Boston: Medicare Fraud Summit Beneficiary/Consumer Panel


Uploaded by USGOVHHS on 17.12.2010

Transcript:
IT'S MY PLEASURE TO INTRODUCE YOU TO ANN HARTSTEIN SECRETARY
OF THE MASSACHUSETTS OF EXECUTIVE OFFICE OF ELDER
AFFAIRS. PLEASE WELCOME, ANN.
[APPLAUSE] GOOD MORNING, EVERYONE.
ON BEHALF OF THE GOVERNOR DUVAL PATRICK AND THE SECRETARY OF THE
EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES I'M HONORED TO BE
HERE TO WELCOME YOU TO THE MASS HEALTH CARE FRAUD PREVENTION
SUMMIT. AS PART OF THE NATIONAL
DISCUSSIONS WE ARE HAVING TODAY ON PREVENTING HEALTH CARE FRAUD.
I WANT TO THANK CHANCELLOR MOTLEY FOR MAKING THE UNIVERSITY
AVAILABLE TO US AND DR. BUT DEBT, CARMEN ORTIZ AND ATTORNEY
GENERAL TONY WEST, FOR BEING HERE AS WELL.
IT'S A PLEASURE TO HAVE ALL OF YOUR PARTICIPATION HERE WITH US
TODAY. I WANT TO THANK THE PANELISTS
HERE WITH ME. I'M PLEASED TO BE ABLE TO
MODERATE THIS PANEL ON CONSUMER PARTICIPATION.
THERE IS MANY DIFFERENT WAYS FOR INFORMATION TO BECOME AVAILABLE
IN TERMS OF FRAUD AND CONSUMERS ARE A MAJOR WAY FOR THAT TO
HAPPEN. HAVING SPENT MY ENTIRE CAREER
WITH SENIORS AND NOW AS A SECRETARY OF ELDER AFFAIRS, I'M
WELL AWARE OF THE FRAUD ASSOCIATED WITH HEALTH CARE
CONSUMERS AND IMPACT ON THE SYSTEM.
AS WE PROVIDE HEALTH CARE COVERAGE THE INCREASING NUMBER
OF SENIORS IN OUR SOCIETY AS MANY KNOW THE FAVORITE
BABYBOOMERS WILL BE TURNING 65 IN THE NEXT WEEK.
THE NEED TO COMBAT FRAUD INCREASES AS WELL.
MASSACHUSETTS EMBRACES THE OPPORTUNITY TO WORK WITH THE
U.S. DEPARTMENT OF HEALTH AND HUMAN SEVERANCES AND THE U.S.
DEPARTMENT OF JUSTICE THROUGH OUR MASSACHUSETTS SENIOR
MEDICARE PATROL PROGRAM AND OTHER STATE AGENCIES AND LOCAL
AGENCIES WHO EDUCATE CONSUMERS IN HELPING PREVENT AND UNCOVER
HEALTH CARE FRAUD AND YOU'LL HEAR OR HEAR MORE ABOUT OUR
MEDICARE SENIOR MEDICARE PATROL PROGRAM IN A MINUTE.
MASSACHUSETTS HAS A LONG HISTORY OF SERVICE AND COMMITMENT TO
SENIORS AND IN FACT, ANOTHER FIRST AS ATTORNEY ORTIZ
MENTIONED EARLIER IS THE FACT THAT IN 1973, THE BAY STATE
ESTABLISHED THE FIRST IN THE NATION CABINET LEVEL DEVOTED
AGENCY DEVOTED TO SENIORS. SINCE THAT TIME, WE HAVE BEEN
DEDICATED PARTNERS OF THE U.S. ADMINISTRATION ON AGING AS WELL
AS MEDICARE AND MEDICAID TO ENSURE THAT MASSACHUSETTS
SENIORS KNOW ABOUT THE SPECTRUM OF FEDERAL, STATE AND LOCAL
PROGRAMS. TO MAKE THAT WORK, ELDER AFFAIRS
OFFERS SERVICES THAT EDUCATE SENIORS ABOUT THEIR HEALTH CARE
AND LIFESTYLE SHOWS CHOICES AND PROVIDE HOME ASSESSMENTS OF
SENIORS NEEDS AND OFFER INDIVIDUAL SUPPORT TO MEET THOSE
NEEDS. THEY PROVIDE CASE MANAGEMENT
WHERE APPROPRIATE AND PROVIDE CLASSES OF SELF MANAGEMENT
PROGRAMS TO ASSIST PEOPLE TO STAY HEALTHY.
WE WORK WITH SENIORS, THEIR FAMILIES AND EVERYONE ACROSS THE
LIFESPAN TO MAKE SURE THAT PEOPLE HAVE INFORMATION AND
ACCESS TO SERVICES FOR SENIORS. ELDER AFFAIRS AS A STATE UNIT ON
AGING IN THE COMMONWEALTH IS THE CONNECTION BETWEEN THE FEDERAL
GOVERNMENT FUNDING AND THE MASSACHUSETTS AGING NETWORK
WHICH INCLUDES LOCALLY BASED 27 REGIONAL AGING SEVERANCES ACCESS
POINTS KNOWN AS ASAPS. 24 AREA AGENCIES ON AGING AND
THE MUNICIPALITY-BASED 349 COUNSEL'S ON AGING.
IN MASSACHUSETTS, COUNCILS ON AGE ARE THE LINK FOR SERVICES
THROUGHOUT MASSACHUSETTS. LAST YEAR, OVER HALF A MILLION
MASSACHUSETTS RESIDENTS CAME TO COUNCILS ON AGING SEEKING
INFORMATION ABOUT NUTRITION PROGRAMS, MEALS ON WHEELS, FUEL
ASSIST ABS, HOME ENERGY PROGRAMS, HOME CARE SUPPORTS AND
MANY OTHER SERVICES. AT ELDER AFFAIRS WE KNOW
INFORMED CONSUMER IS LESS LIKELY TO BE THE VICTIM OF HEALTH CARE
FRAUD. FOR MEDICARE RECIPIENTS, THE CMS
FUNDED SHINE PROGRAM, KNOWN AS SHIP, ACROSS THE COUNTRY.
STANDS FOR THE SERVING HEALTH INFORMATION NEEDS OF ELDERS, IS
THE INFORMATIONAL KEY TO UNDERSTANDING FEDERAL HEALTH
CARE OPTIONS AND BENEFITS AND YOU'LL HEAR FROM SHINE
COUNCILORS TODAY. METED CARE BENEFICIARY OF ANY
AVERAGE WHO NEEDS HELP CHOOSING AMONG HEALTH CARE PLANS MAY CALL
OR WALK INTO A COUNCIL ON AGING OR ANY NUMBER OF OTHER COMMUNITY
AGENCIES WHERE SHINE COUNCILORS HAVE OFFICE HOUSE AND AN
APPOINTMENT TO MEET ONE-ON-ONE WITH ONE OF OUR 450 WELL-TRAINED
SHINE VOL TREATMENTS THE COUNCILORS PROVIDE MEDICARE AND
HEALTH INSURANCE INFORMATION AS WELL AS TEACHING MEDICARE
BENEFICIARIES TO BE ON ALERT FOR BILLING AND FRAUD.
AND YOU HEARD AGAIN SOME SITUATIONS WHERE THEY BROUGHT
THESE TO THE ATTENTION OF THE AUTHORITIES.
I TALKED WITH MANY MEDICARE BENEFICIARIES AND THEIR FAMILY
MEMBERS WHO ARE APP HENCE AND I HAVE CONFUSED BEFORE TALKING TO
A SHINE COUNSELOR AND CAME AWAY FROM THOSE SESSIONS RELIEVED AND
EMPOWERED TO MAKE GOOD HEALTH INSURANCE DECISIONS FOR
THEMSELVES. OUR SHINE PROGRAMS ARE LOCATED
BOTH AT COUNCILS ON AGING AND OUR REGIONAL AGING SERVICES
ACCESS POINTS. THE AGENCY IS CHALLENGED WITH
ASSESSING NEEDS OF INDIVIDUALS AND DEVELOPING SERVICE PLANS
WITH THEM TO HELP MEET THEIR NEEDS.
