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The New Health Care Law

AARP Webinar Q-and-A: Protecting Yourself From Health Care Fraud

Q: If I don’t report fraud, either because I don't understand what is happening or I am a victim of fraud, am I personally liable for damages?

A: If you did not intentionally help in allowing the fraud to happen, you would not be held responsible. There is no legal liability for not reporting a fraud if you did not know a fraud was occurring or you were an innocent victim. You may have liability if you knowingly participate in a fraud, however.
 
Q: Is a provider required by law to provide information showing that changes have been made for charges to Medicare when an error is found?

A: After you talk with your provider about an error, the correction should appear on a subsequent Medicare Summary Notice. If you have any questions about whether the correction was actually made, you can call Medicare at 800-MEDICARE (800-633-4227). You can also go to MyMedicare.gov to check your personal Medicare statement.
 
Q: For medical providers, how much of a factor is greed? Is it that providers aren’t afraid of getting caught?

A: The criminals who abuse the health care system certainly are motivated by greed. Many of the biggest abusers are hardened criminals engaged in elaborate schemes. When providers are prosecuted they face jail time, restitution costs and the loss of their licenses.  
 
Q: With all the organizations fielding fraud investigations, is there a centralized database to create efficiencies in time and resources?

A: One important provision of the new health care law is to make it easier for all the federal agencies involved in health care claims to share data. This includes Social Security Disability Insurance, Veterans Affairs, the Defense Department, Indian Health Services, Medicare and Medicaid. Additionally, there will be a significant effort to build better and faster ways of analyzing claims data.
 
Q: Does the federal government have plans to expand HEAT (Health Care Fraud Prevention and Enforcement Action Team) to other cities?

A: HEAT groups are placed in cities where there’s a high incidence of health care fraud. The strike forces began in south Florida and Los Angeles. Detroit and Houston were later added as target cities. Brooklyn; Baton Rouge, La.; and Tampa, Fla., are the newest locations with task forces. With expanding resources from the new health care law, HEAT can strategically concentrate resources and personnel to bring prosecutions where unexplainable billing patterns most frequently appear.
 
Q: I've been hearing ads in local supermarkets for prepaid insurance. Are these legitimate offers?

A: You’re smart to want to make sure that the information you see in advertisements is legitimate. Before purchasing any type of insurance you need to do your homework. Make sure you get all the details in writing about what’s covered and, just as importantly, what’s not covered, and what you have to do to be reimbursed for a claim. With any kind of prepaid plan or discount card, be sure you know the limitations on where the plan can be used, what services would be covered and how long the plan is in effect.
 
Q: I currently have Medicare but no Part B coverage. I also have Tricare for Life as my supplemental insurance coverage, which takes care of prescription medicines as well as other services. I have been told that I should consider getting an additional policy and doing away with my Tricare coverage. Was this a case of a high-pressure sales tactic?

A: Always verify any information you get and do careful comparisons before changing any coverage. To do their job, salespeople need to be convincing. But to do your job as a consumer, you need to ask probing questions and do your own review of the pros and cons of your current coverage versus any new coverage. One way to do this is to use the plan comparison tool at Medicare.gov.
 
Q: Do the electric wheelchair sellers on TV charge a fair amount to Medicare, or is shopping through a local dealer a better option?

A: Before making a choice, ask each durable medical equipment supplier what Medicare reimbursements they expect to receive for providing you with equipment. Be suspicious of any supplier who says it will bill Medicare for a power wheelchair or scooter when you don’t meet Medicare’s qualifications.  
 
Q: What actions are taken to force advertisers to stop false TV ads?

A:  Ads are not "pre-approved" by any federal regulator. If you see an advertisement you think is making false or deceptive claims about some product, notify the television channel, the Federal Trade Commission and/or the Federal Communications Commission

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