CMS Medicare Drug Coverage Fraud Alerts

These proactive preventative steps seemed to herald a new approach to fraud and abuse detection. This new approach allowed the expansion of the core efforts of government agencies to other partnering groups and organizations to detect, report, investigate, and refer findings. This provides for increased monitoring from diverse fronts and increases scrutiny of the health care provider industry as a whole. From a home care and hospice prospective, it is important that we understand what prescription drug plans are allowed and not allowed to market and promote to the Medicare beneficiary. It is also important that we know the parameters of any allowable telemarketing from companies offering prescription drug plans and that we be able to assist our patients in adding their telephone numbers to the Do Not Call lists. In regard to privacy and inappropriate use of personal information, there are several telephone numbers to have available for use. They are: • Medicare Beneficiaries Contact - (800) MEDICARE or (800) 633-4227 • The Federal Trade Commission's ID Theft Hotline - (866) 653-4261 These numbers can prove useful for other concerns, not just those relating to the Medicare prescription drug benefit. It is also important that home care and hospice providers acquire an understanding of how the more basic Medicare Part D plans are structured and be able to at a minimum assist Medicare beneficiaries in contacting plans. In regard to hospice care provision and reimbursement, it is also important to realize that this new prescription drug plan is separate from and does not affect those medications included as part of the hospice patient's hospice election drug benefit. And as always, providers should understand and learn from the directions taken by CMS pertaining to one program area in that successful activities and efforts are then often replicated in other arenas. © 2006 Sage Publications.