THE REGIONALS WORK COLLABORATIVELY WITH LOCAL LAW
ENFORCEMENT AGENCIES TO INVESTIGATE ALLEGATIONS OF
ABUSE, NEGLECT AND EXPLOITATION OF SENIORS THROUGH OUR
PROTECTIVE SERVICES PROGRAM. ON THE HEALTH CARE FRONT, ELDER
AFFAIR OPERATES A STATE-FUNDED PHARMACY ASSISTANCE PROGRAM,
PRESCRIPTION ADVANTAGE, WHICH OFFERS MEDICARE BENEFICIARIES,
PRESCRIPTION DRUG COVERAGE TO FILL THE MEDICARE PART D
DOUGHNUT HOLE. AND PRESCRIPTION CUSTOMER
SERVICE REPRESENTATIVES CAN ANSWER OTHER QUESTIONS THAT
CONSUMERS HAVE ABOUT DRUG COVERAGE FOR SENIORS.
IN MASSACHUSETTS, SENIORS AND THEIR FAMILIES AND CAREGIVERS
WITH PROBLEMS AND CONCERNS HAVE ACCESS TO US 24-7.
WE HAVE A 1-800 AGE INFO PHONE INFORMATION LINE AS WELL AS A
WEBSITE THAT IS AVAILABLE. ELIMINATING FRAUD AND HEALTH
CARE IS A RESPONSIBILITY WE SHARE.
WE ARE COMMITTED TO EDUCATING THE SENIORS AND THEIR FAMILIES
AS WELL AS ALL MEDICARE BENEFICIARIES.
AND TO BE ACTIVE PARTNERS. WE ARE EQUALLY COMMITTED TO
STRENGTHENING OUR PARTNERSHIP WITH CENTRAL AND STATE AGENCIES
WORKING THROUGH OUR MASSACHUSETTS SENIOR MEDICARE
CONTROL PROGRAM IN ELIMINATING HEALTH CARE FRAUD AND YOU'LL
HEAR MORE ABOUT THAT IN ABOUT 30 SECONDS.
IT GIVES ME GREAT PLEASURE TO INTRODUCE OUR PANEL FOR THIS
SEGMENT OF THE PROGRAM WHO WILL TALK ABOUT THE ROLE OF THE
CONSUMER IN ADDRESSING FRAUD IN THE HEALTH CARE SYSTEM.
WE HAVE WITH US, KATHY GREENLEE, THE ASSISTANT SECRETARY FOR
AGING AT HHS, LUCILIA PRATES THE DIRECTOR OF THE MASSACHUSETTS
SENIOR MEDICARE PATROL PROGRAM AND TWO VOLUNTEERS, YVES-ROSE
CRISPIN A SENIOR MEDICARE AND SHINE COUNSELOR SERVING WITH THE
HAITIAN AMERICAN PUBLIC INITIATIVE AND VIRGINIA LEMIRE,
A SHINE COUNSELOR FROM MASSACHUSETTS.
WE WILL HAVE PRESENTATIONS BY THE PANELISTS AND HAVE HOPEFULLY
HAVE TIME TO FIELD QUESTIONS FROM THE AUDIENCE.
SO WITHOUT FURTHER ADIEU, ONCE AGAIN, IT'S MY HONOR AND
PLEASURE TO INTRODUCE THE FIRST SPEAKER, ASSISTANT SECONDE FOR
AGING AT THE U.S. DEPARTMENT OF HEALTH AND THE HUMAN SERVICES,
KATHY GREENLEE. THANK YOU VERY MUCH.
[APPLAUSE] GOOD MORNING.
IT'S GOOD TO BE IN BOSTON AGAIN AND I JUST WANT TO THANK ANNE
AND YOUR LEADERSHIP HERE IN MASSACHUSETTS.
IT'S GOOD TO BE BACK. WE HAVE A WONDERFUL NETWORK HERE
IN MASSACHUSETTS OF INDIVIDUALS WHO SERVE THE SENIORS OF YOUR
STATE AND THEIR CAREGIVERS AND FAMILIES.
IT'S AN HONOR TO BE HERE IN YOUR FINE STATE.
MY JOB THIS MORNING TO KICK OFF THE PANEL IS TO TALK ABOUT THE
ADMINISTRATION ON AGING SENIOR MEDICARE PATROL PROGRAM.
SOMETHING THAT WE ARE VERY PROUD OF.
I HAD THE CHANCE IN THE SUMMER TO PARTICIPATE IN THE FIRST ONE
OF THESE FRAUD SUMMITS BETWEEN DEPARTMENT OF JUSTICE AND HEALTH
AND HUMAN SERVICES IN MIAMI. AND I DON'T KNOW ABOUT THE
PLANNING BUT WE WENT TO MIAMI IN THE SUMMER AND WE HAVE COME HERE
WHEN IT'S REALLY COLD OUTSIDE. SO IT'S GOOD TO BE IN THE STATES
AND TALK ABOUT WHAT WE ARE DOING AT THE NATIONAL LEVEL.
WE HAVE MANY CRITICAL PARTNERSHIPS AT THE FEDERAL
LEVEL THAT MAKE THIS ALL HAPPEN. BUT THE FRAUD HAPPENED LOCALLY
SO IT'S GOOD TO TALK TO YOU. I DON'T NORMALLY TALK ABOUT THE
U.S. ATTORNEY'S OFFICE IN MY COMMENTS BUT I WANTED TO
ACKNOWLEDGE HOW NICE IT IS TO FOLLOW THE PANEL OF LAW
ENFORCEMENT AND U.S. ATTORNEYS IN THE STATE MEDICAID UNIT.
I COME FROM THE STATE OF KANSAS WHERE I WORKED FOR A VERY LONG
TIME. I'M AN ATTORNEY.
AND I WENT TO A PRESENTATION SEVERAL YEARS AGO TO GET MY
CONTINUING LEGAL EDUCATION CREDIT WHERE THE KANSAS U.S.
ATTORNEY'S OFFICE WAS PRESENTING.
AND I LOVE LISTENING TO THE LAWYERS TALK ABOUT THEIR CASES.
THEY HAVE PROSECUTED IN KANSAS, PROVIDER WHO WAS BILKING THE
MEDICARE SYSTEM AND THIS FRAUD WAS BASIC.
THE PROVIDER IN CAN AS WAS BILLING MEDICARE FOR URINARY IN
CONTINENT DEVICES FOR SENIORS. THIS IS NOT ALARMING OR UNUSUAL.
THE DIFFERENCE AND THE SCAM WAS THE PRODUCT.
INSTEAD OF GETTING A CATHETER, THE EXPENSIVE MEDICAL DEVICE,
THE SENIORS IN OUR STATE WERE RECEIVING ADULT DIAPERS.
SOMETHING VERY, VERY DIFFERENT. I TELL THAT YOU STORY TO POINT
OUT AS A FOLLOW-UP TO THE PRIOR PANEL, THAT SOME HEALTH CARE AND
MEDICARE FRAUD CAN BE VERY, VERY SOPHISTICATED.
BUT SOME IS VERY BASIC LIKE SUSAN WAS TALKING ABOUT.
THE ARM BANDS YOU GET AT CVS BEING BILLION DOLLAR TO
MEDICARE. OR SOMETHING LIKE -- BEING
BILLED TO THE MEDICARE SYSTEM. OR SOMETHING LIKE INCONTINENT
DEVICES. BECAUSE MEDICARE FRAUD SPANS THE
G. GAMUT, THE ONE THING WE KNOW THAT IS THE COMMON DENOMINATOR,
A COMPLEX SYSTEM OR SCAM OR SOMETHING SIMPLE, EACH OF THESE
INVOLVE A ONE BY ONE BILLING THAT INVOLVES MEDICARE
BENEFICIARY. AND YOU CAN AGGREGATE THIS TO
HAVE BILLIONS AND MILLIONS OF DOLLARS IN FRAUD BUT IT COMES
DOWN TO ONE BY ONE BY ONE OF PROVIDER GIVING A MEDICARE
NUMBER AND BILLING THE SYSTEM. AND SO, AT THE MOST BASIC LEVEL,
IT'S IMPORTANT THAT WE STOP AND TALK ABOUT THE CRITICAL ASSET WE
HAVE AS A NATION WITH ALL THE INDIVIDUALS AND THEIR 48 MILLION
INDIVIDUALS IN THIS COUNTRY WHO RECEIVE MEDICARE, THEY CAN HELP
US DETECT FRAUD. AND BE REALLY THE FRONT END OF
THIS CRITICAL PARTNERSHIP WITH LAW ENFORCEMENT.
