March - GeorgiaCares

GeorgiaCares Referring, Educating, and Training News
G.R.E.A.T. News
GeorgiaCares Referring, Educating, and Training News
Volume 13 Issue 3, March 2016
Medicare General Enrollment Period (January 1 - March 31)
Inside This Issue
Medicare is health insurance for people 65 or older, people under 65 with certain
disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent
kidney failure requiring dialysis or a kidney transplant). When you're first eligible for
Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
Some people get Part A and Part B automatically:

News

Medicare
Preventive Services

Counseling Tips


If you’re already getting benefits from Social Security or the Railroad
Retirement Board (RRB)
GeorgiaCares
Spotlight

If you’re under 65 and disabled

Fraud in the News

If you have ALS (Amyotrophic Lateral Sclerosis)
Upcoming Events


Jan. 1 - Mar. 31, 2016
Medicare General
Enrollment Period
If you are not automatically enrolled in Medicare and you’re close to 65, you’ll need to sign
up during the Initial Enrollment Period (IEP). The IEP is a 7 month period that surrounds
your 65th birthday. Contact Social Security, or if you worked for a railroad, contact
the RRB. In most cases, if you don’t sign up for Medicare when you’re first eligible, you
may have to pay a late enrollment penalty for as long as you have the coverage.
General Enrollment Period
March 9, 2016
GeorgiaCares
Coordinator’s Meeting
March
is
Developmental
Disabilities
Awareness
Month
If you didn’t sign up for Part A (if you have to buy it) and/or Part B (for which you must pay
premiums) during your Initial Enrollment Period, you can sign up between January 1–
March 31 each year. Your coverage won’t start until July 1 of that year, and you may have
to pay a higher Part A and/or Part B premium for late enrollment.
If you (or your spouse) are still working, you may have a chance to sign up for Medicare
during a Special Enrollment Period. Call GeorgiaCares at 1-866-552-4464 (option 4) for
more information on Medicare Enrollment Periods.
Visit
www.acl.gov
Source: Centers for Medicare and Medicaid Services. Medicare & You Handbook. 2016.
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GeorgiaCares Referring, Educating, and Training News
Medicare Preventive
Services
March is Colorectal Cancer Awareness Month
Colorectal cancer is the fourth most common cancer in the United States
and the second leading cause of death from cancer. Colorectal cancer
affects all racial and ethnic groups and is most often found in people ages
50 and older.
The best way to prevent colorectal cancer is to get screened regularly
starting at age 50. There are often no signs or symptoms of colorectal
cancer – that’s why it’s so important to get screened.
People over age 50 have the highest risk of colorectal cancer. You may
also be at higher risk if you are African American, smoke, or have a family
history of colorectal cancer.
Everyone can take these healthy steps to help prevent colorectal cancer:


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Get screened starting at age 50.
Quit smoking and stay away from secondhand smoke.
Get plenty of physical activity and eat healthy.
Source: healthfinder.gov
Colorectal Cancer Screenings
How often is it covered?
Medicare Part B (Medical Insurance) covers several types of colorectal cancer screening
tests to help find precancerous growths or find cancer early, when treatment is most
effective. One or more of these tests may be covered:
 Screening barium enema. For barium enemas, you pay 20% of the Medicare
approved amount for the doctor's services. In a hospital outpatient setting, you also
pay a copayment.
 Screening colonoscopy. You pay nothing for the screening colonoscopy, if your
doctor accepts assignment.
 Screening fecal occult blood test. You pay nothing for the screening fecal occult
blood test. This screening test is covered if you get a referral from your doctor,
physician assistant, nurse practitioner, or clinical nurse specialist.
 Multi-target stool DNA test. You pay nothing for a multi-target stool DNA test.
 Screening flexible sigmoidoscopy. You pay nothing for the screening flexible
sigmoidoscopy, if your doctor accepts assignment.
Note: If a screening colonoscopy or screening flexible
sigmoidoscopy results in the biopsy or removal of a lesion
or growth during the same visit, the procedure is considered
For more information on
diagnostic and you may have to pay coinsurance and/or a
covered preventive and
copayment, but the Part B deductible doesn't apply.
screening services, call
Who’s eligible?
GeorgiaCares at
All people age 50 or older with Part B are covered. People
1-866-552-4464 (option 4)
of any age are eligible for a colonoscopy.
or visit www.medicare.gov
Source: www.medicare.gov
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GeorgiaCares Referring, Educating, and Training News
Counseling Tips
Medicare Coverage of Hospice Care
Medicare will help pay for your hospice care if you meet all of the following criteria:

You have Part A

The hospice medical director (and your doctor, if you have one) certify that
you have a terminal illness (your life expectancy is six months or less)*

You sign a statement electing to have Medicare pay for palliative care such
as pain management, rather than care to try to cure your condition

