I just assisted an older adult with a slip and fall. This gentleman is 80 years old and tripped in a local grocery store. This had nothing to do with any balance issues, it everything to do with a mat that was protruding from the floor. This significance to the aging world is this: now due to the growing Medicare shortfall in Washington liability insurers (which include carriers who write CGL policies, auto policies, homeowners’ policies and those defendants who are self-insured such as supermarkets) are required to determine and report whether a claimant is covered and is entitled to Medicare benefits. If the claimant received Medicare benefits during their treatment for the injury, Medicare is and will be relentless in its pursuit of a 100% reimbursement.

This new law will pose new challenges for plaintiff’s attorney and the plaintiff. If the attorney or insurance carrier does not comply, they risk being sued by the Government for reimbursement up to five years post-closure and monetary fines. If there is a settlement and Medicare does not know about it and mistakenly pays for services it has a right to recover, it can go after the attorneys whose fees are paid out of the settlement.

Also the Medicare recipient can lose his or her benefits. Lawyers could be exposed to malpractice claims for not handling a client’s benefits properly. Insurers can be liable for monetary fines for failure to report. If a plaintiff loses his Medicare benefits, the plaintiff may bring a legal malpractice claim against the attorney and a bad faith claim against the insurer for not making sure Medicare benefits were protected.

This is bad for older adults because there is and will be less of an incentive to assist older adults with their legitimate personal injury claims. A settlement amount will have to cover Medicare charges up to 100%, attorney fees and provide money for the plaintiff.  If that type of recovery does not seem likely, most attorneys will strongly consider rejecting the case.

Finally, negotiations with the liability insurance carrier will become more difficult. They will demand information about your client, such as social security number, so that they can comply with the requirements and avoid fines. Once the claim is settled, it can take up to four months before Medicare signs off on the settlement.

The Senior Medicare Patrol is a trained group of individuals, mostly retired professionals and other senior citizens, who can, as a result of their training, recognize and report instances or patterns of health care fraud. They also are educated as to how threats to financial independence and health status may occur when citizens are victimized by fraudulent schemes.

The SMP program empowers seniors through increased awareness and understanding of healthcare programs. This knowledge helps seniors to protect themselves from the economic and health-related consequences of Medicare and Medicaid fraud, error and abuse. The activities of the SMP program also serve to enhance the financial, emotional, physical and mental well-being of older adults — thereby increasing their capacity to maintain security and independence in retirement, and to make better financial and healthcare choices.

The result of training the almost 2.6 million beneficiaries, counseling over 1.0 million beneficiaries and 97,000 media outreach events?  Over $105.7 million in savings, including Medicare and Medicaid funds recovered.

How can you protect yourself from healthcare fraud?

1) Only go to your personal doctor, hospital or clinic for medical help. Only they should make referrals for special equipment, services, or medicine.

2.) Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.

3) If someone calls and tries to threaten or pressure you into something simply hang up the phone.

4.) If someone comes to your door and says they are from Medicare or some other health care company, SHUT THE DOOR! ….. It’s shrewd to be rude!

5.) Do your homework and talk to your healthcare provider before buying or investing in internet “cure-all” or “miracle” products or services.

6.) Don’t keep mail in your mailbox for more than one day. People can and will steal

personal information right out of your mailbox!

7.) Rip up, shred or otherwise destroy your Medicare or other healthcare papers and other important documents instead of just throwing them away, but remember to record your doctor’s visits, prescriptions, etc., in a healthcare journal Crooks will go through the trash!

8. Treat your Medicare and Social Security numbers like credit cards. If someone offers to buy your Medicare or Social Security number, DON’T DO IT…It’s simply not worth it.

9. Remember that Medicare doesn’t SELL ANYTHING.

10. Follow your instincts – if it seems too good to be true, IT USUALLY IS!

11.  ALWAYS READ your Medicare Summary Notice (MSN) or health care billing statement (Explanation of Benefits). Your MSN & other Explanation of Benefits forms are generally stamped “This is Not a Bill” and come in AFTER you receive medical care. Look for three (3) things on your billing statement(s):• Charges for something you didn’t receive • Billing for the same thing twice• Services that were not ordered by the Doctor.

12. Every State has a SMP look up the number on Google and call!