WHAT WE DO AT THE SENIOR MEDICARE PATROL PROGRAM IS TO
OUTREACH SPECIFICALLY INTO COMMUNITIES TO HELP EDUCATE
OLDER AMERICANS ABOUT HOW TO DETECT MEDICARE FRAUD, GIVE THEM
INFORMATION ABOUT HOW TO LOOK FOR BILLING ERRORS, AND WHAT TO
DO TO REPORT POTENTIAL HEALTH CARE FRAUD.
THE GOAL IS TO STOP IT AND TO PUT THE CRIMINALS BEHIND BARS
AND TO HELP OUR PARTNERS AT CMS SO THOSE INDIVIDUALS ARE NOT
BILLING THE MEDICARE SYSTEM ANY LONGER.
LIKE I SAID BEFORE, WE WORKED FEDERALLY WITH CMS WITH THE
OFFICE OF INSPECTOR GENERAL. OBVIOUSLY WITH THE DEPARTMENT OF
JUSTICE. IT HAS BEEN A MOST AMAZING YEAR
THIS PAST YEAR WITH HHS AND WITH THE LEADERSHIP OF SECRETARY
KATHLEEN SEBELIUS. I HAD THE PLEASURE OF WORKING
WITH THE SECRETARY FOR MANY, MANY YEARS.
AND THE I KNOW INTUITIVELY OF HER STRONG, STRONG PREFERENCE
AND DESIRE TO HAVE AN EDUCATED PUBLIC, EDUCATED PUBLIC WHO
KNOWS HOW TO HELP US DETECT FRAUD.
AND THAT EDUCATED CONSUMER SYSTEMS ONE OF THE BEST THINGS
WE CAN DO. ONE OF THE BEST INVESTMENTS WE
CAN MAKE. WHAT WE DO AT THE SENIOR
MEDICARE PATROL PROGRAM IS FAIRLY SIMPLE.
AND THE ADVICE WE HAVE TO SENIORS IS ALSO SIMPLE.
WE NEED TO PROTECT YOUR MEDICARE NUMBER.
LIKE YOU SAW ON THE WONDERFUL PUBLIC SERVICE ANNOUNCEMENTS
THAT STARTED US OFF THAT FEATURE A COUPLE OF OUR VOLUNTEERS TO
TELL SENIORS TO PROTECT YOUR NUMBER.
REVIEW YOUR MEDICARE SUMMARY STATEMENT.
AND IT'S GOOD FOR SENIORS TO MAKE A RECORD OF THEIR HEALTH
CARE VISITS, PROCEED YOURS THEY HAD, SO THEY CAN LOOK AT THEIR
MEDICARE SUMMARY STATEMENT AND ASK QUESTIONS.
AND IF THEY DON'T UNDERSTAND SOMETHING THAT IS ON THE
STATEMENT, THEY CAN EITHER GO BACK TO ANOTHER PROVIDER OR CALL
1-800 MEDICARE OR GO ONLINE TO STOP MEDICARE.GOV TO ASK MORE
QUESTIONS. THIS PAST YEAR, WE WERE ABLE TO
SIGNIFICANTLY INCREASE THE AMOUNT OF SUPPORT WE HAVE
FINANCIALLY FOR THE SMP PROGRAM BECAUSE OF THE TERRIFIC
PARTNERSHIP AND LEADERSHIP OF DR. PETER BUDETTI THAT YOU MET
EARLIER TODAY. PETER APPROACH ME IN OUR VERY
FIRST MEETING. HE SAID THIS IS A FABULOUS
PROGRAM. WHAT CAN I DO TO HELP?
HE MEANT TO THE TUNE OF $9 MILLION AND HELPED US THROUGHOUT
THE COUNTRY SEND ADDITIONAL RESOURCES WE HAVE BEEN ABLE TO
USE TO HIRE MORE VOLUNTEER COORDINATORS AND ULTIMATELY
REACH MORE VOLUNTEERS. THIS HAS BEEN SUCCESSFUL AND IN
THE STATE OF MASSACHUSETTS, PETER HELPED US DISTRIBUTE TO
YOU, SPECIFICALLY, WITH THE ELDER SERVICES AND THE AMERICAN
ACT, AN ADDITIONAL $300,000. SO LAST YEAR IN MASSACHUSETTS,
YOU GOT NEARLY A HALF MILLION DOLLARS TO HELP THE SPECIFIC
OUTREACH TO SENIORS HERE IN YOUR STATE TO GIVE THEM BETTER
INFORMATION ABOUT WHAT THEY CAN DO TO PROTECT THEMSELVES.
EVERY TIME THE SECRETARY TALKS ABOUT THE S&P PROGRAM AND WE
HAVE THE OPPORTUNITY TO TALK TO YOU, WE GET INCREASED REFERS
FROM BENEFICIARIES. WE HOPE ALSO TO GET INCREASED
VOLUNTEERS SO I'M ALWAYS HEARING SOMETHING FROM VOLUNTEERS.
I THINK VOLUNTEERS ARE FABULOUS AND I'M GLAD TO BE HERE WITH
THEM. THEY ARE THE EYES AND EARS AND
THEY ARE FABULOUS PEOPLE TO HANG OUT WITH BECAUSE THIS REALLY
MAKES THEM ANGRY. AND THEY LIKE TO GET OUT THERE
AND EDUCATE PEOPLE AND SAY REALLY, MEDICARE FRAUD IS
SOMETHING WE ALL NEED TO STOP. AND YOU SEE GREAT EXAMPLES OF
THINGS THAT ARE JUST WRONG. THIS ALSO HAS BEEN A WONDERFUL
YEAR IN THE RESPECT THAT WE RECEIVED NATIONAL ATTENTION FOR
THE SENIOR MEDICARE PATROL PROGRAM.
WE WERE AWARDED BY THE NATIONAL HEALTH CARE ANTIFRAUD
ASSOCIATION 2010 EXCELLENCE IN PUBLIC AWARENESS AWARD, FOR
RAISING PUBLIC AWARENESS ABOUT THE PROBLEM OF HEALTH CARE FRAUD
IN OUR NATION'S HEALTH CARE FRAUD SYSTEM.
WE WERE QUITE HONORED TO RECEIVE THIS AWARD.
NEXT YEAR, WE WILL BE LAUNCHING MORE PUBLIC SERVICE
ANNOUNCEMENTS LIKE THE ONE YOU JUST SAW SO WE CAN HAVE THE DUAL
MESSAGE OF HELPING EDUCATE SENIORS ABOUT STOPPING MEDICARE
FRAUD BUT ALSO LOOKING FOR MORE PEOPLE WHO CAN ASSIST US.
THE SENIOR MEDICARE PROGRAM, AS WE CALL IT, BEGAN AS A
DEMONSTRATION PROJECT IN FIVE STATES.
WE HAVE THROUGH THE LAST SEVERAL YEARS, BEEN ABLE TO EXPAND SO WE
HAVE A PROGRAM IN EVERY STATE AND THE DISTRICT OF COLUMBIA AND
THE THREE TERRITORIES, GUAM, PUERTO RICO AND THE U.S. VIRGIN
ISLANDS. WE WERE EVER WHERE EDUCATING
SENIORS. WE ALSO HAVE BEEN ABLE TO
PARTNER WITH THE NATIONAL HISPANIC COUNCIL ON AGING.
SO WE CAN DO OUTREACH. AT OUR S&P VOLUNTEER PROGRAM A
YEAR AGO, WE GAVE SPECIAL RECOGNITION TO THE MEMBERS OR
THE VOLUNTEERS IN OUR NETWORK WHO CAN GO DIRECTLY TALK TO
INDIVIDUALS IN OTHER LANGUAGES OTHER THAN ENGLISH SO WE CAN
EXPLAIN SUFFICIENTLY TO BENEFICIARIES WHO DO NOT SPEAK
ENGLISH AS A MAJOR LANGUAGE OR NOT ENGLISH PROFICIENT, HOW TO
UNDERSTAND THEIR STATEMENTS SO THEY ARE NOT ESPECIALLY
TARGETED. NATIONWIDE WE HAVE CLOSE TO
5,000 VOLUNTEERS AND LIKE I SAID, WE ARE LOOKING FOR MORE.
