Fraud Prevention – Tip Of the Month
Monthly Fraud Prevention Facts
In recent years, beneficiaries often contacted SMP with potential billing errors involving Self Administered Drugs (SAD). SAD are medications given to a Medicare beneficiary in a hospital and are defined as medications normally taken at home by most patients. Such situations often occur when a patient is in the ER, or is in the hospital under observation status. This becomes a billing “error” when other drugs (i.e. anesthesia, injections) are incorrectly billed to Medicare as SAD. Such claims are then denied and are billed to the patient.
An additional requirement took effect on March 8, 2017. When a beneficiary is under observation status for more than 24 hours, their status and the SAD implications must be explained to them in plain language before 36 hours has passed. The patient or representative must sign the standardized form (Medicare Outpatient Observation Notice, MOON) with the reason for the observation status inserted.
If you are billed for drugs that are not normally taken at home during a hospital visit, or you are billed for SAD and not notified of an “under observation” stay, please call your Wyoming Senior Medicare Patrol at Wyoming Senior Citizens, Inc. at 1 800 856-4398.
Contact your Senior Medicare Patrol (SMP) program in Wyoming at 1 (800) 856-4398 for assistance.
Report Suspected Fraud
To report suspected fraud, call the Wyoming Senior Medicare Patrol at 1 (800) 856-4398, send an email to firstname.lastname@example.org, or stop by your Wyoming Senior Citizens, Inc. office in Riverton, Casper, or Cheyenne. Addresses are listed on our website at http://www.wyomingseniors.com/wsci-locations-contact-information.