Fighting Fraud and Making Medicare Stronger

Crosspost from The White House Blog

Fighting Medicare fraud has long been a top priority for President Obama. Today, we are releasing a new infographic that describes how the Affordable Care Act – the new health care law – is helping the Obama Administration crack down on Medicare fraud and make Medicare stronger. The new infographic shows how the law increases penalties for criminals who commit fraud and provides new enforcement tools to stop fraud and save taxpayers money. 

We are committed to using these new tools to fight Medicare and other health care fraud, and we are getting results:  The Administration’s anti-fraud efforts recovered $4.1 billion in taxpayer dollars last year, the second year recoveries hit this record-breaking level. Total recoveries over the last three years were $10.7 billion. Prosecutions are way up, too: the number of individuals charged with fraud increased from 797 in fiscal year 2008 to 1,430 in fiscal year 2011 – a more than 75 percent increase.

Just last week, the Department of Health and Human Services and the Department of Justice announced “a nationwide takedown by Medicare Fraud Strike Force operations in seven cities has resulted in charges against 107 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing.”  And on Monday, the Departments announced that, as a part of their Health Care Fraud Prevention and Enforcement Action Team initiative, they had resolved an investigation into a pharmaceutical company’s unlawful promotion of a prescription drug.  The Justice Department reported that, “the resolution – the second largest payment by a drug company – includes a criminal fine and forfeiture totaling $700 million and civil settlements with the federal government and the states totaling $800 million.” 

The infographic also shows how the Affordable Care Act is making Medicare stronger and providing new benefits. For example:

• 32.5 million people with Medicare received at least one free preventive service thanks to the health care law.
• People with Medicare who hit the prescription drug donut hole have already saved $3.4 billion on their prescription drugs.
• By 2021, the average person with Medicare will save nearly $4,200 thanks to the new health care law.

Click here to download a PDF of the graphic

You can learn more about these efforts and our work to implement the Affordable Care Act by visiting whitehouse.gov/healthreform.

Are your bones weak?

Do you know someone older who accidentally bumped their arm and ended up needing a sling? This type of injury could have been caused by osteoporosis. Ten million Americans have osteoporosis, and 34 million more have low bone mass. Osteoporosis means your bones have lost density or mass. As your bones become less dense, they become weaker.

People can’t feel their bones getting weaker. So, you may not know that you have osteoporosis until you break a bone. A person with osteoporosis can fracture a bone from a minor fall, or in serious cases, from a simple action such as a sneeze.

While people of all ages and backgrounds can develop osteoporosis, you’re at higher risk if you’re:

• White
• Older than 50
• Small in body size
• Eat a diet low in calcium
• Not physically active
• A post-menopausal woman

Medicare can help you prevent or detect osteoporosis at an early stage, when treatment works best. Talk to your doctor about getting a bone mass measurement–it may be free.

Also, take steps to keep your bones healthy. Get the calcium and vitamin D you need every day, and do regular weight-bearing and muscle-strengthening exercises.

May is National Osteoporosis Awareness and Prevention Month—learn more about what puts you at risk for osteoporosis and how to prevent or treat it at the National Osteoporosis Foundation or the Centers for Disease Control. Also, watch our short YouTube video about Medicare’s efforts to curb osteoporosis.

Check Your Blood Pressure Regularly

Most of us have a friend or relative who has had high blood pressure at some point in their life—it affects the health of approximately 68 million Americans. High blood pressure increases the risk for heart disease and stroke, 2 of the 3 leading causes of death.

You may even have high blood pressure, so it’s important to get your blood pressure checked routinely. Medicare can help—we cover blood pressure screening as part of your “Welcome to Medicare” visit and your Yearly Wellness Visit—at no cost to you.

There are lots of ways you can check your blood pressure regularly, to keep on top of any changes between wellness visits. Check your local newspaper’s events calendar for local senior centers or libraries offering free blood pressure screenings. Visit health fairs that come to your community, where nurses may be on duty to check your blood pressure. Some supermarkets and drug stores offer a free automated machine next to their pharmacies, so why not use it the next time you pick up your prescriptions? You’ll feel good knowing you’re paying attention to an important part of your health.

May is National High Blood Pressure Education Month—learn more about how you can lower your blood pressure. Also, watch our short YouTube video about Medicare’s efforts to curb hypertension.

Patient survey results help you choose a home health agency

By Marilyn Tavenner, Acting Administrator

The day is finally here – weeks after a fall that resulted in a broken hip, you’re ready to go home. You know you’re going to continue to need treatment and services at home, but where do you find a resource to help you through this next step on the road to recovery?

Now there’s an objective and meaningful way to compare other patients’ actual experiences with home health agencies and services—the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey – and we’ve just released the first set of survey results on our Home Health Compare page.

People with Medicare that are getting home health services fill out this short survey that asks about the care they got from the home health agency in the last 2 months, how they’d rate the care, and how strongly they’d recommend that agency.

