care providers.

Participants will sample a new recipe for a diabetic appropriate food.  Team-teaching the program will be Stacie Petersen, B.S.N. & Certified Diabetes Educator; Deborah Willcox R.D.,LMNT, of Franciscan Care Services in West Point and Debra Schroeder, UNL Extension Educator in Cuming County.  Guest speaker for the programs will be Terry Nelson, DPT, of Franciscan Care Services.

Control Diabetes for Life will be available from 7:00-9:00 p.m. at the Tekamah Herman Public High School in the Family Consumer Science (Home Ec.) Classroom. Look for the signs when coming in the front doors.

“Control Diabetes for Life” is a joint project of University of Nebraska-Lincoln Extension, Franciscan Care Services of West Point and cooperating schools.  The program is offered free-of-charge.  “Control Diabetes for Life” will help participants learn to control diabetes and prolong the onset of complications from the disease.

Participants are asked to pre-register for “Control Diabetes for Life” by calling the Burt County Extension office at 402-374-2929.  Please register by Friday, March 10, so the proper number of handouts may be prepared.  Nebraska School Food Service Association has approved the session for two hours of continuing education credits for food service staff.

Control Diabetes for Life!  Start by attending the March 13 distance education program.  Call today to register!

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March 1, 2017

Spotlight on Fraud:  The New Medicare Cards 

Starting next year a major change will be occurring in Medicare. In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act. This law requires the removal of the social security numbers from all Medicare cards by April 2019. This new initiative is referred to as the Social Security Number Removal Initiative (SSNRI.) A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the social security number. When the initiative gets under way all Medicare beneficiaries will be assigned a new MBI and be sent a new Medicare card.

The primary goal of the initiative is to decrease Medicare beneficiaries' vulnerability to identity theft by removing the social security number from their Medicare cards and replacing it with a new Medicare MBI that does not contain any other personal information.

The new MBI will have the following characteristics:

  1. The same number of characters as the current Medicare number, but will be visibly distinguishable from the Medicare number
  2. Contain uppercase alphabetic and numeric characters throughout the new MBI
  3. Not contain inappropriate combinations of numbers or strings that may be offensive

For providers, the new MBI will occupy the same field as the Medicare number on transactions

  1. Be unique to each beneficiary (e.g., husband and wife will have their own MBI)
  2. Be easy to read and limit the possibility of letters being interpreted as numbers (e.g., alphabetic characters are upper case only and will exclude S, L, O, I, B, Z)
  3. Not contain any embedded intelligence or special characters

The Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare, has established a transition period during which the Medicare number or MBI will be accepted from providers, beneficiaries, plans and others. CMS expects the transition period to run from April, 2018 through December 31, 2019. After the transition period only the MBI will be used.

Starting around April 2018, CMS will start mailing new Medicare cards. There are approximately 60 million beneficiaries in Medicare. So, CMS will probably mail the cards in phases over a period of time. Remember, as a beneficiary you can still use your current Medicare number during the transition period if it takes a while to receive your new Medicare card. If a beneficiary is new to Medicare after April, 2018 and Medicare has started issuing the new cards, the beneficiary will receive the new MBI. Therefore, healthcare providers must be able accept the new MBIs by April, 2018.

The Nebraska SHIIP wants all Medicare beneficiaries to be aware of possible fraud and scams relating to the new Medicare cards. Remember, CMS and Medicare will never contact you by phone or email to ask for personal information relating to the issuance of the new Medicare cards. Any such contact is a scam. Don't be taken in. Also, there will be no charge for the issuance of the new Medicare cards. Anyone seeking to have a beneficiary pay money for the new card is a scammer. Be especially careful of anyone seeking to have access to your checking account to pay any fee for the new card. Beneficiaries are especially vulnerable if they are isolated, frail or may have cognitive loss. Caregivers should be on the alert for these kinds of scams. SHIIP is currently educating beneficiaries at its outreach events of the issuance of the new Medicare cards. CMS will also be conducting intensive education and outreach to beneficiaries to help them prepare for this change.

The issuance of the new Medicare card is a significant change. If a beneficiary or caregiver has any questions about the SSNRI, please don't hesitate to call SHIIP at 1-800-234-7119.

