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1. Share of Cost, SMP Reports Recent Fraud Case Successes As Medicare fraud is a hot topic in California, our Senior Medicare Patrol (SMP) is continually receiving and resolving complex cases. Below is a quick glimpse of a few recent cases our SMP team has successfully resolved. If you or someone you know has a question about fraud or would like to report fraud, contact […]...
2. Share of Cost, Phone Scams on the Rise Share of Cost, Phone Scams on the Rise...
3. Share of Cost: Spanish Medicare Fraud; Prevention PSA is on Youtube The National Hispanic Senior Medicare Patrol (NHSMP) has launched a new outreach and communications campaign, which includes a Spanish language public service announcement (PSA).  The PSA is currently being aired in South Florida through mid-September. The PSA, titled El Fraude al Medicare es un Delito. Denúncielo. (Medicare Fraud is a Crime. Report It.), is part of the NHSMP’s Spanish language […]...
4. Share of Cost, Phone Scam Titles Change But the Tactics Remain the Same We continue to receive reports of new phone scams. Yet while the “title” of the scam may change, the fundamental tactics are the same. Below is a warning of two recent scams reported to us this month, followed by a list of common tactics. This list provides a helpful reminder of what to watch out […]...
5. Share of Cost, CMS Offers New Safeguards and Incentives in Preventing Medicare Fraud Share of Cost, CMS Offers New Safeguards and Incentives in Preventing Medicare Fraud...
6. OIG Features Fraud Alerts via Podcasts, Learn About Diabetes Phone Scams OIG Features Fraud Alerts via Podcasts, Learn About Diabetes Phone Scams...
7. Long Term Care Share of Cost Providers receiving an eligibility verification message (see following example) that indicates a subscriber has an LTC SOC should not  clear the SOC online.  Subscribers with aid codes 13, 23, 53 and 63 must have their LTC SOC cleared on the claim.  The LTC facility  includes the LTC SOC amount for Medi-Cal-covered services on the  Payment […]...
8. Share of Cost, 82 Year Old Beneficiary Catches Medicare Fraud on Video Share of Cost, 82 Year Old Beneficiary Catches Medicare Fraud on Video...
9. Share of Cost, Highest Recovery Results Yet in Medicare Fraud Prevention Efforts for 2012 Share of Cost, Highest Recovery Results Yet in Medicare Fraud Prevention Efforts for 2012...
10. Share of Cost Clearance Transaction To clear a subscriber’s SOC, the provider accesses the Medi-Cal eligibility verification system, enters a provider number, Provider Identification Number (PIN), subscriber identification number, BIC issue date, billing code and service charge.  The SOC information is updated and a response is displayed on the screen or relayed over the telephone. Several clearance transactions may be […]...
11. Share of Cost: Consumers Beware of Medicare Advantage Marketing Fraud Last week Julie Schoen, our California Senior Medicare Patrol (SMP) Project Director, spoke on Medicare fraud on a statewide press teleconference hosted by California’s Department of Managed Health Care (DMHC). Both agencies, DMHC and SMP, are committed to protecting beneficiairies from the sometimes malicious and fraudulent practices of a few insurance agents. While most agents […]...
12. Help Stop Telemarketing Scams on Medical Alert Services Help Stop Telemarketing Scams on Medical Alert Services...
13. Certifying Share of Cost Benefits and Coverage Subscribers are not eligible to receive Medi-Cal benefits until their monthly Share of Cost dollar amount has been certified online. Certifying SOC means that the Medi-Cal eligibility verification system shows the subscriber has paid or become obligated for the entire monthly dollar SOC amount owed. Claims submitted for services rendered to a subscriber whose SOC […]...
14. Share of Cost, Scammers Capitalize on Supreme Court’s Ruling to Uphold the Affordable Care Act Share of Cost, Scammers Capitalize on Supreme Court’s Ruling to Uphold the Affordable Care Act...
15. Share of Cost Case Summary Your Medi-Cal case has been affected by a lawsuit called Sneede v. Kizer.  This lawsuit limits which family members may use medical expenses that are not billed to Medi-Cal to meet their family’s Share of Cost. If you are a spouse or a parent, you have the choice of listing your medical expenses in any […]...