PULL Together: - Community of Vermont Elders

PULL Together:
Vermont Senior Medicare Patrol (SMP) Newsletter
Vermont Senior Medicare
Patrol or SMP is funded by
the Administration on
Aging (Grant # 90SP007401-00). There are 54 SMP
projects located throughout the United States,
Puerto Rico and the Virgin
Islands.
From the Director - Anita Hoy
Anita Hoy
VT SMP Director
802-229-4731
[email protected]
Medicare Fraud Enforcement Fumbles, Except in
Vermont - Joe Sherman
Autumn 2014
INSIDE THIS
ISSUE:
The Southern
Half
2
Volunteering
with SMP
2
COVE Funding
3
COVE Annual
Fundraiser
4
Medicare Minute
5
Scam Alert
8
Our federal government is intent on rooting out medical fraud. As of
late, the effort costs about $600 million a year. A significant amount of the money
goes to find evidence of false claims and billings for Medicare. Doing the detective
work nationwide are health-care investigators, FBI agents, paralegals, computer
geeks, states attorney generals, and a small army of outside contractors. They do
everything from using computers to ferret out systematic patterns of corruption to
chasing down paper documents and telephone logs, from busting into warehouses
packed with the props of fraudulent claims-- wheelchairs, knee braces, crates of
canes--to taking hospital administrators to court.
Despite all the work and high intent, the government finds its enforcement efforts fumbling. The New York Times recently said the battle was being lost. Yet in August, in Arizona, the government announced a record settlement. The Carondelet
Health Network, which runs two hospitals in Tucson, St. Josephs Hospital and St.
Mary’s Hospital, agreed to pay Medicare $35 million for allegedly billing patients for
rehab that was not. . .
Continued on page 6
PAGE
2
The Southern Half - Kelly McElheny
The Vermont SMP program has been busy rolling out the new Medicare Minute program from the Medicare Rights Center. This 10 – 15
presentation provides a monthly update on services, changes to services,
and tips on how to protect you from Medicare Abuse, Error and Fraud.
Medicare Minutes have been well received by Senior Centers in Brattleboro, Bennington and Castleton, as well the Vermont Association for the
Blind and Visually Impaired (VABVI) support groups and the Bennington
County Retired Teachers Association. They have also served as a stepping
stone to greater collaboration with the State Health Insurance Program
(SHIP) coordinators as they too have also found the information provided
to be helpful in their New to Medicare education programs.
Speaking of SHIP, It’s that time of year again! Open enrollment begins
in October and continues through December for both Part D and Medicare
Advantage plans. In an effort to get the word out, the I have been working
throughout the summer with SHIP coordinators, Sandi Bartlett
(Bennington/Rutland) and Sharon O’Neill (Windham/Windsor) to develop
a common “New to Medicare” training to assist beneficiaries with navigating their way through the process.
New to Medicare presentations are scheduled for October and November in Windham, Windsor and Bennington Counties. On October 8th, at
the Brattleboro Senior Center, a New to Medicare class will be held following the Medicare Minute at 12:00pm. On October 8th in Woodstock,
Sharon O’Neill the Southeastern VT SHIP Coordinator will be presenting
to new enrollees at Thompson Senior Center. On October 14 th at 4:30 pm,
Sandi Bartlett the Southwestern VT SHIP Coordinator will be holding a
New to Medicare class at Southwestern Vermont Medical Center. On
October 29th, at the River Garden in Brattleboro at Noon, there will be a
SMP general presentation with a short introduction to Medicare. Finally
on November 6th, at the Bennington Library, Sandi and I will be presenting
a New to Medicare class.
PULL
TOGETHER:
VERMONT
SENIOR
MEDICARE
PATROL
(SMP)
NEWSLETTER
Look for New to Medicare classes in Springfield, White River Junction
and Rutland communities in the upcoming months!
To reach Kelly about volunteering or to schedule a presentation, call:
802-258-0052, by email: [email protected]
VOLUME
1,
ISSUE
PAGE
4
Volunteering with Vermont SMP
SMP has more than 80 volunteers statewide, some of whom provide education, others who distribute information or make contact with community
organization. Still others assist with media, website and social networking,
materials development, and other administrative duties.
Recently, one of our administrative volunteers left our home State to seek
warmth in Florida. She had been working at our Berlin office on Wednesdays
for approximately 5 hours at a time. While here, she assisted with scheduling,
contacting organizations to talk about our presentations, making flyers, sending our thank you notes and then some data entry to keep our records up to
date. We would like to find someone who would be interested in this position,
potentially to work on Wednesdays for a few hours at a time. Please contact
Anita at 802-229-4731 to learn more.
Of course, we are always seeking new volunteers as educators and to
reach the media. All SMP Volunteers:

Meet with Vermont SMP staff to decide on a role….

