Todays Agenda An overview of fraud trends from California Sandy - PowerPoint PPT Presentation

Today’s Agenda • “An overview of fraud trends from California” • Sandy Morales, Case Manager, Senior Medicare Patrol • “Revisions to the CMS MA and Part D Marketing Guidelines” • Julie Lowrie, Outreach Specialist, Senior Medicare Patrol • “An Advocate’s Perspective on the Marketing Guidelines” • David Lipschutz, Associate Director and Senior Policy Attorney, Center for Medicare Advocacy

California Fraud Cases: Jan – Sept 2019 427 total cases Billing Issues 7% 10% Deceptive Home Health Care Enrollments 5% 2% 1% Deceptive Hospice Enrollments MA Plan 4% DME Brace Scams Marketing 12% Misconduct Fraudulent Genetic Tests 9% Medicare Advantage Plans and Agents Deceptive Hospice Enrollments Medicare Phone Scams Medicare Supplement Scams New Medicare Card Scams Fraudulent Genetic Tests Misc. 21% 29% DME Brace Scams

Medicare Back Brace Scam Tele-Doctor Telemarketer Equipment Company  Beneficiaries receiving cold calls, visits to their homes  Receiving multiple packages of braces  Medicare paying thousands $$

• Non-terminal beneficiaries tricked • Caregivers deceived • Kickbacks, referrals (Home Health, Deceptive Skilled Nursing) Hospice • Palliative v Curative Enrollments • Impact of hospice on record • Inadequate or no care