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February 22, 2017

Prevent Complications from Diabetes

Contrary to what you have heard, there is not one universal “diabetic” diet (any more than there is one weight-loss diet).  People with diabetes can eat the same food as everyone else, and that includes sugar.  A diet for people with diabetes is the same healthy diet that applies to everyone.  Every person on this planet can reap the benefits of a diet that’s full of wholesome, good for you foods, including plenty of fruits and vegetables, whole grains, low-fat dairy, lean meats and healthy fats. 

That said, because when, what and how much we eat has a direct effect on blood sugar, people with or at risk of developing diabetes (just like those that are trying to lose weight)need  to take more care in selecting what and how much they eat.  A meal plan is simply a plan that assists you in determining how much or what type of food is right for you at each meal throughout each day.

You and your family are invited to participate in Control Diabetes for Life to learn the latest research based information to help you make wise food selections in order to hold blood sugar levels in tight control and at optimum levels.  The next session of Control Diabetes will be held on Monday, March 13, 2017.

Blood glucose control is just one aspect of preventive care.  Following a meal plan, being physically active, losing excessive weight, keeping your blood pressure and cholesterol levels in check, quitting smoking and taking aspirin are all important ways to prevent future health problems.   

High blood glucose is a major cause of serious diabetes complications.  Recognizing diabetes early and getting your blood glucose levels under control allows for swift action to slow its progression and avoid complications.  Lowering your A1C by just one percentage point lowers your chance of getting eye, kidney or nerve disease by 40 percent. 

Good control requires both diligence and willingness to try new strategies. Learn new strategies by attending “Control Diabetes for Life.” The March 13 session will focus on “Make Your Commitment to Diabetes Self-Management.”

Set a goal to take control of your diabetes. Aim for lower blood glucose levels to feel better now and stay healthy for years to come. Monday, March 13, topics include: “Commit to be Fit”, “What’s New in Diabetes Care”, “Fiber and Protein in Your Diet”, and “The Dos and Don’ts of Dealing with Criticism”.  There will also be a question and answer period. 

Participants will sample a new recipe for a diabetic appropriate food. Team-teaching the program will be Stacie Petersen, BSN & Certified Diabetes Educator; Deborah Willcox, RD, LMNT, and Terry Nelson, DPT all of Franciscan Care Services in West Point and Debra Schroeder, UNL Extension Educator in Cuming County. These sessions are designed to supplement the education that you receive from your local diabetes education team and are not a substitute for diabetes classes through your local health care providers.

Control Diabetes for Life will be available in Burt County from 7:00–9:00 p.m. at the Tekamah Herman Public High School in the Family and Consumer Science Classroom. (Signs will be posted.)

“Control Diabetes for Life” is a joint project of University of Nebraska-Lincoln Extension, Franciscan Care Services of West Point and school hosting the programs. The program is offered free-of-charge. “Control Diabetes for Life” will help participants learn to control diabetes and prolong the onset of complications from the disease.

Participants are asked to pre-register for “Control Diabetes for Life” by calling the Burt County Extension office at 402-374-2929. Please register by Friday, March 10, so the proper number of handouts may be prepared. Nebraska School Food Service Association has approved this session for two hours of continuing education credits.

Control Diabetes for Life! Start by attending the March 13 program. Call today to register!

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February 9, 2017

Medicare Basics

The Medicare Basics program was shared with 19 individuals early this month and it was very well received by the group. One person even said it was the most professional and informative program he had ever seen! That’s high praise and yes, it made me feel very good, but I don’t get all the credit. I’ve got a great Medicare team behind me at the Nebraska Department of Insurance in the Senior Health Insurance Information Program (SHIIP). They train us, keep us updated and provide PowerPoints as well as answer any questions we might have. If you missed this informational meeting make plans to attend one in Blair on May 24th or in Fremont on September 26th. If these sessions don’t fit your timeline as you turn 65 please call the Nebraska Extension Office in Burt County at 402-374-2929 and I’ll make every attempt to help you understand the Medicare program and your options.

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February 3, 2017

Scam Alert:

Numerous news reports have recently been published on the “Can you hear me?” phone scam, as reported in the Omaha World Herald and USA Today among others. 

In summary, an automated or live call asks recipients, “Can you hear me?” in order to get a “Yes” response to use to fraudulently authorize purchases.

Here is the advice from the Better Business Bureau:

• Hang up on any unsolicited automatic robocall. If you are on the federal Do Not Call List and a company calls out of the blue to ask questions, it's likely a scam.

