Keeping Medicare for Tomorrow

Funded by Department of Health and Human Services Administration for Community Living/Administration on Aging SMP’s

Goal of the Missouri SMP Empower Medicare beneficiaries to prevent healthcare fraud through outreach, counseling and education.

SMP Team Members Complete a 2 day training Provide education, advocacy, and counselling to individuals, their families and caregivers.

Services Provided by SMP’s - Free of Charge  Screening for possible fraud and abuse of the Medicare/Medicaid programs  Billing assistance and appeals process  Explanation of coverage  Policy Comparisons

SMP Coalition Missouri Attorney General’s Office – Consumer Fraud, Elder Abuse and Neglect, Identity Theft, Medicaid Fraud Ma4 CLAIM CMS Social Security Department of Senior and Disability Services

Partnership Missouri Association of Area Agencies on Aging CLAIM Leading Age

Most recent-$60 billion lost annually ($6.8 million/hr) Estimate of Loss to Fraud and Abuse

Effects of Fraud to Beneficiaries Diminishes the quality of treatment beneficiaries may receive.

Effects of Fraud to Caregivers  Decreases funding available for important programs  Difficult for honest providers to compete with dishonest providers

Effects of Fraud to Taxpayers  Raises taxes  Raises health insurance premiums  Raises health insurance deductibles  Raises administrative costs

Violators Can Include Organized crime A doctor or provider Durable medical equipment suppliers Medicare beneficiaries Any individual or business Insurance Companies

Fraud When someone intentionally executes, or attempts to execute, a scheme to obtain money or property of any health care benefit program.

Abuse When health care providers or suppliers perform actions that directly or indirectly result in unnecessary costs to any health care benefit program.

Abuse Can Lead to Fraud When a provider continues to abuse regulations after warnings, it can become fraud.

New Medicare Cards

Medicare Certified Arthritis Kits

Diabetic Shoes

Medical ID Theft

ObamaCare Scams

How Do You Make a Difference? Protect Detect Report

Protect Treat your Medicare card and number like your credit card Watch out for identity theft Medicare doesn’t call, , or visit to sell you anything.

Detect  Keep a Personal Health Care Journal  Review Medicare Summary Notices and Explanations of Benefits  Access your Medicare information at

Report Call the provider Gather information and documentation Call the SMP

Who Can I Contact? The Missouri SMP , Toll-free