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Seniors at the Freda Mohr Center welcomed a special guest last Thursday when U.S. Health and Human Services Secretary Kathleen Sebelius met with them to discuss healthcare and ways seniors can protect themselves against fraud.
Sebelius was joined by Los Angeles County Supervisor Zev Yaroslavsky, 3rd District, and Paul S. Castro, CEO of Jewish Family Service of Los Angeles, which operates the Freda Mohr Center. She assured the approximately 30 seniors at the forum that they would continue to receive Medicare benefits under the new federal Affordable Healthcare Act, and said there are new programs the federal government is working on to reduce fraud. The new federal healthcare act calls for an additional $350 million to be used over the next 10 years to combat fraud. The act will also toughen sentences for people convicted of committing healthcare fraud, and provides greater oversight of insurance abuse.
“I understand your needs, because I have an 89-year-old father who is a recipient of Medicare,” Sebelius said. “The Affordable Healthcare Act guarantees all of the traditional benefits of Medicare, but is also a bill that closes the so-called donut hole. This year, seniors will receive a $250 check, and next year, they will receive a 50 percent benefit for prescription drugs.”
The donut hole refers to the amount seniors must pay out of pocket when their prescription drug costs are higher than their Medicare allowance. Sebelius said access to prescription drugs is extremely important for seniors and others on fixed incomes, which is why officials included the provision that seniors be partially reimbursed if they must spend their own money on medicines.
“We want to ensure people are taken care of, and will be working to find other ways to close the gap with prescriptions,” Sebelius said. “We think it will be very beneficial.”
Sebelius also touted provisions in the healthcare act that pay for a yearly wellness screening for seniors. She said many seniors forego visiting the doctor if they believe they are not covered by insurance, and become more susceptible to a variety of ailments. Sebelius said the wellness screenings will be particularly beneficial to women, who will have increased access to mammograms.
“There won’t be any co-pays with the preventative screenings. We see it as a way to ensure people seek out preventative care and get things checked out,” Sebelius added. “Helping folks before they show up with a disease just makes sense.”
In terms of fraud, the Health and Human Services Secretary said programs will be implemented to reduce the billions of dollars that is lost each year to theft. She said some of the schemes are very sophisticated, and officials with her office would be working closely with United States Attorney General’s Office and state attorneys general to crack down on Medicare fraud.
“We are going to do a better job of screening providers before they get into the system. If we suspect illegal activity, we will make sure it is checked out. We have a strike force in L.A. because this is one of the areas with a lot of fraud. In the last ten months, we have charged 465 [L.A.] defendants for defrauding Medicare for just under a billion dollars.”
Sebelius said seniors offer one of the best resources for preventing fraud. She added that everyone must check their doctors’ bills and Medicare statements to ensure there is no fraud, and report anything suspicious. Another fraud protection program being offered through the Agency for Aging is the Senior Medicare Patrol. Seniors can sign up for the program, and members visit senior centers and other locations to instruct others on protecting themselves against fraud. Joyce Rosenthal, a member of the Senior Medicare Patrol, said participating has been very rewarding. For information on the Senior Medicare Patrol, call (877)808-2468, or visit www.smpresource.org.
“We are the first line of defense,” Rosenthal said. “You have to become your own advocate, collect your Medicare bills, collect your Medicare summaries and learn how to read them. Do you recognize the doctor’s name on the bill? What about the service the doctor billed you for? If you suspect fraud, you have to report it. Unless we know about it, we can’t do anything about it.”
In addition, Sebelius discussed a new program that is currently under development known as the Class Act, which would allow people to pay into an account for five years, and then withdraw money for discretionary healthcare costs. She also said her office is working on a program to ensure the Medicare reimbursement payments given to healthcare providers will be adjusted to reflect inflation.
“Doctors should not have to go to Congress every year and worry whether they are going to get paid or not,” Sebelius added. “Congress has done a short term fix to ensure doctors are assured of their Medicare pay, but that will end at the end of the year. We are working on it, and it is something we are committed to fixing, the president is committed to fixing, and we just need to get Congress on board.”
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