The
Nevada Senior Medicare Patrol (SMP) educates Nevadans on
how to detect and report healthcare fraud in Medicare
and Medicaid in order to protect these vital healthcare
programs for the future.
Every year the
Medicare system is drained of billions of dollars as a
result of fraud, waste, errors and abuse – almost $134
MILLION in Nevada in 2008 alone! The Nevada SMP is
funded and supported by the U.S. Administration on
Aging, and works closely with the Centers for Medicare &
Medicaid Services. There is a
SMP
in every state whose mission is to educate Medicare
beneficiaries and their caretakers to become critical
health care consumers enabling them to identify
suspicious situations or billings so that we can
increase the chance that the Medicare system is solvent
for future generations.
Examples of abuses can include, but are not limited
to:
• Billing for services different than those actually
provided
• Providing and billing for unnecessary procedures or
services
• Overcharging for services
• Billing for a service or procedure provided by an
assistant at a level that by regulation may only be
charged by a doctor
• Billing for a higher level of service than what was
actually provided (e.g. billing the level allowed for a
new patient when actually the beneficiary is an existing
patient)
Examples of fraud can include, but are not limited
to:
• Billing for services not received
• Billing non-covered services as covered services –
i.e., billing routine nail care as a foot surgery.
• Offers of “FREE” or medically unnecessary services and
then billing Medicare.
Medicare beneficiaries play a vital role in detecting
these instances of abuse and we rely on them to report
the errors to the Medicare system.
Here are some
ways to protect yourself and the system:
• Protect your Medicare number! In the wrong hands, it
is a license to steal. Unless you need it for a doctor’s
visit, leave your Medicare card at home, in a safe
place.
• Record your doctor’s visits in a Personal Healthcare
Journal, which is available from the Nevada SMP
• Carefully review your quarterly Medicare Summary
Notice and/or your Explanation of Benefits (from another
insurance company). Check the dates of service to make
sure there are no duplicate billings for services
received and verify that the billing is for a service
that you did receive.
• Don’t be influenced by advertising for services,
medications, or products. Educate yourself and make your
own decisions.
12 Tips to
Protect Yourself From Healthcare Fraud
We are responsible for helping citizens across our state
to identify issues to protect themselves and their loved
ones from being victimized. We do this in a number of
ways.
• We deliver presentations for interested parties to
educate them on the signs of fraud, waste and abuse.
• We also recruit senior professional volunteers from
the community to help. These dedicated seniors work at
healthcare fairs, one-on-one counseling sessions and by
networking with the State’s senior service provider
system to get our message into the community.
• We provide resources and referrals to other senior
support agencies and non-profits in the state.
• Finally, we maintain a statewide, TOLL-FREE hotline
(888-838-7305) so that Nevada beneficiaries have a local
resource to resolve and/or investigate these complicated
issues.
The Nevada SMP is here to help you! Please call us
if:
• You suspect fraud, errors, waste or abuse to
Medicare.
• You are a retired professional senior who would be
interested in volunteering.
• You are a member of senior group, law enforcement
agency or other interested community group that would
like a presentation.
Our statewide, toll-free number is 1-888-838-7305. We
can also be reached by email at
smpinfo@ag.nv.gov
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