• Avoid responding with "yes," "sure" or "OK."

• Hang up if you're asked to press a button to be placed on the Do Not Call registry. Doing anything else could help scammers identify an active phone number. No government agency will ever solicit for the Do Not Call Registry.

Write down the phone number of callers with this behavior and file a scam report with the BBB Scam Tracker at bbb.org/scamtracker/us or by calling 800-649-6814.

• Write down the phone number of callers and file a scam report with the Better Business Bureau atbbb.org/scamtracker/us or by calling 800-649-6814 and the Federal Trade Commission’s Do Not Call List. Call toll-free 1-888-5-OPT-OUT (1-888-567-8688)

·  Check your credit card, phone and cable statements carefully for any unfamiliar charges. If you suspect you have been victimized, call the billing company and dispute anything you did not authorize. The earlier you identify the unauthorized charges on your account, the easier it will be to recover any lost money. 

Omaha World Herald article: http://www.omaha.com/money/this-phone-scam-just-needs-you-to-say-yes-hang/article_9dcd0d0e-0ed8-5701-9aa1-7c0657f1c1c0.html

USA Today: http://www.usatoday.com/story/tech/nation-now/2017/01/27/can-you-hear-me-phone-scam/97152110/

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February 3, 2017

Protecting Yourself from Fraud Associated with Medicare

As you obtain quotes on, purchase, or change Medicare plans, (Supplements, Prescription drug plans, and Medicare Advantage Plans) you will be dealing with a variety of insurance agents, companies, and unsolicited mailings, emails, phone calls, and other creative marketing tactics. It is important to carefully scrutinize these various entities to insure that those you are dealing with are legitimate and that your personal information is kept safe and secure. The following are best practices and what to do if you suspect your information has been compromised.

Consumers SHOULD

·        Protect their SSN and Medicare numbers

·        Shred documents containing health care information or other personal information before throwing them away

·        Look for official government seals, logos, or .gov web addresses

·        Be an informed consumer and take the time to compare coverage options before making a decision

·        Review information from health plans to make sure only services, equipment and prescriptions used by consumers, or their household members, are listed

·        Be aware of product promotions, so-called “special deals,” or other offers that seem too good to be true because these offers may be related to fraud or identity theft

·        End any suspicious call or visit immediately (you may need to call a family member or the police for help.)

·        Report suspicious calls or visits to your state Department of Insurance (DOI).

Consumers should NOT:

·        Respond to unsolicited advertisements

·        Give out information over the telephone or Internet unless the requestor has proven they have authority to have this information

·        Give personal information to anyone who calls or comes to their home uninvited

·        Sign blank insurance forms or applications

·        Be pressured into making purchases, signing contracts, or committing funds 

Information Needed To Report Suspected Fraud:

·        The name or ID number of the individual or entity suspected of fraud

·        Contact information for the individual or entity suspected of fraud

·        summary of the suspected fraud

·        The date for when the suspected fraud occurred

·        Whether you suspected the fraud or heard about it from a third party

You can submit a report of suspected fraud to:

HHS Office of the Inspector General (OIG): The OIG Hotline accepts tips and complaints from about potential fraud, waste, abuse, and mismanagement in any Department of Health and Human Services' programs (Medicare, Medicaid, Health Insurance Marketplace, SNAP, etc.)

Phone: 1-800-HHS-TIPS (1-800-447-8477) or through the mail:

HHS OIG, ATTN:

OIG HOTLINE OPERATIONS

PO Box 23489

Washington, DC 20026

Federal Trade Commission (FTC): The FTC accepts complaints related to many topics, including:

·       Identity theft

·       National Do Not Call Registry violations

·       Computers, the internet and online privacy

·       Telemarketing scams

·       Credit scams

·       Sweepstakes, lotteries, and prizes

·        Business opportunities and work-at-home schemes

·       Health and weight loss products

·       Debt collection, credit reports, and financial matters 

Online: Secure Complaint Assistant

Phone: 1-877-ID-THEFT (1-877-438-4338)

Nebraska Department of Insurance (NDOI): To report insurance fraud

Online: Fraudulent Claim Form

Nebraska Senior Medicare Patrol (SMP): For help identifying and reporting possible Medicare fraud. Phone: 1-800-234-7119

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