Nebraska SMP Empowering Seniors to Prevent Healthcare Fraud
Nebraska Long Term Care Ombudsman Program
Nebraska Health & Human Services System – State Unit on Aging
P.O. Box 95044
Lincoln, Nebraska 68509-5044
http://www.dhss.ne.gov/smp
Who?
The Nebraska SMP (formerly the Senior Medicare Patrol Project) is composed of professional staff and volunteers. The SMP is a program of the Nebraska Long Term Care Ombudsman Program, part of the Nebraska Health and Human Service System - State Unit on Aging.
What?
The goal of the Nebraska SMP is, through education and advocacy, to increase public awareness of Medicare and Medicaid fraud, error and waste and the associated financial and human costs; to assist individuals in identifying and reporting possible concerns; and to help prevent fraud by teaching consumers how to protect themselves from healthcare-related scams.
How much?
Estimates of annual losses due to healthcare fraud range from 5 to 10 percent of all healthcare expenses, which adds up to $80 and $160 billion dollars per year. The U.S. Government Accountability Office (GAO) estimates that $1 out of every $10 spent on public insurance programs is lost to fraud. In addition to the impact on public and private insurance programs, the most recent figure produced by the Federal Trade Commission (FTC) estimates that consumers themselves lose more than $10 billion to healthcare fraud, each year.
Beyond economic injuries, healthcare fraud poses serious threats to personal health. When fraud includes touting unapproved products on the internet as “cures” for cancer and providing consumers with unnecessary or improper medical equipment or treatment, healthcare fraud is personal and affects us all.
What Can I Do?
Although the majority of healthcare providers are honest, fraud can and does occur, even in Nebraska. If you have questions about the accuracy of your healthcare charges, contact your provider (e.g. physician, hospital, medical equipment vendor). If you are not satisfied with the response you receive or suspect healthcare fraud, contact the Nebraska SMP.
Examples of Possible Health Care Fraud
- Altering claims to receive a higher payment amount.
- Billing twice for the same service or item.
- Billing for medically unnecessary services or items.
- Billing for services or items not provided.
- Misrepresenting the diagnosis to justify payment.
- Continuing to bill for services no longer medically necessary.
- Billing for rental equipment after date of return.
- Ordering unnecessary lab tests.
- Using another person’s Medicare card to obtain medical care.
- Billing group services as individual services for each patient.
ProtectingYourself From Fraud and Waste
- Protect your Medicare or Medicaid card as you would your credit cards.
- Never allow anyone to convince you to contact your physician requesting a service that you do not need.
- Be cautious of “free” offers that require your Medicare or Medicaid number.
- Never accept medical supplies or equipment from a door-to-door salesman.
- Never allow anyone to review your medical records or your prescriptions without your doctor’s approval.
- Never accept an offer of free medical equipment. Remember only your doctor can order medical equipment for you.
- Always review your Medicare Summary Notice to insure that it properly reflects the services that you received.
- Always keep a record of your health care appointments and the services you received and compare them to your Medicare Summary Notice.
- Ask questions or report anything you feel is suspicious.
- Never sign a blank form.
- Always get a receipt for rented medical equipment that you return.
To discuss a complaint of possible Medicare or Medicaid fraud or to schedule an educational presentation, contact:
Nebraska SMP 800-942-7830
Funded in part by an Administration on Aging grant
