New Medicare Statements in the Mail to Help Seniors
Redesigned health care summaries designed to help
seniors identify improper payments; mailed quarterly
June 10, 2013 – Medicare says senior citizens and
other beneficiaries of the program will soon be receiving a redesigned
statement of their claims for service and benefits. The new look is
aimed at helping them spot “potential fraud, waste and abuse.”
The notice posted online by the Centers for
Medicare and Medicaid Services says the “newly redesigned Medicare
Summary Notices are just one more way the Obama Administration is making
the elimination of fraud, waste and abuse in health care a top priority.
Because of actions like these and new tools under the Affordable Care
Act, the number of suspect providers and suppliers thrown out of the
Medicare program has more than doubled in 35 states.”
Notice gives seniors and people with disabilities accurate
information on the services they receive in a simpler, clearer way,” CMS
Administrator Marilyn Tavenner is quoted as saying. “
CMS says, “It’s an important tool for staying
informed on benefits, and for spotting potential Medicare fraud by
making the claims history easier to review.
“The redesigned notice will make it easier for
people with Medicare to understand their benefits, file an appeal if a
claim is denied, and spot claims for services they never received.”
CMS plans to send the notices to Medicare
beneficiaries on a quarterly basis.
“A beneficiary’s best defense against fraud is to
check their Medicare Summary Notices for accuracy and to diligently
protect their health information for privacy,” said Peter Budetti, CMS
deputy administrator for program integrity. “Most Medicare providers are
honest and work hard to provide services to beneficiaries.
Unfortunately, there are some people trying to exploit the Medicare
The agency statement says, “Medicare beneficiaries
and caregivers are critical partners in the fight against fraud. In
April of this year, CMS
proposed rule that would increase rewards— up to $9.9 million
– paid to Medicare beneficiaries and others whose tips about suspected
fraud lead to the successful recovery of funds.”
CMS’ Update on Anti-Fraud Efforts:
The Affordable Care Act has enabled CMS to expand
efforts to prevent and fight fraud, waste and abuse.
● Over the last four years, the Obama
administration has recovered over $14.9 billion in healthcare fraud
judgments, settlements, and administrative impositions, including record
recoveries in 2011 and 2012.
● Since the Affordable Care Act, CMS has revoked
14,663 providers and suppliers’ ability to bill in the Medicare program
since March 2011 (Chart 1). These providers were removed from the
program because they had felony convictions, were not operational at the
address CMS had on file, or were not in compliance with CMS rules.
● In 18 states, the number of revocations has
quadrupled since CMS put the Affordable Care Act screening and review
requirements in place, as well as the implementation of proactive data
analysis to identify potential license discrepancies of enrolled
individuals and entities. These efforts are ensuring that only qualified
and legitimate providers and suppliers can provide health care products
and services to Medicare beneficiaries (Chart 2).
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