The initial survey results cover the period from October 2010 to September 2011. Most people who got home health care from Medicare-certified home health agencies during that time said they got the care they needed. In fact:

• 84% of patients gave their home health agency a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).
• 80% of patients said “yes, they would definitely recommend the home health agency to friends.”
• 87% of patients said their home health team provided care in a professional way.
• 86% said their home health team communicated well with them.
• 83% said their home health team discussed medicines, pain, and home safety.

By making the results public, we help keep home health agencies openly accountable and continuously working to improve their quality of care.

Let Medicare make it easier for you on your road to recovery.  We can help you make an informed decision when choosing a home health agency that best meets your needs—visit our Home Health Compare for the latest patient survey results.

Let’s be clear: plain writing works

Speaking and writing about the Medicare program in plain language isn’t just good practice—it’s the law. The Plain Writing Act of 2010 requires us to make sure you’ll find our Web pages, booklets, letters and other materials clear and to the point.

You don’t have to look far to find examples of plain writing in our publications and on our Web site. Last July we released A Quick Look at Medicare, an easy-to-read 4-page brochure that sums up what Medicare does, what your choices are, and how you can contact us.

Also, we’ve recently redesigned the Medicare Summary Notice (MSN) to make it easier for you to find and understand your Medicare claims information.

The Affordable Care Act has also given us new opportunities to reach wider audiences with plain writing. For example, we wrote a plain language overview on the health care law for doctors and other health care providers that was mailed with the February edition of WebMD magazine to more than 175,000 doctor’s offices around the country.

We’ve made a lot of progress with plain writing during the past 15 months, but there’s still work to do. How do you think Medicare is doing using plain writing in our documents and Web pages? We need to know, so we can make our materials better. Give us feedback on our efforts and learn more about our ongoing commitment to plain writing by visiting the CMS Plain Language Web page.

Getting More Accurate Tobacco Information to Consumers

By: Margaret Hamburg, M.D. Crosspost from FDAVoice

Tobacco use is the leading preventable cause of disease and death in our country. And this Administration is committed to implementing strategies that will stop our nation’s youth from starting to use tobacco and also help adults to quit. Today we’re taking two critical steps forward that will help reduce harm from tobacco and tobacco products.

Americans will soon have more information on the chemicals found in certain tobacco products, reflecting FDA’s commitment to inform and protect the public. For the first time ever, tobacco companies will be required to report the quantity of harmful and potentially harmful constituents – HPHCs – that are in their products to the FDA.

The detailed information that we receive will help FDA determine how best to make science-based decisions to reduce the terrible toll of tobacco-related disease and death. We also hope that by having to disclose this information, industry will voluntarily start to make their products substantially less addictive and harmful.

We are also forging new territory as we seek to ensure that tobacco companies provide accurate information and will not be able to mislead American consumers, especially by making it sound like certain products are less risky than they are. The landmark Family Smoking Prevention and Tobacco Control Act signed by President Obama gives FDA the authority to ensure the claims for tobacco products marketed to reduce risk or exposure, such as “low tar” or “light,” are truthful and demonstrated by sound science.

So today we issued a draft guidance that provides direction for tobacco companies when they submit applications for modified risk tobacco products – MRTPs – tobacco products that are sold, distributed, or marketed to the public for use to reduce harm or the risk of tobacco-related disease.

We want to make sure consumers and the public have an accurate understanding of the health risks of tobacco products—so mistaken beliefs don’t cause them to start or continue using products that lead to preventable disease and death.

We are doing everything that we can to protect all Americans – especially our youth – from the dangers of tobacco, and we’re hopeful these two additional steps will accelerate our goal to make tobacco-related disease and death part of America’s past – not its future.

Margaret Hamburg, M.D., is Commissioner of the U.S. Food and Drug Administration

Cutting the clutter – the newly designed Medicare Summary Notice

It’s a whole lot easier to read and understand your Medicare Summary Notice (MSN), thanks to a recently completed redesign. You’ll see a brand new format when you check your MSN at MyMedicare.gov.

MyMedicare.gov gives you faster access to your Medicare claims information—you can check it 24 hours a day, 7 days a week, 365 days a year. Customize your MSN to see procedures broken down by single claim, or by a time period you choose, and print out your own statement anytime. Reviewing your MSN online means a shorter wait to see what you were charged for health care services, medical supplies or equipment, and how much Medicare paid.

We want the MSN to be something that makes it easier for you to find and understand your Medicare claims information.  We spent more than a year improving it. We did one-one-one interviews and focus groups with people like you, and used their feedback to improve the design and language.

As a recent joint Kaiser Health News / Washington Post article pointed out, we’ve also redesigned the MSN to make it easier for you to help us prevent fraud and find billing errors. Did you know you could get a reward of up to $1,000 for a tip that leads to uncovering fraud? Remember, you’re our best defense against fraud, so check your MSN for services or items you didn’t get.

Here are some of the improvements you’ll see in your new MSN:

•          Larger text size and wider spacing to make reading easier
•          Plain, concise language you can understand quickly
•          A “snapshot” of
  •    how much of your Part A or Part B deductible you’ve paid so far this year
  •    the providers you saw during the reporting period
  •    whether Medicare approved all your claims
•          Brief descriptions of your medical procedures
•          Easy-to-understand definitions for terms you might not know
•          A checklist to help you make sure you’re getting the most from your Medicare
•          Information on how to report fraud, preventive medical services, and important Medicare reminders
•          Easy instructions for how to file an appeal

You’ll start seeing these changes in early 2013 in the mailed copy of your MSN, but why wait? Visit MyMedicare.gov and start using the newly redesigned MSN online today.

