By Betty Berry, Tuesday, May 24, 2011
Q: In the past, I’ve heard about Medicare fraud and how important it is for everyone to fight it. I’m sure fraud occurs in all areas of care, but I am concerned with services provided by in-home care agencies. What red flags would you suggest we look for?
A: You are correct. Fraud occurs in all areas of our health care system. Although most home health agencies are honest, there are a few who commit fraud.
To know if billing for services is correct, you need to be aware of two things. First, you need to understand exactly what services your doctor has prescribed for your care. You will also need to educate yourself as to what Medicare does and does not cover.
If there is something in your care plan that you don’t understand, ask questions. Continue to ask until you are satisfied that you understand what services you are to receive and what to expect from those services.
Don’t hesitate to question the in-home care agency about visits by the staff that you feel are excessive or unneeded. Always check your Medicare summary notice carefully. Make sure the dates of service match the dates you were visited and that the description of the care provided is correct.
Always question payments made for services or equipment that you never received. Never give in to pressure to accept services or equipment that you know are not prescribed as part of your care plan.
The doctor approving your home health service should be involved in your care, and if changes to your care are suggested, your doctor should be involved in determining those changes.
Be suspicious of any agency that offers you free services or equipment in exchange for your Medicare number. Treat your Medicare and Medi-Cal numbers like they were cash or credit cards and never give your number to anyone who doesn’t have official need for it.
If you suspect fraud, you should call Medicare at the customer service telephone number on the front of your Medicare summary notice. Each call will be taken seriously.
Q: I have a friend who has several chronic health problems and at times is not coping with them very well. I think she could use some encouragement. Do you know if there is some type of activity or class that would be beneficial to her overall attitude about living with these conditions?
A: Your friend is very lucky to have a friend like you who is concerned about her well-being.
To answer your question — the answer is yes. Next month, there is a new program being offered in the east county.
The program “Healthier Living: Managing Ongoing Health Conditions” offers participants effective and practical coping strategies to manage their health conditions. It is a six-week program and is scheduled for Tuesday mornings from 9 to 11:30 a.m. starting on June 14 and concluding on July 19. It will be held at the Goebel Senior Adult Center, 1385 E. Janss Road in Thousand Oaks. It is open to seniors age 60 and up with ongoing health conditions, and it is free.
The program consists of six 2 -hour workshops that will be facilitated by trained leaders. The curriculum includes behavior modification and coping strategies to enable participants to better cope with their chronic diseases, manage their medications and increase physical activity levels.
Registration is required for this series and can be made by calling 658-0365.
Healthier Living is co-sponsored by SCAN Senior Resource Center, Goebel Senior Adult Center and Senior Concerns.
June 5, 7 a.m.: Senior Concerns Love Run. 5K, 10K and 1K run/walk, 2815 Townsgate Road, Westlake Village. For information, call Susan at 497-0189 or email firstname.lastname@example.org.
June 8, 1:30-3 p.m.: Seminar, “Self Assess Your Driving Ability,” Westlake Civic Center, 31200 E. Oak Crest Drive, Westlake Village. To be facilitated by the Senior Concerns advocate. No reservations required. For information, call 495-6250.
Betty Berry is a senior advocate for Senior Concerns. The advocates are at the Goebel Senior Adult Center, 1385 E. Janss Road, Thousand Oaks, CA 91362; phone 495-6250 or email email@example.com (please include your phone number). You are invited to submit questions on senior issues.