Resource Directory Results
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To Print a Single Resource – Click the “Print Resource” link within the resource listing to view a printer-friendly page. When the page opens, right-click within the page and select “Print”.
To Print Multiple Resources – First, select specific resources for your list by checking the “Add to List” box next to each resource. Or, to print all the resources shown on the page, check the “Add All To Print List” box. Next, click “Print List” to generate a printer-friendly PDF document. You can then print the document or save it to your computer.
NOTE: Remember to print your list before you leave this page. Checked items will be lost if you leave this page.
Lesson 12: Medicare Fraud and Abuse
Medicare Fraud and Abuse
What Is Medicare Fraud & Abuse?
Fraud occurs when someone intentionally falsifies information or deceives Medicare. Abuse occurs when doctors or suppliers do not follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that are not medically necessary.
A complaint about the quality of care you got from a doctor, hospital, or other provider or facility is not considered fraud or abuse. If you have a complaint about your quality of care, please click here.
Reporting Fraud
If you think a charge is incorrect and you know the provider, you may want to call their office to ask about it. The person you speak to may help you better understand the services or supplies you got. Or, your provider may realize a billing error was made.
If you`ve contacted the provider and you suspect that Medicare is being charged for a service or supply you didn`t get, or you don`t know the provider on the claim, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Medicare.gov
Lawerence KS 66044
Description:
Medicare.gov has all of the information and tools you need for questions or help with Medicare. You can:
- enroll in Medicare online
- compare and enroll in Medicare health or prescription plans
- find and compare doctors
- check to see if a test or service is covered by Medicare
- chat with a Medicare representative
- research and compare nursing homes and home health agencies
- get extra help with medical and prescription drug costs
- get a new Medicare card
Medicare Nursing Home Compare
Use the site to obtain a free copy of A Guide to Choosing a Nursing Home.You can search the site to obtain and compare nursing home information from all parts of the country, including their performance at their last Medicare state survey.
Medicare Plan Finder
Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area.
Use Medicare's Plan Finder to find and compare Medicare Advantage (Part C) plans available in your area. Have the enrollee's zip code ready.
You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Part A and Part B deductibles, coinsurance, and copayments if you meet certain conditions.
Medicare Savings Programs
There are four kinds of Medicare Savings Programs
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
If you have income from working, you may qualify for SLMB benefits even if your income is higher than these limits. - Qualified Individual (QI) Program
You must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. (You can't get QI benefits if you qualify for Medicaid). - Qualified Disabled and Working Individuals (QDWI) Program
The QDWI program helps pay the Part A premium. You may qualify if any of the following apply to you:
Are a working disabled person under 65
Lost your premium-free Medicare Part A when you went back to work
Aren't getting medical assistance from your state
Meet the income and resource limits required by your state
How to Apply for Medicare Savings Programs
Many people do not know or understand if they qualify for Medicare Savings Programs. Council on Aging can help. Call us at 513-721-1025 for help in determining your eligibility.
If you qualify for a Medicare Savings Program in your state, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.
Ohio Attorney General
Columbus OH 43215
Description:
By law, the Attorney General is the chief law officer for the state of Ohio. The Office protects Ohio families from predatory financial practices through enforcement authority in the areas of consumer protection, antitrust, charitable organizations, and health care fraud.
The office offers services to protect the most vulnerable Ohio citizens, including children, the elderly, victims of crime and those who are preyed upon by greed in its many forms: unfair, illegal or shady business practices, criminal conduct and abuse of power and corruption. Programs are also available to support veterans, active duty military, and their families.
The Consumer Protection Section protects Ohioans from predatory and illegal business practices. With authority granted by the Ohio Consumer Sales Practices Act and other statutes, the section enforces laws that prohibit unfair and deceptive practices including but not limited to: false advertising, shoddy workmanship, and failure to perform services or to deliver goods.
Consumers can file a complaint online or by calling 800-282-0515.
Ohio Senior Medicare Patrol Project
Cincinnati 45237
Description:
Ohio SMP Is Seeking Volunteers
Did you know that one out of every seven Medicare dollars goes to fraud, waste and abuse? That Medicare fraud, waste and abuse cost you $13 billion?
To help address this national problem, Pro Seniors receives funding from the Administration on Aging for a Senior Medicare Patrol Project. Named Ohio SMP this project helps older Americans be wiser health care consumers. Seniors are taught to better understand their Medicare statements so they can detect potential fraud and errors and then take the appropriate steps to correct them.
At the heart of Ohio SMP are volunteers who are often retirees. They educate groups of older Americans about illegitimate Medicare practices or provide individual assistance to those questioning the accuracy of their statements. Presentations may be offered in the volunteer's own community at churches, retired professional organizations, social groups and other locations where seniors gather. Project staff is also available to assist in coordinating presentations. In addition to the Administration on Aging, Ohio SMP has received strong support from the Council on Aging of Southwestern Ohio.
Anyone interested in volunteering may contact Jane Winkler at (513) 458-5523.
Stop Medicare Fraud and Abuse
Easton Maryland
Description:
Official Web site of US Department of Health and Human Services and the US Justice Department with information about Medicare Fraud, how to prevent it, and how to report it.