Welcome to the "Beneficiary Card Sharing Education" presentation. The format of this presentation is designed for you to learn about the issues associated with sharing your Medicaid cards or numbers through several examples and the discussions that follow. Let's begin by reviewing the learning objectives. The objectives of the course are to help you spot Medicaid fraud, identify beneficiary card sharing, protect yourself and your card, and report fraud. We will begin at the top of the list by defining Medicaid fraud. What do you think Medicaid fraud is? How might you define it? The definition in the Code of Federal Regulations is: An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State law and this means using information that is not true or misusing someone's personal information to get Medicaid to pay for medical care or services, whether or not they are provided. Let's take a look at some examples of activities that may be considered Medicaid service provider fraud. Most health care professionals are honest, but some activities can be considered fraudulent, such as billing for medical services never performed, filing claims for more than the actual cost of services, and charging for tests, services, and products that are not necessary. Who might be involved in Medicaid fraud? Doctors, dentists, pharmacists, personal care attendants or home health aides, medical transportation companies, and other health care professionals are some examples. Even large institutional providers, such as hospitals and nursing homes, can be involved in these types of activities. How do you think Medicaid fraud affects you? It may reduce the quality of medical services you receive and increase the amount paid for your care. It wastes your taxes on medical fraud instead of paying for medical services you really need. Medicaid fraud affects everyone. One activity that can play a role in various kinds of Medicaid fraud, sometimes unknowingly, is sharing Medicaid cards. Let's talk a little about what card-sharing is and why people might share their Medicaid cards. Then we'll discuss some real-life examples of card sharing and the problems this activity can create. A general definition of Medicaid card or number sharing is giving your Medicaid card or number to someone other than your doctor, clinic, hospital, or other Medicaid health care professional. This can include sharing your card even when you are trying to help someone who really needs care but doesn't have health care coverage. It is important not to provide your Medicaid card or number to anyone else, or you may not be able to get the care you need. You will see this in some of the case examples talked about during this presentation. But first, let's look at a new law about the penalties for card sharing so you know what kind of legal trouble people could face for illegally sharing or misusing Medicaid cards or numbers. People who use your Medicaid number for their own care or to commit fraud, or who allow others to use their Medicaid number to receive care may face up to 10 years in prison and a $500,000 fine if convicted according to a new law passed in 2015. Sometimes it can be hard to know what to do. Let's look at some reasons why you might decide to share your Medicaid number. Why would some people share their Medicaid card or number? To help a family member or friend who needs to see a doctor but does not have insurance and to protect yourself because someone said they would hurt you or your family if you did not share your Medicaid card or number. Sometimes it's not so easy to know what is fraud and what isn't. We know that in the real world sometimes people do the wrong thing for the right reasons, or at least what they think are the right reasons. Sharing a Medicaid card or number is considered a fraudulent activity and, as we'll see, this activity can have serious consequences for the people involved. However, you may face strong pressure at times to share your Medicaid card or number. In some situations, you may think you're really helping someone when you do this, but generally you're not. Let's look at some case studies of why people may share their Medicaid card or number and why it's actually important for everyone to think twice before doing this. [music playing] My name is Rose. My friend Mary has been really sick for over a month. I am worried about her, and I want to help. Mary has no insurance. I just want her to get better. I took Mary to the health clinic and gave them my Medicaid number. I did not think it would hurt anyone. The doctor did an exam and some tests on Mary. The doctor told Mary she is very sick. Mary has to see a heart doctor now. Then, I went to see my doctor because I was sick. She said my last exam showed I have a heart problem and wants me to see the same heart doctor Mary saw. What am I supposed to do now? How do I tell my doctor what happened? Rose is now seeking treatment for her illness. Her records show Mary's medical information. To get the treatment she needs, she must admit to what she has done. What do you think will happen to Rose's Medicaid benefits? Will Rose be required to pay back the money for Mary's doctor visits? Will sharing her Medicaid number affect the treatment Rose may need? Depending on the laws and rules that apply to the Medicaid program in Rose's State, she could lose her benefits or be limited to using specific medical professionals. The State Medicaid agency (SMA) would have to investigate the use of her card by another person and decide on possible penalties to apply in this case. She would be responsible to repay benefits that should not have been paid for by Medicaid. If Rose remains eligible for Medicaid, her benefits would not be affected. Rose's medical record has been affected and someone else's information is in her medical records. This is a serious problem and could lead to mistakes in treating Rose. Do not share your Medicaid card or number, records, or other medical information with anyone except your doctor or other health care professional and do not give your Medicaid card or number to anyone who has not provided you with medical services. Do not risk affecting your medical records or losing Medicaid benefits by sharing your Medicaid ID card or number. If the person is not your medical provider, someone your doctor referred you to for services, or a Medicaid provider you are receiving services from, do not give out your card or number. Most beneficiaries are honest, but a few choose to participate in activities that are