Your terminal condition is documented in your medical record

You receive care from a Medicare-certified hospice agency
You do not need to be homebound to qualify
for the Medicare hospice benefit. The benefit
is a comprehensive set of services delivered
by a team of providers. A lot of hospice
services are provided in the home
but inpatient care is covered under specific
circumstances.
The hospice benefit is always covered
under Original Medicare. If you have a
Medicare Advantage Plan and elect hospice,
Original Medicare will automatically pay for
your hospice care. Your Medicare Advantage Plan will continue to pay for care that is
unrelated to your terminal condition.
*The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited
number of 60-day benefit periods. You must have a face-to-face meeting with a hospice
doctor or nurse practitioner if you reach your third benefit period. The third benefit period
begins on day 180 of hospice. After that, you must continue to have face-to-face meetings
with a hospice doctor or nurse practitioner before the start of each following 60-day benefit
period. The meeting must take place no earlier than 30 days before the new benefit period to
confirm you still qualify for hospice care.
Source: www.medicareinteractive.org
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GeorgiaCares Referring, Educating, and Training News
GeorgiaCares
Spotlight
Georgia Legal Services Program, GeorgiaCares
Georgia Legal Services Program, the Atlanta
Area GeorgiaCares Program attended a
health fair on January 30th at North Point
Mall to bring awareness to health and
prevention. They were able to speak to over
75 people to let them know that
GeorgiaCares was available to assist with
their Medicare needs, including preventive
Pictured: Sharonda Madison, GeorgiaCares
services, fraud prevention, and everything
Coordinator
Medicare related. Not only did they speak to
beneficiaries, but they also spoke to family members who had loved ones on Medicare,
people who were becoming Medicare age, and disabled clients who needed assistance
with their Medicare. The event was a great success, and GLSP was also able to talk
about potential new partnerships with other vendors.
GeorgiaCares Program, January 2016 Coordinator’s Training
Pictured from left to right: Kerrie Sirmans, Coordinator;
Valerie Binyon, Staff; Linda Gail, Coordinator; Nancie
Daugherty, Coordinator; David Watkins, Program
Consultant; Sharrell McKnight, Coordinator; Belinda
Jones, Coordinator; and Linda Harris, Staff
Volunteer Opportunities
For information on how you can volunteer
for GeorgiaCares, call 1-866-552-4464
(option 4) or contact your local
Area Agency on Aging.
Visit the GeorgiaCares website at
www.mygeorgiacares.org to download a
volunteer application.
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Pictured from left to right: Carline Robertson, Program
Consultant; David Watkins, Program Consultant;
Butch Swinney, Coordinator; Kristi Bates, Coordinator;
Carol Cannon, Staff; Evelyn Gay, Coordinator; Don
Gay, Coordinator; Leola Merrion, Staff; Christine
Williams, SHIP Coordinator
You can make a difference for people
with Medicare
GeorgiaCares Referring, Educating, and Training News
Fraud in the News
United States And Vermont Doctor Resolve Matter Involving
Non-FDA Approved Drugs And False Claims
February 17, 2016
The Office of the United States Attorney for the District of
Vermont announced today the resolution of its investigation of
Dr. Gamal H. Eltabbakh for submission of false claims for
payment to Medicaid and Medicare. Under the terms of the
agreement between the parties, Dr. Eltabbakh and his
company, Lake Champlain Gynecologic Oncology P.C.
(“LCGO”), paid $500,000.00 to the United States. The money
will be divided between the federal Medicare ($391,957.81),
federal Medicaid ($63,031.81), and Vermont Medicaid ($45,010.38) programs to which Dr.
Eltabbakh submitted the alleged false billings.
The settlement resolves allegations that from approximately January 2010 through February
29, 2012, LCGO purchased a portion of the drugs used by Dr. Eltabbakh in chemotherapy
treatments, including Aloxi, Neulastum, Bevacizumb, Taxotere, Gemzar, Hycamtin, and
Alimta, from a Canadian drug distributor and other sources. The government further alleged
that the drugs had not received final marketing approval from the FDA and were not covered
by Medicare and Medicaid.
Pursuant to the terms of the settlement agreement, the agreement and payment are neither
an admission of liability by Dr. Eltabbakh or LCGO, nor a concession by the United States
that its claims were not well founded.
This matter was investigated by the United States Attorney’s Office, the U.S. Food and Drug
Administration Office of Criminal Investigations, and the U.S. Department of Health and
Human Services Office of Inspector General (HHS OIG). “We will continue to ensure that
Medicare and Medicaid only pay for drugs that meet the coverage requirements of the
programs,” said Special Agent in Charge Phillip M. Coyne of HHS OIG. “Working with our
Federal partners, we will continue to ensure beneficiaries receive safe and effective
treatments.”
Source: www.justice.gov
If you suspect fraud, errors, or abuse when you use Medicare or
if someone tries to sell you a product or service you don’t need,
report it by calling GeorgiaCares at 1-866-552-4464, option 4.
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GeorgiaCares Referring, Educating, and Training News
GeorgiaCares State Office Staff
Access to Services Section Manager, Cheryl Harris
SHIP Coordinator/GeorgiaCares Team Lead, Christine J. Williams
SMP Coordinator, Carline Robertson
Data Specialist, Patsy McDoodle
Volunteer Coordinator, David Watkins
Business Operations Generalist, Veronic Clemons
Division of Aging Services
GeorgiaCares Program
2 Peachtree Street, NW, 33rd Floor
Atlanta, GA 30303
1-866-55AGING (1-866-552-4464), Option 4
Fax: 404-657-5285
http://www.mygeorgiacares.org/
https://www.facebook.com/GeorgiaCares
Funds for this publication were provided in part by the U.S. Administration for
Community Living (ACL), Administration on Aging (AoA), and the Centers for
Medicare and Medicaid Services (CMS)
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