THOSE VOLUNTEERS GO OUT INTO THE COMMUNITIES AND THEY PROVIDE
BASIC EDUCATION. SINCE 1997, WE TRAINED 68,000
VOLUNTEERS. THOSE VOLUNTEERS HAVE TALKED TO
2.9 MILLION BENEFICIARIES AND BECAUSE THEY DO PUBLIC EDUCATION
EVENTS, THAT PUBLIC EDUCATION IS ALSO REACHED 18 MILLION
INDIVIDUALS. WE THEN DO SPECIFIC CASES.
CASE RESOLUTION. WE HANDLED 87,000 MEDICARE AND
MEDICAID CASES WHERE WE CAN INVESTIGATE IMPROPER BILLING
PRACTICES AND REPORT THEM TO CMS OR LAW ENFORCEMENT AND BE ABLE
TORSIVE THROUGH OUR EFFORTS, ALMOST 106 MILLION DOLLARS TO
THE MEDICARE PROGRAM. THIS REALLY IS THE FRONT LINE IN
OUR VOLUNTEERS SEE EVERYTHING FROM SCOOTER SCAMS TO
DOOR-TO-DOOR MARKETERS. WE HAD A GREAT EXAMPLE HERE
WHERE IN THE STATE OF MASSACHUSETTS, SOMEONE CALLED US
BECAUSE THEY WERE DELIVERED A SCOOTER AND THE SCOOTER CAME AND
IT WAS A WHEELCHAIR THAT CAME AND IT WAS USED.
THE INDIVIDUAL KNEW IMMEDIATELY THEY DIDN'T WANT THIS USED
WHEELCHAIR. THEY DETECTED A PROBLEM.
THIS IS NOT SOMETHING I WANT. THEY HAD THEM COME GET THIS.
THE WHEELCHAIR MEDICAL EQUIPMENT PROVIDER TOOK A WEEK TO COME
PICK IT UP AND BILLED MEDICARE FOR A MONTH WORTH OF SERVICE.
THAT'S ONE PERSON ON ONE WHEELCHAIR IN ONE MONTH.
BUT WHAT THEY WERE ABLE TO DO IS THE ULTIMATE GOAL.
WATCH WHAT IS HAPPENING, ASK QUESTIONS, RAISE THE ISSUE TO
THE MEDICARE PROGRAM SO THAT WE CAN STOP IT BECAUSE ONE BY ONE
BY ONE, THE SCAM ARTISTS ARE TAKING ADVANTAGE OF EVERY
INDIVIDUAL MEDICARE BENEFICIARY. IN THE END, THAT COSTS US ALL AS
TAXPAYERS BUT THE OTHER PIECE OF THIS THAT IS OFTEN UNSEEN IS
THAT MEDICARE BENEFICIARIES PAY A COPAY.
AND BECAUSE OF THE BILLING, THEY OFTEN HAVE IMPROPER MEDICAL
RECORDS. IF YOU'RE BEING BILLED FOR
DIABETES SUPPLIES AND YOU DON'T HAVE DIABETES, IT'S A PROBLEM.
SO, IT'S VERY, VERY IMPORTANT THAT WE ALL CONTINUE TO PARTNER
TOGETHER, ONE BY ONE AND THEY ALL ADD UP TO THE WONDERFUL CASE
EXAMPLES WE WERE ABLE TO HEAR FROM OUR COLLEAGUES.
I LOOK FORWARD TO THE OTHER EXAMPLES FROM OUR FINE
VOLUNTEERS IN THE STATE OF MASSACHUSETTS WHO CAN TELL YOU
MORE ABOUT THE SCARY THINGS HAPPENING HERE AT HOME.
THANK YOU. [APPLAUSE]
GOOD MORNING. IT'S AN HONOR TO BE HERE WITH
ALL OF YOU TODAY AND I'M SECRETARY GREENLY.
MY NAME IS LUCILIA PRATES AND I'M THE STATEWIDE DIRECTOR
SENIOR MEDICARE PATROL PROGRAM. IT'S A STATEWIDE COLLABORATION
AMONG GOVERNMENTAL, NONGOVERNMENTAL, STATEWIDE AND
LOCAL AGENCIES AND COMMUNITY-BASED ORGANIZATIONS
AND THAT CORE VOLUNTEERS ACROSS THE COMMONWEALTH.
THE PROGRAM HAS BEEN CONDUCTING OUTREACH AND EDUCATION ON THE
PREVENTION OF HEALTH CARE ERRORS SPOTTING ABUSE SINCE 1999.
UNDER THE LEADERSHIP ROLE OF ELDER LEADER SERVICES.
THE PROGRAM BECAME A STATEWIDE PROGRAM WITH A PARTICULAR FOCUS
ON REACHING AND EDUCATING HARD TO REACH, UNDER SERVED,
UNSERVED, LIMITING ENGLISH PROFICIENT, AND OTHER VULNERABLE
POPULATIONS ACROSS THE STATE. TO BECOME ENGAGED, HEALTH CARE
CONSUMERS, THEY ARE THE FIRST LINE OF DEFENSE IN PREVENTING
HEALTH CARE ERRORS, FRAUD AND ABUSE.
THE SENIOR MEDICARE PATROL PROGRAM EDUCATES HEALTH CARE
CONSUMERS ABOUT THE IMPORTANCE OF BEING ACTIVE PARTICIPANTS IN
THEIR HEALTH CARE IN THE HEALTH CARE OF THEIR LOVED ONES.
WE CAN EACH HAVE A VITAL ROLE AND WE EACH HAVE THE
RESPONSIBILITY OF PROTECTING TAXPAYER DOLLARS BY EDUCATING
OURSELVES, OUR FAMILY MEMBERS, FRIENDS, COWORKERS AND
COMMUNITIES AT LARGE. OF THE SIGNIFICANT COST
ATTRIBUTED TO HEALTH CARE FRAUD AND ABUSE, WHICH WE FELT IN A
HEALTH CARE COST, AND FURTHER COMPROMISE OUR HEALTH CARE
SYSTEM. WE ALL NEED TO BE INVOLVED AND
PROACTIVE ABOUT OUR HEALTH CARE. DOCUMENT ALL OF OUR HEALTH CARE
APPOINTMENTS, DIAGNOSTIC PROCEDURES, ORDERED,
PERFORMANCE, PRESCRIBED AND RECEIVE DURABLE MEDICAL
EQUIPMENT, HOME HEALTH CARE SERVICES AND THE LIST GOES ON.
REVIEW ALL AND ANY AND ALL BILLS ASSOCIATED WITH HEALTH CARE.
COMPARE ALL OF OUR NOTES TO OUR EXPLANATION OF BENEFITS.
MEDICARE SUMMARY NOTICES, AND REPORT ANY AND ALL
IRREGULARITIES AND DISCREPANCIES WITH MEDICAL BILLS TO THE S&P
PROGRAM. SENIORS WILL OFTEN SAY TO US,
THIS IS A FULL-TIME JOB. I CAN'T DO THIS.
THIS IS WHY WE HAVE OUR VOLUNTEERS WHO ARE READY AND
WILLING TO HELP PEOPLE ADDRESS THESE ISSUES.
THIS IS COMPLEX. IT'S VERY COMPLEX.
ESPECIALLY IF YOU'RE A SENIOR OR YOU'RE SOMEONE WHO DOESN'T SPEAK
ENGLISH. CAN I HAVE MY FIRST SLIDE,
PLEASE? SO THE SENIOR MEDICARE PATROL
PROGRAM IS MADE UP OF ENTITIES SERVING AS OUR SIDE REBODY.
THE MASSACHUSETTS E SENIOR MEDICARE PATROL PROGRAM WORKS IN
PARTNERSHIP WITH THE EXECUTIVE OFFICE OF ELDER AFFAIRS, SHINE
PROGRAM, SENIOR HEALTH INFORMATION NEEDS OF ELDERS
SERVING HEALTH INFORMATION NEEDS OF ELDERS.
AS PART OF THE PROGRAM'S EFFORTS TO REACH AND EDUCATE DIVERSE
POPULATIONS, ON HOW TO PROTECT, DETECT AND REPORT HEALTH CARE
ERRORS, FRAUD AND ABUSE, WE HAVE FOSTERED EIGHT SHINE
PARTNERSHIPS ACROSS THE STATE THAT ARE FUNDED BY S&P SO THAT
WE CAN ADDRESS THE NEEDS OF THESE POPULATIONS.
