Medicare Corner
Medicare home health care fraud
Who to contact for more information: • First, speak with your doctor or a hospital discharge planner if you need home health. • Contact your State Health Insurance Assistance Program (SHIP) to learn more about Medicare coverage and costs for home health. SHIP counselors provide unbiased Medicare counseling. • Contact your Senior Medicare Patrol (SMP) if you may have experienced Medicare fraud, errors, or abuse. •Contact 1-800-MEDICARE (1-800- 633-4227) or go to medicare.gov for a list of Medicare-approved home health agencies. Contact your Medicare Advantage Plan for a list of home health agencies in your plan’s network.
If you have Original Medicare, you should receive a Medicare Summary Notice (MSN). If you have a Medicare Advantage Plan, you should receive an Explanation of Benefits (EOB). To prevent and detect home health fraud, you should read these Medicare notices thoroughly when you receive them. You should report any suspicious charges. You should also protect your Medicare number and only share it with health care providers and other trusted individuals. Here are some examples of potential home health fraud or abuse to watch for: You see charges on your MSN or EOB for services that you did not receive, that were not prescribed by your doctor, or when you do not meet Medicare’s homebound criteria.
You are enrolled in home health services by a doctor you do not know. A home health agency offers you “free” groceries or “free” transportation in exchange for personal information or to switch to a different home health agency. You are charged a copayment for home health services. You are asked to sign forms saying that you received home health services that you did not receive. If you think you may have experienced potential Medicare fraud, errors, or abuse, you should contact your local Senior Medicare Patrol (SMP).
Pima Council on Aging is your local SHIP/SMP. For more information call us at (520) 546-2011 or email us at Medicare@pcoa.org
Medicare and Home Health Care: What home health care does Medicare cover?
Medical social services: If you qualify for home health care, Medicare pays for services ordered by your doctor to help you with social and emotional concerned related to your illness. This may include counseling or help finding resources in your community. Medical supplies: Medicare pays in full for certain medical supplies, such as wound care, dressings, and catheters, when
Home health care includes health and social services that you receive in your home to treat an illness or injury. Medicare covers the following home health care: Skilled nursing services: Services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness. For example, a nurse may come to your home to administer medication through an IV or injection. Skilled therapy services: Physical, speech, and occupational therapy services that
are reasonable and necessary for treating your illness or injury. They must be performed by or under the supervision of a licensed therapist. Home health aide: Medicare pays for an aide if you require skilled nursing or therapy services. A home health aide provides personal care services, including help with bathing, toileting, and dressing. Medicare will not pay for an aide if you only require personal care and do not need skilled nursing or therapy services in the first place.
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April 2023, Never Too Late | Page 7
Pima Council on Aging
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