Could you be saving money?

Many people could be saving money on premiums and prescriptions, and don’t even know it. Recently, a 90-year-old woman in Oklahoma came to her local State Health Insurance Counseling and Assistance Program (SHIP) because she was unable to pay for her prescriptions and her Medicare Part D premium.

A counselor at the SHIP helped her apply for Extra Help and found her a new Part D plan that better fit her needs. Now she spends no money on her premium and very little on her prescriptions – saving her thousands of dollars over the course of the year. She is just one of many people that can save money – and you could be one too.

Medicare Savings Programs

If your monthly income is less than $1,277 ($1,723 as a couple), you may be able to save money with these 4 different Medicare Savings Programs that help pay for premiums and more:

• Qualified Medicare Beneficiary (QMB) Program
• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualified Individual (QI) Program
• Qualified Disabled and Working Individuals (QDWI)

Each program has a different monthly income limit – get more information about the 2012 limits and how to find out if you qualify.

Extra Help

Many people with limited income and resources may qualify for Medicare’s “Extra Help” program, but they must apply to find out. You could be one of them. You may qualify if you have up to $16,755 in yearly income ($22,695 for a married couple) and up to $13,070 in resources ($26,120 for a married couple). Get more information about Medicare’s “Extra Help” program.

You can get help with Part D prescription drug coverage premiums, deductibles and copayments. This means you don’t have to go without medications because you can’t afford them, and can get help just like our 90-year-old friend in Oklahoma.

It’s easy and free to apply for “Extra Help.”

Save money, live well, and share the information.

Join the fight against Medicare fraud

Medicare fraud affects everyone. You can team up with Medicare to help.

Our Senior Medicare Patrol volunteers are teaching people like you how to spot, report, and stop fraud, and protect themselves from identity theft.

Here are some things you can do:

• Guard your Medicare and Social Security numbers. Treat them like you would treat your credit cards.
• Hang up the phone if someone calls and asks for your Medicare number, Social Security number, or bank or credit card information. We will NEVER call and ask for this information, and we will NEVER call you or come to your home uninvited to sell Medicare products.
• Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. It’s illegal, and it’s not worth it!
• Do not let anyone borrow or pay you to use your Medicare ID card or your identity.
• Check your Medicare claims for errors. Look at your Medicare Summary Notice (MSN) or statements from your Medicare plan. You can also check www.MyMedicare.gov or call 1-800-MEDICARE (1-800-633-4227) as soon as your claims have been processed. The sooner you see and report errors, the sooner we can stop fraud. TTY users should call 1-877-486-2048.
• Call 1-800-MEDICARE to report any suspected fraud.

Learn more about spotting and reporting fraud, and get tips on protecting yourself from identity theft.

Find out about Senior Medicare Patrol activities in your area.

Making Medicare claims and benefits statement clearer, simpler

As part of National Consumer Protection Week, the Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), Marilyn Tavenner, announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits.  The redesigned statement, known as the Medicare Summary Notice (MSN), will be available online and, starting in 2013, mailed out quarterly to beneficiaries.

This MSN redesign is part of a new initiative, “Your Medicare Information: Clearer, Simpler, At Your Fingertips,” which aims to make Medicare information clearer, more accessible, and easier for beneficiaries and their caregivers to understand.  CMS will take additional actions this year to make information about benefits, providers, and claims more accessible and easier to understand for seniors and people with disabilities who have Medicare.  This MSN redesign reflects more than 18 months of research and feedback from beneficiaries to provide enhanced customer service and respond to suggestions and input.

“Consumer protection starts with making sure consumers not only get timely and accurate information, but that they understand what services they’re receiving from Medicare,” said Acting Administrator Tavenner.  “The new Medicare Summary Notice empowers Medicare’s seniors and people with disabilities.  The statement is easier to understand and navigate, and makes clear what information to check and how to report potential fraud.  The new MSN also makes it easier for people with Medicare to understand their benefits and file appeals if a claim is denied.”

To see a side-by-side comparison of the former and redesigned MSNs, please visit: http://www.cms.gov/apps/files/msn_changes.pdf 

The redesign of the MSN includes several features not currently available to Medicare beneficiaries with the current MSN:

• A clear notice on how to check the form for important facts and potential fraud;
• An easy-to-understand snapshot of the beneficiary’s deductible status, a list of providers they saw, and whether their claims for Medicare services were approved.
• Clearer language, including consumer-friendly descriptions for medical procedures;
• Definitions of all terms used in the form;
• Larger fonts throughout to make it easier to read;
• Information on preventive services available to Medicare beneficiaries.

Starting later this week, the redesigned MSN will be available to beneficiaries on mymedicare.gov, Medicare’s secure online service for personalized information regarding Medicare benefits and services; and, in early 2013, paper copies of the redesigned MSN will start to replace the current version being mailed.