AND THESE ARE OUR PARTNERSHIPS. I WANTED TO PUT THEM UP THERE
BECAUSE THERE ARE TOO MANY TO MENTION.
WE HAVE EIGHT ACROSS THE STATE SERVING DIVERSE LANGUAGE GROUPS.
WE ACTUALLY SERVE 19 DIFFERENT LANGUAGE GROUPS WHO ARE REACHED
WITH TIME SENSITIVE INFORMATION ALONG WITH THE S&P MESSAGE AND
WHO DISSEMINATE THE LATEST SCAMS AND SCHEMES TO SEE POPULATIONS
THEY SERVE. IF 2008, THE SENIOR MEDICARE
PATROL PROGRAM IN MASSACHUSETTS BEGAN WORKING WITH THE EXECUTIVE
OFFICE OF ELDER AFFAIRS ON ANOTHER PROJECT.
ON THE IMPLEMENTATION OF THE SENIOR MEDICARE PATROL
INTEGRATION PROGRAM. WHICH IS CHARGED WITH REACHING
AND EDUCATING RURAL AMERICANS AND RURAL ELDERS ABOUT THE
IMPORTANCE OF UNDERSTANDING THEIR HEALTH BENEFITS AND HOW TO
PROTECT, DETECT AND REPORT HEALTH CARE ERRORS, FRAUD AND
ABUSE. THE S&P INTEGRATION PROJECT
FUNDING OFFERED AN OPPORTUNITY FOR THE FOSTERING OF
COLLABORATIONS WITH THESE TARGET COMMUNITIES AND THE LEARNING AND
INFORMATION SHARING OPPORTUNITIES FOR SERVICES
NETWORKS. RESULTING IN A BETTER
UNDERSTANDING OF THE HEALTH CARE ISSUES AND HEALTH BENEFITS
ELIGIBILITY, COMPLEXITIES CONFRONTED BY THESE VULNERABLE
POPULATIONS. AS A RESULT OF MASSACHUSETTS
BEING DESIGNATED A HIGH-FRAUD STATE RANKING AMONG THE TOP 18
IN THE COUNTRY BY MEDICARE AND MEDICAID SERVICES, THE PROGRAM
WAS RECENTLY AWARDED $300,000 FROM THE DEPARTMENT OF HEALTH
AND HUMAN SERVICES ADMINISTRATION ON AGING, WHICH
WE ARE VERY GRATEFUL FOR. THIS FUNDING WILL ALLOW FOR THE
FURTHER EXPANSION OF THE PROGRAMS FRAUD PREVENTION WORK
ACROSS THE STATE. IT WILL INCREASE THE VISIBILITY
OF THE PROGRAM AND STRENGTHEN EXISTING OUTREACH AND EDUCATION
EFFORTS. OUR RECRUITMENT OF ADDITIONAL
S&P VOLUNTEERS, WHICH MEANS WE WILL GET MORE BOOTS ON THE
GROUND. THEY ARE OUR FRONT LINE OF
DEFENSE. THE CONSUMER AND THE VOLUNTEERS.
AND THEY DO GET ANGRY. YOU'RE RIGHT.
AS WELL AS ALLOW US TO CONTINUE TO DEVELOP OTHER INNOVATIVE
STRATEGIES WITH ORGANIZATIONS SUCH AS AREA AGENCIES ON AGING,
SERVICE ACCESS POINTS, THE COUNCILS ON AGING, AGING AND
DISABILITY RESOURCES CONSORTIUM, THE TRIADS, RETIRED PATROL MAN'S
ASSOCIATION, AND OTHER LAW ENFORCEMENT ENTITIES AND MANY
MORE. OUR STRATEGY AS TO WHO WE
ACTUALLY APPROACH IS ALL DONE IN PARTNERSHIP WITH OUR COMMITTEE
AND WITH OUR GRANTEES. SO AT THIS TIME, I'D LIKE TO
POINT OUT THAT YOU HAVE SOME OR EVERYONE HAS THIS IN THEIR
PACKETS. AYE LIKE TO INVITE YOU TO HOST
AN S&P INFORMATIONAL SESSION AT YOUR ORGANIZATION OR TO, IF HAVE
YOU ANY QUESTIONS ABOUT THE S&P PROGRAM, TO FEEL FREE TO CALL
US. I ENCOURAGE YOU TO USE YOUR
PERSONAL HEALTH CARE JOURNAL AND WE ALSO HAVE ADDITIONAL
INFORMATION, PENS, MAGNIFIERS WHICH I NOW NEED AND THEY ARE
ALL OUT ON THE TABLE IN THE REGISTRATION AREA.
I'D LIKE TO INVITE AN EXAMPLE OF A CASE.
THIS IS A TYPICAL DAY FOR US WHERE WE RECEIVE CALLS FROM
INDIVIDUALS OUT IN THE COMMUNITY WHICH HAPPENS TO BE FROM
NON-ENGLISH SPEAKING INDIVIDUAL WHO IS A CANCER PATIENT AND SHE
WAS OR PURCHASED A MEDICAL DEVICE FROM A DURABLE MEDICAL
EQUIPMENT ON HER OWN INITIATIVE BECAUSE IT WAS DEEMED NOT
MEDICALLY NECESSARY. THE DEVICE WAS ONLY $212.50.
BUT, THE DEVICE NEVER ARRIVED AT HER HOME AND SHE CALLED THE
COMPANY AND EXPLAINED THAT SHE HAD NOT RECEIVED THIS DEVICE.
SHE WAS ASKED FOR HER RECEIPT. SHE PROVIDED THE RECEIPT.
AND SHE SAID SHE FOUND SOMETHING ON THE INTERNET FOR $75 SO DON'T
BOTH TORE SEND IT. THIS GOES TO TELL YOU HOW MUCH
THINGS ARE MARKED UP. SO WE IMMEDIATELY ENTERED THIS
INTO OUR SMART HACK DATABASE, WHICH IS -- IT HAS A VERY
INTERESTING NAME BUT IT IS A VERY SMART TOOL, WHERE WE TRACK
ALL THE CASES. AND I CALLED THE DURABLE MEDICAL
EQUIPMENT COMPANY AFTER THEY TOLD THIS WOMAN THAT THE CHECK
WAS IN THE MAIL AND IT WOULD GET TO HER AT SOME POINT.
THIS ISSUE STARTED OUT IN JULY. BITE END OF MONDAY, AT THE END
OF THE DAY ON MONDAY, THE CHECK HAD BEEN MAILED OUT, ALLEGEDLY
FOR THE THIRD TIME BUT WITH RETURN MAIL RECEIPT.
SO WE ARE WAITING TO HEAR BACK FROM THIS WOMAN.
WHEN WE CALL AND IDENTIFY OURSELVES AS THE SENIOR MEDICARE
PATROL PROGRAM, THERE IS SOME EXPEDITIOUS ACTION THAT TAKES
PLACE. SO, FOR ADDITIONAL INFORMATION,
YOU SHOULD FEEL FREE TO CALL THE SENIOR MEDICARE PATROL PROGRAM.
OUR INFORMATION IS ON OUR PEN. AND I JUST WOULD LIKE TO LEAVE
WITH YOU THIS THOUGHT, THAT UNDERSTANDING ALL THE COMPONENTS
AND INTRICACIES OF THE EVER-CHANGING HEALTH CARE
SYSTEM, DELIVERY SYSTEM, IS A DAUNTING TASK THAT CAREGIVERS,
LIMITED-ENGLISH-SPEAKING AND LOW-LITERACY AND MANY OTHER
VULNERABLE POPULATIONS. IT'S CRITICAL THAT CONSUMERS
CONTINUE TO BE REACHED AND EDUCATED AND ON THE IMPORTANCE
OF BECOMING PROACTIVE IN THEIR HEALTH CARE AND LEARN HOW TO
IDENTIFY ERRORS, FRAUD AND ABUSE, WHICH PLAGUE OUR HEALTH
CARE SYSTEM. HEALTH CARE ERRORS NOT ONLY COST
BILLIONS OF DOLLARS AS WE HAVE HEARD ON AN ANNUAL BASIS, BUT
MOST IMPORTANTLY, THEY CAN COST YOUR LIFE OR THE LIFE OF A LOVED
ONE. THANK YOU.
