July 9, 2015

}  Complex Cases

-monthly case summary

-case and article sharing

}  Media & PR

}  SMP Business

}  SMP Fall Conference

}  Open Mic

2

Part A billing 33%

Part B billing

7% Suspicious e-mail/Ad/flyer

20%

Agent Misconduct

20%

DME related 20%

15 cases logged Cases from HICAPs (% from HICAPs): 46% - 2 Evelyn Taylor, Santa Cruz SMP liaison - 2 Claire Pisching, Fresno SMP liaison -1 Doug Shaw, San Bernardino HICAP -1 Claudia Valencia, Monterey HICAP -1 Linda Walton and Tyree, OC HICAP

Disposition of Cases: 5/15 cases referred to ACL/OIG 5/15 cases referred to Dept. Managed Health Care 4/15 cases under review by SMP 1/15 cases resolved and closed by SMP

June Complex Cases

Part  A  billing 5Part  B  billing 1Suspicious  e-­‐mail/Ad/flyer 3Agent  Misconduct 3DME  related 3

4

Case & Article Sharing:

Claire Pisching, Fresno/Madera SMP liaison: -the suspension of an agent -Walgreens the first Tuesday of every month (Senior DAY).

Evelyn Taylor, Santa Cruz SMP liaison: -June cases

Follow these 4 easy steps:

STEP 1: Who? What? When? Where? Why? How? Most likely, the beneficiary will not have all of the answers to our questions, so follow-up calls are necessary. The collection of detailed information and documentation is crucial for laying out the foundation for the work ahead of us. Review SMP Fraud Worksheet or Marketing Fraud Worksheet STEP 2: Review the issue and all documentation related to it. STEP 3: Contact the provider (if it’s okay with the beneficiary) and 1-800 Medicare to get more information about date of service in question. If you receive cooperation from the provider, see if you can solve without having to make a referral. STEP 4: If you feel this issue is potential Medicare fraud, waste, or abuse, refer this issue to your Senior Medicare Patrol office in Orange County. You can mail or fax report with all its supporting documents to

Mail to: Fax to: Senior Medicare Patrol 714-560-0319 1971 East 4th Street, Suite 200 Santa Ana, CA 92705

E-mail: T: 714-550-7008 smorales@cahealthadvocates.org

Home office: 951-282-3960

Note: change in

e-mail

Steps: Handling Complex Cases

6 6

Publications & Media Update

}  July Medicare Minutes ◦  Hospital Transitions

◦  Access MMs on the SMP Resource website

}  Recent Articles & Blogs ◦  What Happens When a Beneficiary is Marked as Dead but is

Still Very Much Alive? ~ Importance of Advocacy ◦  Medicare Celebrates Its 50th!

◦  Long-Term Care and the Graying of America ◦  Are You New to Medicare? Review Your Medicare

Enrollment Periods

◦  OIG Reports Show Part D is Vulnerable to Fraud & Provides Tips for Improvement

7 7

Publications & Media Update

}  Our Facebook page… ◦  Wants your “Likes” J

◦  Wants your pics, stories, magical moments!

◦  https://www.facebook.com/california.smp

8 8

Publications & Media Update

}  Recent webinar ◦  Balance Billing & Concierge Medicine – Featuring

Elaine & Micki from CHA/SMP, and Georgia Burke, Directing Attorney with Justice in Aging J

}  June 2015, AARP Bulletin article, see our Recent Press page. Kudos to Micki for this national coverage!

}  Costco Magazine: Take Care with Medicare

}  Volunteer & Outreach Coordinator Call ◦  July 16, 2015 (9:30am)

}  SMP Liaison Linked Up Webinars ◦  August 13, 2015 (10am)

}  4th Thursday Educational Webinars (10am – 11:30am) ◦  July 23, 2015 – DME Fraud (Office of Inspector

General) ◦  August 27, 2015 – Marketing Misconduct (Julie Lowrie) ◦  September 24, 2015 – Medicare Update 2016

}  SMP Conference dates:

Tuesday, September 15 11:30am to 5:00pm Lunch and afternoon snack will be served Wednesday ,September 16 8:00am to 2:30pm Breakfast and lunch will be served *SMP will ONLY reimburse hotel stay for Tuesday night

}  SMP Conference Day 1: -will feature Bureau of Medi-Cal Fraud and Abuse

}  SMP Conference Day 2:

-Roundtable, cases, liaison presentations

10

Red Lion Hotel 500 Leisure Lane Sacramento, CA 95815 (916) 922-2020

}  Hotel group name: CHA Membership/SMP Fall Conference

}  Room rate is $95/night for single and $105.00 for double

}  Reservations call: 916-922-2020 (directly to hotel) or 1-800-733-5466

}  Online reservation is not active yet. Suggest you phone in your reservation.

}  Last day to make reservation under room block is September 1 by 5 p.m.

}  If you need to cancel be sure to cancel at least 48 hours before the conference

11

12

Open Mic