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Coalition of Wisconsin Aging Groups - Wisconsin SMP
 Visit the NEW SMP Website HereFor more information please call 800.488.2596, ext. 317or email Elizabeth Conrad at econrad@cwag.orgFor volunteer opportunities please call 800.488.2596, ext. 342 or email Judy Steinke at jsteinke@cwag.orgFraud Alert Archives
Wisconsin SMP publishes a free monthly newsletter which contains relevant information on healthcare and consumer protection issues, including fraud, waste and abuse in the Medicare and Medicaid programs. It also highlights volunteer activities around the state of Wisconsin. Consumer Alert - December 2009
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ALERT: Medicare Does Not Call You To Request Personal Information
The Kansas SMP recently shared information about a scam that was happening to Medicare beneficiaries in their state. A female caller stated that she was calling from Medicare and that the individual's file was flagged for Part D enrollment or for a change in Medicare coverage. She went on to say that she needed to verify the individual's Medicare number. Once she received the individual's Medicare number, the individual was transferred a second and third time. Each person that the individual spoke to tried to get additional information from her. If you receive any phone calls from someone claiming to be from Medicare, Please Hang Up! Do not be pressured to provide any personal information. Never give out Medicare, Social Security or bank account numbers to strangers. Do not accept "Free" offers from door -to-door salesmen, telemarketers or magazine ads and never sign a blank form. Please report any suspicious phone calls or door-to-door salesmen to your local authorities. Volunteer Opportunities - SMPVolunteerApplication.pdf
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Click here for more information on specific volunteer opportunities.
Who We Are-------------------------------------------------------------------------------- The SMP programs, formerly known as Senior Medicare Patrol programs, help Medicare and Medicaid beneficiaries prevent, detect and report healthcare fraud. The SMP programs not only protect older persons, they also help preserve the integrity of the Medicare and Medicaid programs. What We Do-------------------------------------------------------------------------------- Medicare/Medicaid error, fraud, waste and abuse result in a loss of over $30 billion each year. The Medicare program is important and needs to be protected so the benefit will be available for future generations. Wisconsin SMP provides training and information to Medicare beneficiaries, caregivers and professionals on questions such as:
- What is Medicare/Medicaid and who qualifies?
- What benefits are available at what cost?
- What is Medicare Part A, Part B, Part C and Part D?
- What is healthcare fraud, waste and abuse?
- What can be done if there is over-billing on a Medicare statement?
- How can others in your community be educated to understand and maximize their Medicare benefits?
- Why is healthcare fraud, waste and abuse a concern?
National Medicare Facts
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- 47 million seniors and disabled Americans receive Medicare
- 1 billion Medicare Summary Notices (MSN) are processed each year
- There are more than 1.1 million providers and $30 billion paid in claims each year
Wisconsin Statistics
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- 871,000 Wisconsin citizens receive Medicare
- $5 billion paid in claims each year
Whose Money Is Wasted?
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- Part A is funded by payroll taxes
- Part B is funded by premiums and general tax revenues
- Part D Medicare Prescription Drug program is funded by premiums, including deductibles and co-pays.
Civil Penalties for Patient Dumping
Section 1867 of the Social Security Act states that when someone goes to the emergency room for examination or treatment, a hospital having a Medicare provider agreement is required to conduct an appropriate medical screening examination to determine whether the individual has an emergency medical condition. This section outlines the exceptions rule to Section 1867 and includes examples of patient dumping involving two separate hospitals and a practicing licensed physician.
Common Fraud Schemes by Durable Medical Equipment (DME) Providers
The durable medical equipment (DME) industry has consistently been complicit in fraudulent schemes. Examples include billing for equipment never delivered, billing for higher-cost equipment than actually delivered, and billing for unnecessary equipment or supplies. This section shows cases of fraud involving DME suppliers.
Common Schemes of Transportation Fraud
Common Medicare and Medicaid fraud schemes involving transportation and ambulance companies include submitting false claims. This section provides examples of transportation fraud perpetrated by an ambulance company, by a former president of an ambulance company and by several hospitals.
Fraud Alert - The Newsletter of Wisconsin SMP
Wisconsin SMP publishes a free monthly newsletter which contains relevant information on healthcare and consumer protection issues, including fraud, waste and abuse in the Medicare program. It also highlights volunteer activities around the state of Wisconsin.
Learn More About Medicare Fraud and Abuse
Providers and suppliers have a legal obligation to conform to the requirements of the Medicare program. This section includes an explanation of what constitutes fraud and abuse in the Medicare and Medicaid programs and uses examples to illustrate each point.
Sanctions for Fraud and Abuse
Besides criminal penalties for engaging in fraud or abuse of federal health care programs, administrative sanctions can also result. They may include program exclusions or civil actions. Title XI of the Social Security Act provides several bases for individuals and entities from participation in Medicare, Medicaid and other federal health care programs. This section includes an explanation of what constitutes a program exclusion or civil action and includes examples of both.
Volunteer Opportunities
Wisconsin SMP Volunteer Position Description - 1
- Set-up SMP project booth/table at fairs, health expos, etc.
- Staff the booth to hand out brochures and answer basic questions about the project.
- Report opportunities for such booths/tables to the Volunteer Coordinator
- Submits monthly report of time to the Volunteer Coordinator
Wisconsin SMP Volunteer Position Description - 2
Trained volunteer who could provide brief presentations (15-30 minutes) at local gatherings such as clubs, caregiver support groups, groups of retirees, etc.
Training and materials would be provided
Annual update training would be required
Report opportunities for Outreach to the Volunteer Coordinator
Submits monthly report of time to the Volunteer Coordinator
Wisconsin SMP Volunteer Position Description - 3
Trained volunteer who could assist the Project Director with trainings and presentations (approximately day trainings)
Trained volunteer who could do the presentations alone
Training and materials would be provided
Annual update training would be required
Report opportunities for Trainings/Detailed Presentations to the Volunteer Coordinator
Submits monthly report of time to the Volunteer Coordinator
Wisconsin SMP Volunteer Position Description - 4
Assists the Project Director with clerical duties in the Madison office
Assists the Volunteer Coordinator with clerical duties in their own home
Assists the Project Director with production of technical training manuals-either in their own home or in the Madison office
Assists the Volunteer Coordinator by scheduling volunteer opportunities to other volunteers in their county or district
Submits monthly report of time to the Volunteer Coordinator
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