[APPLAUSE] GOOD MORNING.
MY NAME IS YVES-ROSE CRISPIN. THIS IS A PRIVILEGE TO BE AT
THIS VERY IMPORTANT SUMMIT. I'M A SENIOR MEDICARE PATROL
SHINE COORDINATOR AND COUNSELOR FOR THE HAIR IN AMERICAN PUBLIC
INITIATIVE. WE HAVE BEEN FUNDING BY THE
SENIOR MEDICARE PROGRAM SINCE 2002.
TO EDUCATE THE ELDER HAITIAN COMMUNITY ON THE SENIOR MEDICARE
PATROL MESSAGE OF EMPOWERING ELDERS TO PROTECT THEMSELVES
AGAINST ERRORS, FRAUD AND ABUSE IN THEIR PROGRAMS.
THIS HAS BEEN POPULAR WITH THE SENIOR MEDICARE PROGRAM AND
RECEIVED GRANT FUNDING FROM EDUCATING AND OUTREACH TO THESE
VULNERABLE SENIOR POPULATIONS. THIS IS ESPECIALLY IMPORTANT FOR
OUR HAITIAN ELDER POPULATION TO HAVE ACCESS TO THE SERVICES OF
THE SENIOR MEDICARE PATROL PROGRAM BECAUSE OF THE SHINE.
ON THE HEALTH CARE SYSTEM, THE MANY FACTORS SITTING BEFORE
COMING INTO OUR COUNTRY. AS THE SENIOR MED CARED PATROL
AND COORDINATOR, I MEET WITH SENIORS, CHURCHES, SENIOR
PROGRAMS, ET CETERA, TO EDUCATE THEM TO BECOME EMPOWERED,
MEDICARE AND MEDICAID USERS. THEY ARE WARNED ABOUT NOT
PROVIDING ANY CUSTOMER INFORMATION AND TO PRESENT ANY
ACTIVITY WHICH MAY BE FRAUD OR ERROR.
WE TALK ABOUT IDENTITY THEFT AND WHAT TO BE ON THE LOOKOUT FOR.
OUR PROGRAM WITH SENIOR PATROL SERVES AREA IN THE -- AS WELL AS
HAITIAN COMMUNITY WITH THE COMMONWEALTH.
WE GIVE A DISCUSSION OF SPECIALS AND RADIO PROGRAMS IN OUR
LANGUAGE THAT EMPOWER OUR PEOPLE TO TAKE CHARGE EVER HEALTH CARE
ISSUES AND TO BECOME HEALTH CARE ADVOCATES FOR THEMSELVES.
IN ORDER TO ACCOMPANY THIS GOAL, THEY MUST BE GIVEN THE TOOLS.
PROTECT THEIR PERSONAL INFORMATION AND NOT ALLOWING ANY
MARKETING SCAMS TO TAKE ADVANTAGE OF THEIR LACK OF
KNOWLEDGE ON HOW TO NAVIGATE THE HEALTH CARE SYSTEM.
WE TEACH TO CAREFULLY EXAMINE THEIR EXPLANATION OF BENEFITS
FOR ANY DISCREPANCIES IN THE SERVICE THEY RECEIVE.
WE HAVE REGULAR PROGRAMS TO ADDRESS THE NEWEST CONCERNS,
SECURITY BENEFITS AND THE LATEST FRAUD AND SCAMS TO BE AWARE OF.
THE RADIO PROGRAMS IS AN IMPORTANT RESOURCE FOR OUR
HAITIAN COMMUNITY. BECAUSE FOR SOME, IT IS THE ONLY
LINK TO INFORMATION THAT THEY MAY RECEIVE IN A LANGUAGE THEY
CAN UNDERSTAND. WE DISCUSS LOCAL SCAMS AND WHERE
TO REPORT ANY SUSPICIOUS ACTIVITIES.
OUR RETIRED HAITIAN VOLUNTEERS CONDUCT HOME VISITS TO EDUCATE
THOSE LEAVING THEIR HOMES. THESE VOLUNTEERS WILL CONTACT
THE HOMEBOUND COMMUNITY SO THEY CAN AT LEAST HELP WHENEVER IT IS
NEEDED. RECENTLY, A 83-YEAR-OLD CLIENT
SOUGHT THE SENIOR MEDICARE PART ONE PROGRAM.
-- [INAUDIBLE] BECAUSE THE CLIENT'S HEALTH WAS
DEPENDING ON TAKING THE MEDICATION, HE PAID $300 FOR HIS
MEDICATION. UPON SEEKING THIS FROM THE
SENIOR MEDICARE PROGRAM COUNSELOR, HE WAS REINVOKED.
IF IT WAS NOT FOR THE INTERVENTION OF THE SENIOR
MEDICARE PART ONE COUNSELOR, THE CLIENT WOULD BE OUT OF $300.
THE SENIOR MEDICARE PART ONE PROGRAM WOULD BE -- [INAUDIBLE]
THANK YOU. [APPLAUSE]
GOOD MORNING. MY NAME IS VIRGINIA LEMIRE AND I
LIVE IN LINCOLN, MASSACHUSETTS. I HAVE BEEN A SHINE COUNSELOR
FOR 10 YEARS AND AS YOU KNOW, AS A VOLUNTEER EFFORT.
AND I FEEL VERY PRIVILEGED TO BE A INDIVIDUAL TORE WITH THIS
WONDERFUL GROUP. I HAVE SERVED OVER THE LAST 10
YEARS IN A MID TO UPPER-LEVEL NEIGHBORHOOD IN THE TOWN OF
CONCORD, MASSACHUSETTS. THERE ARE 3600 SENIORS IN
CONCORDE AND THEY ARE GENERALLY WELL EDUCATED AND THINK THEY
KNOW EVERYTHING THEY NEED TO KNOW ABOUT THINGS.
THIS MAKES MEDICARE FRAUD AND ABUSE EDUCATION A REAL
CHALLENGE. GENERALLY, FRAUD AND ABUSE
PROBLEMS THAT I SEE IN CONCORD FALL IN ABOUT SIX DIFFERENT
AREAS AND THESE ARE NOT IN ORDER OF IMPORTANCE.
TRANSFER OF ASSETS, BALANCED BILLING, PERSONAL LIABILITY,
BRAND NAME GENERIC DRUG DISPENSING PROBLEMS, ERRONEOUS
BILLING, AND PART D SIGN UP. I EDUCATE THE SENIORS IN THE
TOWN OF CONCORDE ON THESE ISSUES AND MANY MORE IN COUNSELING
SESSIONS ONE-ON-ONE OR IN PUBLIC SNAKES I DO IT ANY TIME I HAVE
THE OPPORTUNITY. -- IN PUBLIC TALKS AND I DO IT
ANY TIME I HAVE THE OPPORTUNITY. LET ME BRIEFLY ELABORATE ON
THESE SIX DIFFERENT AREAS. TRANSFER OF ASSETS.
WHEN SENIORS HAVE ASSETS IT IS NOT UNUSUAL FOR THEIR CHILDREN
TO COME TO ME ASKING HOW TO TRANSFER MOTHER'S ASSETS TO THEM
SO THAT MEDICAID CAN PAY FOR THEIR LONG-TERM CARE.
OCCASIONALLY IT'S THE MOTHER HERSELF AFTER HER HUSBAND HAS
DIED THAT COME TO ME FOR ADVICE WHEN THE CHILDREN ARE PRESSING
HER TO SIGN OVER HER ASSETS. THIS MAKES ME QUITE ANGRY BUT I
TRY NOT TO LET THAT SHOW TO THE PEOPLE THAT COME TO ME.
IN BOTH CASES, I DO NOT ADVISE THEM ONE WAY OR THE OTHER.
YOU KNOW SHINE COUNCILORS AREN'T SUPPOSED TO TELL PEOPLE WHAT TO
DO. WE TRY TO HELP YOU BE AN
EDUCATED CONSUMER. BUT IF I'M TALKING TO MOM OR THE
CHILDREN, I SAY, HASN'T MOM AND DAD DONE ENOUGH FOR YOU?
[LAUGHTER] THEY HELPED THEM WITH THEIR
EDUCATION POSSIBLY OR HELPED THEM BUY THEIR FIRST HOME AND
THE HOME OR THE ASSETS BELONG TO MOM AND DAD.