considered fraud. Some examples of these activities are: Forging or changing prescriptions (pharmacists are required to be on the lookout for forged or altered prescriptions); reselling drugs, medical supplies, or equipment paid for by Medicaid and using more than one Medicaid card or number. Many times, we feel it is our duty to help a family member or friend that may not have health insurance. In the next example, we will explore what can happen when a Medicaid number is shared with a family member. Let's take a look at Victor's story. [music playing] I have a job but no health insurance. My wife and I are very happy that our kids were able to get Medicaid. My sister, Amelia, and her kids just came from another State to live with us. Amelia's son, Bobby, is sick. She is going to apply for Medicaid, but I do not know if she will be eligible. Bobby needs to see a doctor. I must help my sister and my nephew. I let them use my son's Medicaid number. The doctor said Bobby has allergies. He has to get a shot every month. The doctor wants Bobby's medical records. What will we do if the doctor finds out he is not my son? Will we be in trouble? The medical records for Victor's son now show an allergy condition he does not have. How do you think this will affect Victor and his family? Will using someone else's Medicaid number affect Medicaid for Amelia's children? If Victor's son needs medical care and goes to the doctor, his son's medical records will be wrong. The doctor may think his son has allergies and give him the wrong treatment. If Victor repeated this practice of loaning his Medicaid card or number, he could be charged with fraud. If Amelia was found eligible for Medicaid, she would also be warned about card or number sharing, but her children's Medicaid eligibility would not be affected. Anyone who is aware of someone who wants to share their card or information with another person should advise the person not to do it. Depending on the Medicaid laws and rules in Victor's State, Victor could lose his benefits, but his family's benefits would not be affected. The SMA would have to investigate the matter and decide on possible penalties to apply in this case. If someone needs care and does not have insurance, he or she should find a community health center, publicly supported clinic (for example, a department of health facility) or a hospital or physician office that is known to offer free or discounted high-quality care. What do you think might happen if you share your Medicaid card or number? What might be the consequences? Your medical records could contain someone else's information. This is dangerous, and it could lead to mistakes in treating you when you need care. You may be limited to certain doctors, drug stores, and hospitals, this is called a "lock-in" program. You may have to pay money back to Medicaid and you could be arrested. With inaccurate medical information on their records, beneficiaries could receive the wrong type of care or may have to explain why their record is inaccurate. Lock-in may be used for Medicaid beneficiaries who visit hospital emergency departments for non-emergent health concerns, use two or more hospitals unnecessarily for emergency room services, and use two or more physicians, resulting in duplicated medications and treatments. Usually, a lock-in beneficiary is asked to choose a doctor, hospital, pharmacist, or all three, to be the provider with which he or she is "locked in." Under most circumstances, beneficiaries in a lock-in program are restricted to receiving physician and pharmacy services from only these providers. Beneficiaries who commit fraud may be required to repay money or spend time in prison if found guilty. The activities displayed on this slide are often associated with career criminals, not just medical providers who break the law. Examples include: Stealing Medicaid cards or numbers from beneficiaries, buying Medicaid cards or numbers from beneficiaries who need cash, offering free gifts or services in exchange for cards or numbers and setting up fake medical businesses and billing Medicaid. Remember, when offered free gifts or services, "if it sounds too good to be true, it probably is." Sometimes Medicaid cards or numbers are obtained under threatening situations. Let's take a look at Maria's story. [emergency sirens wailing lightly] My name is Maria. The people in my neighborhood are very close. We talk a lot. My neighbors told me someone they did not know asked for their Medicaid numbers. Today, a man I did not know told me he wanted my Medicaid number. He said he would give me something for the number. I told him no. He got very mad and said I would be sorry. He scared me, so I gave him my Medicaid card. I knew I should not give him my Medicaid card, but what else could I do? I did not feel like I had a choice. Now, I am scared. I am not sure what I should do. If I tell anyone, I might get into trouble. Maria's number is in the hands of a criminal and is likely being used for charges not related to her health care. What do you think Maria should have done? Is there anyone that can help if something like this happens? Treat your Medicaid card and number the way you treat your Social Security card and number—do not loan or sell it to anyone. Keep your Medicaid card or number in a safe place, the way you protect your money or checkbook—out of sight of everyone and You should also be careful to protect other personal information and documents, such as your driver's license and bank account numbers. Sometimes Medicaid information is requested by people who say they want to help, but they may not be who they say they are. You should refuse requests to give your Medicaid card or number to door-to-door or telephone sales people and refuse requests to give your Medicaid card or number to someone you do not know who offers you free medical tests or screenings. They may provide you with medical services or equipment, or they may not. They may be identity thieves, wanting to get your Medicaid number to file false claims to get money from the Medicaid program. In this next case study, Martha had a door-to-door salesman come to her apartment and offer to order something for her. She trusted him—he seemed honest. After we view this example, let's discuss what she should have done. [music playing] A man I did not know came to my apartment. He said he could get me a free motorized scooter to get around. He said he just needed my Medicaid number and would order one for me. I waited for my scooter