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Useful Resources
Minnesota Consumer Awareness Education and Resource Guide for 1998
• Forward
• CHAPTER I: Overview of Medicare
- What is Medicare
- What does Medicare provide
- How is Medicare administered
- Medicare Card
- Medicare Eligibility
- Medicare: Part A
- Medicare: Part B
- Medicare Payment Systems
- Intermediaries and Carriers
- Gaps in Medicare
- Medigap/Supplemental Insurance
• CHAPTER II: Overview of Medicaid
- What is Medicaid
- Objective of Medicaid
- Funding of Medicaid
- Covered Services by Medicaid
- [MA, QMB, SLMB, Spend down, Aid to the blind
- Nursing home benefits, Home Care Nurse Consultants]
- Fraud Disqualification and Sanction
• CHAPTER III: Minnesota Medical Care & Anti-Fraud Project
- Who/What/Where/When/Why
- Medicare Fraud and Abuse Overview
- Definition: Medicare Fraud
- Examples: Medicare Fraud
- Definition: Medicare Abuse
- Examples: Medicare Abuse
- The Cost of Fraud and Abuse in Medicare
- Examples: Fraudulent & Abusive Practices
- [Ambulance, Clinical Labs, DME, HHA and Hospice,
- Hospital Services, Kickbacks, Mental Health Services,
- Nursing Facilities, Physician/Practitioners]
- Definition: Medicaid Fraud and Abuse
- Examples: Medicaid Fraud and Abuse
- America Speaks Out on Health Care Fraud
- What Can Be Done to Fight Fraud and Abuse
- What May Not Be Considered Fraud and Abuse
• CHAPTER IV: Overview of Presentations
- Session Overview
- Room Set-up
- Session Materials
- Adult Learning
• CHAPTER V: Reporting Mechanism
- Reporting Mechanism
- Fraud and Abuse Referral Procedures
- Reporting/Referral Process Chart
- Referral Form
- Phone Reporting of Fraud and Abuse
• CHAPTER VI: Local Community Listing
- Senior Groups and Organizations
• CHAPTER VII: Appendix
- Structure of Medicare
- Brochure
- Handouts
- Tips to Prevent Fraud
- Medicare Summary Notice [MSN]
- EOMBs/EOBs Samples
- Medicare Claims/flow sheet
- Health Insurance Resources
- Fishing for Facts/chart
• CHAPTER VIII: Glossary
- Acronyms/Abbreviations
- Glossary of Terms
• Acknowledgements
Forward
Deceptive healthcare practices result in fraud for an estimated ten percent of every Medicare and Medicaid dollar spent in our country. This manual will assist in combating fraud and abuse in these programs by increasing public awareness of fraudulent practices, and how to reduce and prevent the incidence of such practices, how to detect wrong-doing and encourage people to become involved in self-monitoring and reporting of fraud.
Federal law allows criminal and administrative sanctions against physicians, providers or suppliers who have been found guilty of abusing or defrauding the Medicare or Medicaid program.
MEDICARE: Take Care of It So It Can Take Care Of You!
- When should you suspect fraud?
- How can you protect yourself from being the subject of fraud, abuse and waste?
Be educated about common violations such as misuse of Medicare numbers, kickbacks, billing for services not rendered, billing for one service but delivering another service, providing services that are not medically necessary.
Please report suspected fraud or abuse to:
FRAUD & ABUSE HOTLINE
(1-800-HHS-TIPS)
1-800-447-8477
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