NOT TO THE CHILDREN. I ALSO POINT OUT THE LONG-TERM
EFFECT OF LONG-TERM CARROT MASSACHUSETTS STATE BUDGET,
TRYING TO MAKE THEM FEEL A LITTLE GUILTY.
I URGE CHILDREN OR THE MOM TO CONSULT WITH A LAWYER WHO IS
TRAINED IN ELDER AFFAIRS BECAUSE THEY MIGHT DO SOMETHING THAT IS
AGAINST THE LAW IF THEY DON'T HAVE GOOD ADVICE.
BALANCED BILLING. ALL MASSACHUSETTS DOCTORS MUST,
BY LAW, ACCEPT ASSIGNMENT -- NOW THAT MEANS THAT THE PROVIDER
MUST ACCEPT AS FULL PAYMENT, THE AMOUNT THAT MEDICARE SAYS THAT
PROCEDURE OR TEST IS WORTH. IN MY 10 YEARS OF COUNSELING, I
HAVE NOT SEEN VERY MANY CASES LIKE THIS.
THERE ARE PROBABLY MEN MORE BUT BECAUSE OF THE BALANCE -- THERE
ARE PROBABLY MANY MORE USUALLY THE ELDER WILL PAY IT WITHOUT
QUESTIONING. I EDUCATE PEOPLE ON THE
RELATIONSHIP BETWEEN THEIR EXPLANATION OF MEDICARE BENEFITS
AND THE BILL THAT IS MAILED TO THEM FROM THE PROVIDER.
THEY ARE NOT REQUIRED TO PAY THAT BALANCED BILL AND IT IS
AGAINST THE LAW. PERSONAL LIABILITY.
I EDUCATE CONCORD SENIORS TO ASK QUESTIONS ANY TIME A PROVIDER
ASKS THEM TO SIGN THAT THEY WILL BE PERSONALLY RESPONSIBLE FOR
THE COST OF A PROCEDURE OR TEST. I POINT OUT THAT THE PROVIDER
PROBABLY DOES THIS BECAUSE THEY KNOW THAT MEDICARE WON'T COVER
IT. AND THEY ARE PROBABLY DOING IT
THE ONLY WAY TO THINK OF IT, IS TO AVOID LIABILITY IN THE
FUTURE. SENIORS SHOULD ASK WHY THE
PROCEDURE OR TEST IS NECESSARY RATHER THAN AUTOMATICALLY
CAVE-IN TO THE PROVIDER. NUMBER 4, BRAND NAME DRUGS
DISPENSED INSTEAD OF GENERICS. SENIORS TAKING BRAND NAME DRUGS
SHOULD ASK THEIR PHARMACIST WHEN THE DRUG IS EXPECTED TO GO
GENERIC. I HAD PERSON EXPERIENCE WITH
THIS PROBLEM WHEN MY PART D MAIL ORDER PHARMACY KEPT DISPENSING A
BRAND NAME TO ME AFTER IT HAD GONE GENERIC.
I CALLED THEM REPEATEDLY KNOWING WHAT TO SAY AS A COUNSELOR WHILE
THE OTHERS DON'T HAVE THAT LAW THAT REQUIRES A GENERIC TO BE
PRESCRIBED EVEN IF THE PRESCRIPTION IS FOR THE BRAND
NAME AND BUT IT SPECIFIES THE GENERIC CAN BE DISPENSED.
THEY STILL WOULDN'T ACCEPT RESPONSIBILITY BUT THEY FINALLY
DID SEND ME A REFUND. I HAVE TURNED THAT CASE OVER TO
THE SENIOR MEDICARE PATROL. IF SENIORS ARE NOT CHECKING AND
COMPLAINING ON THESE THINGS, PHARMACIES ARE FREE TO DISPENSE
THE BRAND, AT LEAST UNTIL THEIR INVENTORY OF THE BRAND IS
EXHAUSTED. WHICH I SUSPECT IS WHAT IS
HAPPENING. NUMBER FIVE, ERRONEOUS BILLING.
I HAVE SEEN GROSS OVER CHARGING THAT IF I COULD RESOLVE THESE
ISSUES, I DON'T PASS THEM ON TO THE SENIOR MEDICARE PATROL DUE
TO THEIR LIMITED AND INDIVIDUAL SCOPE.
ONE CASE INVOLVED AN ERRONEOUS REJECTION OF A MAN'S INSURANCE
CARD AND UNDER PRESSURE TO BE PAID, FROM THE EMERGENCY ROOM,
HE SHOWED HIS MASTER CARD. THE HOSPITAL, TWICE, CHARGED
5,000 DOLLARS TO THIS GENTLEMAN'S MASTER CARD, AND
5,000 TO MEDICARE. AFTER A YEAR OF FIGHTING THE
CHARGE, THE MAN CAME TO ME FOR HELP.
AFTER STUDYING THE EXPLANATION OF MEDICARE BENEFITS AND THE
DETAILS OF HIS ACCOUNT, WE CALLED THE BILLING DEPARTMENT.
THE BILLING DEPARTMENT CLAIMED THAT IT WAS UNDER INVESTIGATION.
I TOLD THEM THAT IF I DID NOT HEAR FROM THEM IN 48 HOURS, I
WOULD POST THIS ON THEIR HOSPITAL CEO'S BLOG.
[LAUGHTER] WITHIN 48 HOURS, THE CHECK WAS
ON ITS WAY. SIX, THIS IS MY LAST ITEM AND
I'M A LITTLE UNSURE OF THIS BUT I'M GOING TO SUGGEST IT BECAUSE
I THINK SOMEBODY MAY NEED TO LOOK INTO IT.
I'M CURRENTLY WORKING WITH A WOMAN, AGE 65, SHE IS STILL
WORKING. SHE CAME TO ME BECAUSE SHE WAS
CONFUSED ABOUT HER HEALTH CARE COVERAGE.
IN THE COURSE OF RESEARCHING HER COVERAGE, WE FOUND THAT SHE HAD
A MEDICARE PART D PLAN AND LOW-INCOME SUBSIDY.
SOCIAL SECURITY VERIFIED THAT HER LOW-INCOME SUBSIDY DATED
BACK TO A GROUP SIGN UP IN EARLY 2007.
AND THAT SHE HAD BEEN RECERTIFIED FOR HER INCOME IN
THE LAST YEAR. ON THE BASIS OF INCOME, SHE
DIDN'T QUALIFY FOR LOW-INCOME SUBSIDY AND IF HER INCOME HAD
BEEN CHECKED AGAINST EVEN THE SOCIAL SECURITY DATABASE, THEY
WOULD HAVE REALIZED SHE WASN'T ELIGIBLE.
AND OF COURSE THEY COULD HAVE CHECKED HER AGAINST HER TAX
RETURNS BUT APPARENTLY NEITHER ONE OF THOSE THINGS WERE DONE.
SHE HAD NO MEMORY OF SIGNING UP FOR PART D.
SHE DIDN'T KNOW SHE HAD IT AND WHEN WE CHECK WITH HER PART D
PLAN, SHE NEVER USED IT WHICH INDICATED FURTHER TO ME SHE
DIDN'T KNOW SHE HAD IT. SHE WAS VERY SURPRISED AND
DENIES SHE HAD DONE IT. AND SHE IS A PROFESSIONAL WOMAN
AND I DON'T REALLY DOUBT HER WORD.
IS THIS A NEW TYPE OF FRAUD? ON THE PART OF PART D PLANS?
THOSE SIGNING UP SENIORS WITHOUT THEIR KNOWLEDGE?
THE COMPANY GETS THE ENTIRE PREMIUM AND NEVER PAYS ANY
BENEFITS BECAUSE THE MEMBER IS UNAWARE OF THEIR PLAN.
AND THE SUBSIDY PAYS THE PREMIUM AND NOT THE MEMBER SO IT'S
ANOTHER REASON THE MEMBER NONES NOTHING ABOUT IT.
THIS IS A GOOD CASE FOR SENIOR MEDICARE PATROL.
ALSO PART D ADVERTISING. A SENIOR CAME TO ME A FEW DAYS
AGO WITH A ENVELOPE WITH ALL THIS MEDICARE APPLICATION FOR
PART D IN IT, EVEN A REQUEST FOR ELECTRONIC FUNDS TRANSFER, THE
ONLY REASON SHE CAME TO ME IS SHE HAD QUESTIONS ABOUT ONE
THING SHE WAS MAKING OUT ON THIS APPLICATION.
