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Important Medicare Information

September 15, 2019 11:00 AM | Anonymous member (Administrator)

NRLN President's Forum

Important Medicare Information

Seniors with traditional Medicare plans may have access to better quality home healthcare than Medicare Advantage plan participants, according to a study by researchers at Brown University in Providence, Rhode Island.

"Traditional Medicare beneficiaries are able to select and receive care from any Medicare-certified home health agency," Margot Schwartz, one of the researchers, reported to Reuters Health by email. "The limited networks in Medicare Advantage may result in these beneficiaries receiving care from lower-quality home health agencies."

Some higher-quality home health agencies may also opt not to participate in Medicare Advantage plans because of low reimbursement rates, said Momotazur Rahman, also at Brown University and the study's senior author.

"Payment rates by Medicare Advantage plans to home health agencies are much lower compared to traditional Medicare payment rates," Rahman said by email. "This may drive highly-rated home health agencies away from the Medicare Advantage patients."

Fraud Alert: Genetic Testing Scam

The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing.

Genetic testing fraud occurs when Medicare is billed for a test or screening that was not medically necessary and/or was not ordered by a Medicare beneficiary's treating physician.

Scammers are offering Medicare beneficiaries "free" screenings or cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes. Fraudsters are targeting beneficiaries through telemarketing calls, booths at public events, health fairs, and door-to-door visits.

Beneficiaries who agree to genetic testing or verify personal or Medicare information may receive a cheek swab, an in-person screening or a testing kit in the mail, even if it is not ordered by a physician or medically necessary.

If Medicare denies the claim, the beneficiary could be responsible for the entire cost of the test, which could be thousands of dollars.

Protect Yourself

If a genetic testing kit is mailed to you, don't accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender's name and the date you returned the items.

Be suspicious of anyone who offers you "free" genetic testing and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.

A physician that you know and trust should assess your condition and approve any requests for genetic testing.

Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician's office requests your Medicare information, do not provide it.

If you suspect Medicare fraud, contact the HHS OIG Hotline

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