Complete an application and a background check

We make it easy to study and certify as an SMP Volunteer

Receive supervision and mentoring for as long as you need it…

Set your schedule and availability

Enjoy working on your own or as part of a team

Mileage reimbursement available
Help y
our pe
ers
protec
t them
selves
becom
e a Ve
rmont
SMP v
olunte
er! Ca
ll:
802-22
9-4731
COVE Receives Funding from Fairpoint and Google
The Community of Vermont Elders is delighted to have received funding from Fairpoint and a dozen Chromebooks from Google to develop an
educational program for it’s members. The program, “The Safe Use of the Internet” will be available to members at the beginning of 2015.,
particularly those who use Fairpoint Internet services. If your organization would like to host a presentation after the new year, contact Gini
at COVE: 802-229-4731
3
PAGE
4
Join us for COVE’s Annual Meeting, Dinner,
Raffle, and Silent Auction
Canadian Club, Barre
FRIDAY, NOVEMBER 14, 2014
In 2013, COVE
had more than 60
people attend its
first 150-squuare
raffle luncheon.
We hope those
and more will
attend this 2014
event!
Happiness is purchasing a winning ticket with your
friends!
RAFFLE – Grand Prize $3,000
SCHEDULE OF EVENTS
4:00 – 5:00 Annual Meeting; Silent Auction begins
5:00 Cash Bar begins
5:30 – 8:30 Raffle & Dinner
COVE’s Annual 150 Square Raffle – Details
PULL
TOGETHER:
VERMONT
SENIOR
MEDICARE
PATROL (SMP)
NEWSLETTER

Grand Prize $3,000

10 other prizes total $1,900

$100/ticket – split one with friends!

150 tickets will be sold

Includes two dinners at the Canadian Club

You
DO NOT
have to be present to win
~~ How to Purchase Raffle Tickets ~~
Please contact COVE at 802-229-4731, extension *# or [email protected]
VOLUME
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5
From the Director, Continued...
Medicare Minute: Fall Open Enrollment
Choose a plan that best meets your needs by using the following questions to help
you determine the most appropriate prescription drug overage for you:





What are your current drug costs?
What prescription drugs do you take and which pharmacies do you
use?
What prescription drug plans are accepted at your pharmacy?
Do you travel often?
What is the plan’s star rating?
A Medicare Minute is a short, engaging presentation on timely Medicare error and fraud-related topics.
Each month, Medicare-trained volunteers from the Vermont Senior Medicare Patrol (SMP) will present a new Medicare Minute at a variety of community sites, offering valuable information and resources to audience members.
Following presentations, audiences have the opportunity to ask questions, discuss the content of the presentation,
and share their own experiences with Medicare, fraud, and health care in general. A Medicare Minute presentation
is easy to schedule and can be effectively presented before or after meals and other community events. If you
are interested in becoming a Medicare Minute volunteer, or would like to host Medicare Minute presentations at
your community site, please contact Anita at: 802-229-4731 or by email at: [email protected]
Medicare Minute was supported, in part by grant number 90SM0010-01-00, from the U.S. Administration for Community Living,
Department of Health and Human Services, Washington, DC 20201
Would you like to host a
Medicare Minute at your
site on a regular basis to
keep your members up to
date? Monthly, Quarterly,
Semi-annually?
Would you like to become
a Vermont SMP volunteer
so you can lead these
scripted presentations
….Contact Vermont SMP
to learn more….
PAGE
6
Medicare Fraud Enforcement Fumbles...Continued
supposed to be billed. Carondelet’s bosses denied any guilt but paid the fine. A month later,
a smaller recovery also went the government’s way. It was for $2.2 million from a nursing
and rehab center in New Rochelle, New York. It allegedly oversold the degree of care that
residents needed, lied about it and falsified records to cover the trail.
So, is the government getting a grip on Medicare fraud or letting culprits off the hook
after expensive, prolonged investigations with little but a slap on the wrist?
The government defends the system. Dr. Shantanu Agrawal, head of Medicare’s antifraud Center for Program Integrity, claims that the work is stopping “the bleeding from the
dollars going out the doors.” Critics like Utah Senator Orrin Hatch disagree, voicing skepticism about the effectiveness of enforcement. They say the government is okay at identifying
illegal behavior but is poor at preventing it or recovering much of the lost money.
Joe Sherman is a
writer of international
acclaim. His books
include: Fast Lane of
a Dirt Road: A Contemporary History of
Vermont; In the Rings
of Saturn, which was
nominated for a
Pulitzer Prize, and The
House at Shelburne
Farms: The Story of
One of America’s
Great Country Estates.
Joe lives in Montgomery, VT, with his wife,
Martina Tesarova.
PULL
TOGETHER:
VERMONT
SENIOR
MEDICARE
PATROL (SMP)
NEWSLETTER
The amounts of money are colossal. Fraud drains Medicare of $60 billion annually, or
10 percent of its budget. In 2013, only $4.3 billion of the $60 billion was recovered. The lion’s share of recovered funds was chased down by sleuths paid on a contingency fee basis.
They’re called private recovery-audit collectors or RACs. RACs are bounty hunters to
some and white-hatted cowboys chasing miscreants by others. Across much of America,
RACs have become entangled in legal appeals by hospitals. Lots of litigation has slowed the
rate of money recovery efforts to a crawl. The RACs “have been brought to a halt by their
very success,” insists Marsha Simon, a respected health policy expert in Washington. But
you’ve got to ask yourself, is getting back only 7 percent of what has been stolen something
to call a success?
To put a bigger dent in fraud, Medicare plans to increase the financial bounties that it
pays. Not to RACs, but to whistleblowers. Medicare thinks it can flank some of the legal
snarls associated with the RACs and glorify, as well as reward, the individuals who point out
wrongdoing.
I’m skeptical of informers, but there is promise here. Some big states like New York
have sophisticated predatory operators whose schemes have successfully bilked Medicare.
One particularly virulent fraud schem is called turbocharging. Turbocharging hospitals manipulate Medicare charges. For instance, they create the appearance of excessively costly
care for certain patients, which in turn triggers drastically higher payments from Medicare to
the hospitals Its a win-win for the bad guys and a huge loss from Medicare. By exposing
some of the turbocharging hospitals, most notably Beth Israel Medical Center in New York,
which paid out $13 million in a False Claims lawsuit recently, the government has shown
some mettle.
Still, it all just adds up to a meager 7 percent, and lots of that money is burned up by
the antifraud apparatus itself.
Locally, it’s hard to see how Vermont fits in this monster-sized national medical fraud
story. It’s barely a sidebar. Our lack of big money Medicare crimes is good news we don’t
VOLUME
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PAGE
7
Medicare Fraud Enforcement Fumbles...Continued
hear. There was a whistleblower case at Dartmouth Medical Center back around 2008. The Ivy
League hospital allegedly billed for levels of care above the real care received; this is a popular fraud
tactic called upcoding. The hospital chiefs circled the wagons and paid the fine. The legal records