SHE HAD NOT REQUESTED THIS APPLICATION AND ON THE OUTSIDE
OF THE ENVELOPE IN TINY LETTERS IN THE LOWER LEFT HAND AREA WAS,
ADVERTISEMENT. BUT LIKE MANY SENIORS, SHE WAS
VERY CONFUSED ABOUT THAT. WE HAD TALKED ABOUT CHANGING HER
PLAN. SHE THOUGHT THIS WAS IT.
AND SO SHE WAS MAKING OUT THIS APPLICATION TO A COMPANY THAT
WASN'T VERY ABOVE BOARD IN MY OPINION.
WE NEED TO WATCH THAT THEY ARE ADVERTISING APPROPRIATELY.
AS YOU CAN SEE, SENIOR SHINE AND SENIOR MEDICARE PATROL
COUNCILORS CARRY A GREAT DEAL OF RESPONSIBILITY, AFTER ALL, WE
ARE THE PEOPLE, I'D SAY, WHO HAVE THEIR FEET ON THE GROUND.
THEY ARE RIGHT THERE WITH THE SENIORS.
AND NOT IN AN OFFICE SOMEWHERE ELSE.
BUT WE ENJOY THIS WORK VERY MUCH.
THAT'S WHY I HAVE BEEN AT IT FOR 10 YEARS.
THIS IS BEING A SHINE COUNSELOR IS JUST WONDERFUL.
THANK YOU. [APPLAUSE]
WE DO HAVE A FEW MINUTES FOR QUESTIONS IF ANYONE HAS A
QUESTION. I CAN'T SEE IF YOU RAISE YOUR
HAND. PEOPLE WITH THE MICROPHONE WILL
COME TO YOU. A GREAT PROGRAM.
HAVING AN 81-YEAR-OLD MOTHER WHO PAYS ANY BILL THAT COMES I THINK
BECAUSE SHE IS OF THE GENERATION THAT THE DOCTORS ARE STILL GOD
AND THE HOSPITALS STILL KNOW WHAT THEY ARE DOING.
GREAT TO HEAR THEY HAVE ONE OF THESE PROGRAMS IN EVERY STATE.
BUT I GUESS MY QUESTION IS, ARE YOU AWARE OF OR ARE THERE PLANS
FOR SIMILAR PROGRAMS LIKE THIS FOR INDIVIDUALS WHO ARE ON SSI
DUE TO A DISABILITY? I WORK FOR THE MEDICAL HEALTH
AND ASCENTION SERVICES PROGRAM IN CONNECTICUT AND THIS IS AN
EQUALLY VULNERABLE POPULATION. I'M JUST WONDER FIGURE ANYONE IS
AWARE OF WHETHER THERE HAS BEEN THOUGHTS DURING A SIMILAR KIND
OF OUTREACH PROGRAM TO THAT POPULATION?
THANK YOU FOR BINGING THAT UP.
WE OFTEN FOCUS SPECIFICALLY ON SENIORS BECAUSE THAT'S
BY-AND-LARGE THE LARGEST POPULATION OF INDIVIDUALS ON
MEDICARE. THE OUTREACH WE DO IS FOR ALL
MEDICARE BENEFICIARIES. 8 MILLION PEOPLE WITH
DISABILITIES HAVE MEDICARE BECAUSE THEY HAVE GONE THROUGH
THE SSI DISABILITY DETERMINATION PROJECT OR PROCESS.
THOSE INDIVIDUALS ALSO ARE ELIGIBLE FOR ASSISTANCE THROUGH
THE PROGRAMS FOR ALL PEOPLE WITH MEDICARE, AND I DON'T THINK THAT
THE GENERAL PUBLIC UNDERSTANDS THAT WE HAVE A LARGE NUMBER OF
PEOPLE IN THIS COUNTRY, LESS THAN 65 ON MEDICARE, THE VERY,
VERY CRITICAL PROGRAM FOR THEM AS WELL.
ONE MORE QUESTION. THERE IS A MICROPHONE COMING.
THANK YOU. THE LONGER I'M INVOLVED IN
CONSUMER EDUCATION, PARTNERING WITH COMMUNITY-BASED
ORGANIZATIONS TO REACH CONSUMERS, THE MORE I BEGIN TO
THINK THAT EDUCATING WHAT WE IN THE BUSINESS CALL, THE ADULT
CHILD, WHICH WOULD BE ME, MAY BE A NEW PLACE FOR US TO DIRECT
GREATER RESOURCES AND ATTENTION. I KNOW IN THE EDUCATION OF OLDER
ADULTS, DIMINISHED DECISION-MAKING CAPACITY, I-NOT
EVEN TALKING ABOUT DEMENTIA, JUST DEMENTION DECISION-MAKING
CAPACITY AND IN LIGHT OF THE MATERIALS AND HOW SLY AND SLICK
THE FRAUDULENT MATERIALS ARE, EVEN THOSE OF US WHO THINK WE
HAVE OUR FULL DECISION-MAKING CAPACITY TOW
STRUGGLE -- STRUGGLE WITH, I JUST WANT TO URGE MORE ATTENTION
PERHAPS AND EFFORT TO THE EDUCATION OF OLDER ADULTS WHO
ARE THE GATEKEEPER TO THE BILLS OR RECORD DECISION OF THE ADULTS
IN THE SAME WAY THE ORGANIZATIONS ARE THE GATEKEEPER
FOR THOSE WOE NEED TO PARTNER WITH AND ASK IF THERE IS A PLAN
AS THE BABYBOOMERS ARE THE IN ACCIDENT ELDER, TO FOCUS MORE
ATTENTION ON THAT. THANK YOU FOR THAT COMMENT,
MARCIE. THE SENIOR MEDICARE PATROL
PROGRAM EDUCATES MEDICARE BENEFICIARIES, FAMILY MEMBERS,
CAREGIVERS, I ALWAYS SAY, I FEEL QUITE STRONGLY ABOUT REALLY
BEING AN EDUCATED, ENGAGED CONSUMER, A FULL PARTNER IN MY
HEALTH CARE. I WANT TO KNOW THAT WHEN I GO TO
THE DOCTOR THAT I'M NOT BEING BILLED FOR SOMETHING THAT I
DIDN'T RECEIVE. AND I HAVE PLENTY OF EXAMPLES,
THEY WON'T BORE YOU WITH THEM. THIS HAPPENS REPEATEDLY AND I
ALWAYS THINK -- PEOPLE WHO KNOW ME AND HEARD ME SPEAK?
IN THE THE PAST -- I SAY THIS DOESN'T JUST HAPPEN TO CELIA
BECAUSE I'M THE DIRECTOR OF THE S&P PROGRAM LOOKING FOR FRAUD.
IT HAPPENS TO ALL OF US. I THINK WE ALL NEED TO BE VERY,
VERY VIGILANT ABOUT OUR HEALTH CARE AND ABOUT THE BILLS
ASSOCIATED WITH THAT HEALTH CARE.
PERSONAL HEALTH CARE JOURNAL, IT COULD BE A NOTEBOOK, IT COULD BE
ANYTHING. IT'S CRUCIAL.
IT'S A CRUCIAL TOOL TO HAVE. SO YOU DON'T TEST THAT REPEATED
UNNECESSARILY. I THINK THAT WE ARE WHERE WE ARE
WITH OUR HEALTH CARE AND THE COSTS OF OUR HEALTH CARE BECAUSE
WE HAVE NEVER BEEN GIVEN THE PERMISSION AS CONSUMERS TO BE
ENGAGED. AND I THINK THE OPPORTUNITY HAS
COME. SO LET'S REALLY HARNESS IT AND
MAKE THE BEST OF IT. I WANT TO CLOSE BY SAYING
THAT IN FACT, CONSUMERS ARE THE FIRST LINE OF DEFENSE AGAINST
FRAUD AND THEY ARE OUR BEST OPPORTUNITIES TO MAKE SURE THAT
PROVIDERS ARE DOING WHAT THEY SHOULD DO AND THAT CONSUMERS ARE
GETTING WHAT THEY NEED. SO, I WANT TO THANK THE PANEL
VERY MUCH FOR BEING HERE TODAY. THANK YOU ALL SO MUCH.
[APPLAUSE]