to be delivered. After a month went by and I did not hear from him, I tried calling the number he gave me. It was disconnected. I was upset and called my caseworker at the county office. They sent an investigator to talk to me. She said they would try to find the man. He will be in trouble if he collected money from Medicaid and did not give me my scooter. I will never give my Medicaid card or number to anyone I do not know. I will not talk to people who call or come to my door again and offer me something for free. Martha's Medicaid number is in the hands of a criminal and is likely being used for charges not related to her health care. If Martha did not report this fraud to her caseworker, her Medicaid records could show that she received a scooter. She could then have a problem getting one paid for by Medicaid from a real medical provider when and if she really needs one. This kind of fraud adds to the costs of health care for all people. Do you think the man who came to Martha's door was really selling scooters for Medicaid? What should you do if you are offered medical treatment or equipment your doctor did not order? The salesman may be billing Medicaid for scooters and then reselling them to non-Medicaid customers. The salesman may also be billing Medicaid, not ordering any scooters, and just keeping the money. Ask questions of the person making the offer. Find out how the salesperson obtained your contact information. Get a contact name, address, and phone number. Tell the person you want to think about it. Do not give the person your Medicaid number and call officials at your local or State Medicaid office and give them the information. We have talked about some of the situations you may face. In each of the examples we discussed, Medicaid information was shared, which can affect the care or services the owner of the Medicaid card receives and can affect the person who used the card or number. Are there any other situations you have seen or heard about where a Medicaid number has been shared? What can you do to protect your family's Medicaid numbers? Use these tips to avoid common fraud schemes: Walk away if people approach you in parking lots, shopping centers, or other public areas and offer free services, groceries, transportation, or other items in exchange for your Medicaid number. Hang up the phone if someone calls you claiming to be conducting a health survey or claiming to be a Medicaid collection agency and asks for your Medicaid number. If you get their phone number, keep it, and contact your local Medicaid office. Do not give your information to marketers who claim to be from Medicaid and ask for payment over the phone or Internet. They may want to steal your money. Avoid doing business with strangers or participating in offers advertised on TV, in newspapers, in magazines, or received in the mail that ask you for your Medicaid number. Ask your doctor, clinic, or drug store about equipment or services advertised. They will know if the company selling the equipment or services can be trusted. As we saw in the examples, not all fraud is intentional, but it always carries some form of a consequence. For that reason, we talked about ways to protect yourself and your Medicaid card or number. If you ever suspect you have been a victim of fraud, or if you see or hear about fraud by someone, the best thing you can do is report it. Now, let's talk about ways to protect your medical records from being misused. Do do not sign a medical form before it is filled out and your questions have been answered. Ask for help if you do not understand what a form says and ask for an interpreter or translated form, if needed. Keep track of when someone in your family sees a doctor, gets medicine, or gets supplies. Ask for a copy of everything you sign. Keep your receipts in a file in case you need to check later about a bill that was not correct. Check any statements that you receive from your provider in the mail and report it if you think someone used your Medicaid number in an illegal way. I'll tell you how and where to call in just a moment. If you know of a situation where a Medicaid number is being shared, where do you report this behavior? A fraud reporting card is available on the Centers for Medicare & Medicaid Services (CMS) website that will help you to report such incidents. The purpose of the fraud reporting card is to provide you with a tool to report fraud. On the backside of the card are phone numbers to call to report fraud. Call your SMA or call the Medicaid Fraud Control Unit in your State. If you are not sure of the number for the State contact, check the website on this slide. You can also contact the U.S. Department of Health and Human Services, Office of Inspector General Phone number: 1-800-HHS-TIPS or 1-800-447-8477 Fax: 1-800-223-8164 and TTY: 1-800-377-4950 TTY stands for "Text Telephone." TTYs are used by those who are deaf or hard of hearing. When you call these numbers, specific information will be needed. To help you prepare, the information that will be needed includes: The name of the person you suspect is committing fraud, his or her address and phone number. Why you think the person is involved in fraud. For example, someone offered you money to use your Medicaid number and your name, phone number, and address. You can report suspected fraud without giving your name but giving your name and other contact information helps investigators if they need more information and your identity will be protected to the maximum extent allowed by the law. If you have questions about your Medicaid benefits, you can contact these agencies or organizations for help. Your State or local agency caseworker or your local health care plan case manager. Local community organizations that assist with general health care programs and CMS on the CMS website. During our discussion today we talked about: How to spot Medicaid fraud. Ways to identify beneficiary card sharing. How to protect yourself and your Medicaid card or number and how to report fraud. I hope you have a better understanding of these points. Together, we can make a difference in protecting the integrity of the Medicaid program. This presentation was current at the time it was published or uploaded onto the web. Medicaid and Medicare policies change frequently so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. Use of this material is voluntary. Inclusion of a link does not constitute CMS endorsement of the material. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.