By: Sara Duris
Q. I got a call from a local number and the caller stated that my doctor’s office had asked them to call me about receiving a knee brace that would be paid for by Medicare. I haven’t seen my doctor for a year so I was sure it was a scam, but it is alarming they knew I have had knee problems.
A. Unfortunately, caller ID spoofing is a common practice nowadays, allowing scammers to use software to hijack phone numbers so that it appears a caller is local. Often the best practice is to let such calls go to voicemail and screen your messages to see which calls are legitimate to receive a return call.
Also on the rise are the durable medical equipment scams in which phone calls, letters, postcards and TV ads promote items, such as back and knee braces, as being “free to Medicare recipients.” These scams are usually aimed at getting your personal information, including your Medicare number, or designed to defraud the Medicare system by billing for products that you don’t really need. It is important to remember that these items are not free and usually of poor quality.
If you suspect potential medical identity theft, or Medicare fraud due to unusual or questionable charges on any bills or your explanation of benefits statement, report this to 1-800-MEDICARE or the fraud tip hotline at 1-800-447-8477 (1-800-HHS-TIPS.) Learn more about these issues at www.medicare.gov/fraud.
Q. It seems as though insurance companies won’t authorize hospital stays or rehab stays for very long anymore. Is there any recourse for patients?
A. Yes, the Centers for Medicare and Medicaid Services (CMS) have a quality improvement organization known as KEPRO that is there for Medicare beneficiaries to assist with complaints, patient advocacy, appeals, and care coordination.
Anyone on original Medicare or a Medicare Advantage plan can access these free services: Immediate Advocacy if you have an immediate concern; Discharge Appeal if you are not ready to leave your healthcare setting; and Filing a Complaint if you have concerns about the quality of care received. Additionally, those on Original Medicare can ask for Patient Navigation services which can help you coordinate your care, understand your diagnosis and your treatment plan, as well as offer tips on managing your medications.
In the case of filing a Discharge Appeal, KEPRO staff members will look at the medical record to see if the Medicare beneficiary should stay in the hospital. The beneficiary will be informed of the decision. While the appeal is taking place, the beneficiary does not have to leave the hospital and does not have to pay for the extra days in the hospital while KEPRO staff members review the medical record. Additionally, a Medicare beneficiary has the right to appeal a discharge if he or she does not agree with a decision that skilled services, such as in-home care, will be stopped. The beneficiary must be given a letter from the provider with the planned discharge date explaining how to appeal. A KEPRO physician will look at the medical record to see if the services should continue and the beneficiary will be informed of the decision.
In Michigan, to reach KEPRO about any of the above services, call 855-408-8557, or visit www.KEPROqio.com for more information.