were sealed. Media coverage was scant with a short piece in the pages of the Valley News.
Up in St Albans, the Northwest Medical Center has adopted a refreshingly old-fashion approach
to reducing medical fraud: DIY. Says Jonathan Billings, a hospital spokesman, “We get folks working
at desks and bedsides to bring up concerns before they get big. Here the spirit of our compliance
program is to recognize problems early and attack them cooperatively.”
As for the often reviled recovery audit contractors, “Yes, the RACs are active here,” says Jamie
Pinkham, the hospital auditor. “And elsewhere in Vermont. But all the hospitals in Vermont, which
tend to be not-for-profit, take compliance with Medicare very seriously.”
As for whistleblowers, Vermont state law has stronger anti-retaliation provisions, which protect
whistleblowers from things like getting fired by angry superiors, than federal law.
Vermont hasn’t had a Carondelet-scale fraud yet. It gave black eyes to two Arizona hospitals
because of federal investigations but also allowed the managers to walk. Multi-million dollar fines, of
course, are not peanuts, but legal actions that put administrators and doctors in jail would have
teeth. Sharp teeth and a hard bite are things that the government’s Medicare antifraud program is
missing.
So, can Vermont hospitals and Medicare/Medicaid patients help staunch the money bleeding
from Medicare? Should we accept the 7 percent rate of recovery and be pleased our hospitals don’t
seem to be predatory or hiding illegal billings for seniors? I don’t think so.
Here’ a couple suggestions:
1. All of us seniors should review Medicare bills closely. Contact Medicare (http://
www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/report-fraud/
reporting-fraud.html) and the VT Attorney General’s office (http://www.atg.state.vt.us) about
errors, big, small and suspect.
2. Support thoughtful laws for medical whistleblowers, along with stiffer sentencing of fraudulent
hospitals, administrators and physicians. Not just fines, which big hospitals pay for with future increases in rates.
3. RACs should not be paid like bounty hunters, nor their recovery of Medicare theft be stalled
by appeals crawling through our overburdened courts. The RACs need to be reinvented.
4. Most importantly, Medicare must stop being a health care system hemorrhaging its financial
lifeblood. Back in 2009, the number of Americans 65 and over was 39.6 million, about 13 percent of
the U.S. population. In 2020, those of us 65+ will be 54.8 million. By 2030 the eye-popping number
will be 72.1 million, about twice what it was in 2009.
And all will be on Medicare. A system that can’t survive for any of us if it keeps bleeding.
To provide feedback, contact Joe Sherman at: [email protected]
Vermont state
law has
stronger antiretaliation
provisions,
which protect
whistleblowers
...
PAGE
8
Protect, Detect and Report incidences of Medicare Error, Fraud and Abuse
A few tips from the Office of Inspector
Tip General
of the Month
(OIG)
Community of Vermont Elders
Vermont SMP Director, Anita Hoy
P.O. Box 1276
Berlin, VT 05601
Phone: 802-229-4731
E-mail: [email protected]
Website: www.vermontelders.org
All seniors should review Medicare bills closely.
To report errors, big, small and suspect contact Medicare (http://
www.medicare.gov/forms-help-and-resources/report-fraud-andabuse/report-fraud/reporting-fraud.html) , the VT Attorney General’s
office (http://www.atg.state.vt.us) or Vermont SMP
([email protected])
Reviewing medical billing statements and reporting errors is the single,
most effective way to combat Medicare fraud.
We are Seeking Volunteers to assist with scheduling and leading presentations, help develop
website and social networking too. Come join the Vermont SMP team to help us connect with community organizations...There is always a need for volunteers in every area of Vermont. You design your
schedule and we’ll work with you to design a position to suit your interests and skills. Contact Anita at
802-229-4731 or by email: [email protected] right away.
Telemarketing Scam Stole Money From Older Consumers
How low can scammers go? As low as stealing from older consumers to line their own
pockets. According to The Federal Trade Commission (FTC), some scammers claimed to be
calling on behalf of the government to verify information for a new Medicare card or Medicare
-related package. In fact, it was a ruse to get people’s bank account information to make unauthorized withdrawals from their accounts.
The callers said they needed to verify people’s identities using information that included the
consumers’ bank account numbers. According to the FTC, the scammers told people that the information
would not be used to debit their bank accounts, and that there was no charge for their services. But the FTC
alleges that was a lie. Within a month or two, victims learned their bank accounts had been debited, often for
$400 or more.
At the FTC’s request, a federal court has temporarily halted this scheme that took millions of dollars from consumers without their consent. The FTC is seeking to permanently end the operation and return victim’s money.
If you or someone you know has been a victim of this, or any other, telemarketing scam, please contact Vermont SMP for help. You never know if you might get your money back!
Excerpt from the FTC Consumer Information Blog, October 2, 2014 by Colleen Tressler, Consumer Education Specialist