Dear Marci, Someone at my senior center told me that I should be on the lookout for hospice care fraud. What is hospice care fraud, and how can I protect myself? -Sabrina (Sacramento, CA) Dear Sabrina, Medicare fraud and abuse involve a wide range of behaviors that result in unnecessary costs to the Medicare program, costs for the beneficiary, or other harm to the beneficiary. Medicare fraud may take place on a small scale, like through the actions of one health care provider, or on a much larger scale. Hospice is a primarily home-based program of pain management and comfort care for those with a terminal illness. Hospice care has been identified as one area of Medicare that is vulnerable to fraud and abuse. For this reason, it is important to know what hospice care fraud might look like, so you can identify and report it. Some examples of hospice care fraud include:Providing services to patients who are not terminally illPaying incentives to referral services (such as physicians or nursing homes)Billing for a higher level of care than was actually provided or neededTargeting assisted living facility and nursing home residents whose life expectancy exceeds six monthsFailing to obtain physician certification on plans of careFalsifying records to fake eligibility or physician certificationHigh-pressure marketing of hospice services to beneficiaries who do not qualify for Medicare-covered hospice careProviding inadequate or incomplete servicesTo protect yourself from hospice care fraud, remember the rules around Medicare’s coverage of hospice care services. Medicare will not cover these services for someone who is not terminally ill, and who has not signed a statement electing to have Medicare pay for palliative care rather than curative care, except for in very limited circumstances where a hospice provider is participating in a demonstration program called the Medicare Care Choices Model (MCCP). If you do not meet both of those requirements, and the hospice is not in MCCP, providers should not provide you with, or offer to provide you with hospice services. Protect your Medicare number. Only give your Medicare number or Social Security number to your doctors and other providers. Be careful when others ask for your Medicare number or offer free services if you provide your Medicare number. Check your Medicare Summary Notices (MSNs)and billing statements regularly. Carefully look for any suspicious charges or errors. Use a calendar to track your doctors’ appointments and services to be able to quickly spot fraud or billing mistakes. Remember also that providers are not permitted to routinely waive cost-sharing for Medicare beneficiaries or offer gifts or financial incentives for you to get services from them. Keep your eye out for offers to provide services that are never covered by Medicare. If you see any suspicious charges on your MSN, or have any reason to believe your provider is inappropriately billing Medicare for hospice care, call your provider or billing office to see if they have made a billing error. If you still suspect a provider of hospice care fraud, contact your Senior Medicare Patrol (SMP).Your SMP can provide you with information to protect yourself from Medicare fraud, errors, and abuse. Additionally, if you have quality of care complaints about your hospice provider, your SMP can help you contact the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for your region. -Marci

Dear Marci, I was just diagnosed with a terminal illness. My doctor and social worker have suggested that I speak with my family and consider beginning hospice care. How will Medicare cover hospice care if I choose it? – Manny (Bridgeport, CT) Dear Manny, Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit is primarily home-based and offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. It is important to remember that the goal of hospice is to help you live comfortably, not to cure an illness. To elect hospice, you must:Be enrolled in Medicare Part AHave a hospice doctor certify that you have a terminal illness, meaning a life expectancy of six months or lessSign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care (unless your hospice is participating in the Medicare Care Choices Model (MCCM) program through the Centers for Medicare and Medicaid Innovation (CMMI))The MCCM program lets hospice patients receive both palliative and curative care for their terminal condition.And, receive care from a Medicare-certified hospice agencyOnce you choose hospice, all of your hospice-related services are covered under Original Medicare, even if you are enrolled in a Medicare Advantage Plan. Your Medicare Advantage Plan will continue to pay for any care that is unrelated to your terminal condition. Hospice should also cover any prescription drugs you need for pain and symptom management related to your terminal condition. Your stand-alone Part D plan or Medicare Advantage drug coverage may cover medication that are unrelated to your terminal condition. The hospice benefit includes two 90-day hospice benefit periods, followed by an unlimited number of 60-day benefit periods, pending certification by a doctor. If you are interested in Medicare’s hospice benefit:Ask your doctor whether you meet the eligibility criteria for Medicare-covered hospice care.Ask your doctor to contact a Medicare-certified hospice on your behalf.Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you contact is unable to help you, contact another.Once you have found a Medicare-certified hospice:The hospice medical director (and your doctor if you have one) will certify that you are eligible for hospice care. Afterwards, you must sign a statement electing hospice care and waiving curative treatments for your terminal illness.Your hospice team must consult with you (and your primary care provider, if you wish) to develop a plan of care. Your team may include a hospice doctor, a registered nurse, a social worker, and a counselor.-Marci

Dear Marci, I travel often, both within the U.S. and abroad. If I have a medical emergency when I’m traveling, will my care be covered by Medicare? -Myrna (Davenport, IA) Dear Myrna, Both Original Medicare and Medicare Advantage Plans cover emergency or urgently needed services that you receive anywhere in the United States or its territories. If you have a Medicare Advantage Plan, be aware that if you are receiving emergency or urgently needed services:Your plan cannot require you to see an in-network providerYou do not need a referralThere are limits on how much your plan can bill you if you receive emergency care while out of your plan’s networkYour plan must cover medically necessary follow-up care related to the medical emergency if delaying care would endanger your healthYou have the right to appeal if your plan does not cover your careIf your condition was not an emergency but appeared to be an emergency at the time, Original Medicare or Medicare Advantage must still cover your care. For example, let’s say you have chest pain that you think may be a heart attack. If you go to the emergency room and doctors discover that your pain is heartburn, your care should still be covered because the situation appeared to be an emergency. If your Medicare Advantage Plan denies coverage of an emergency or urgently needed service because you saw an out-of-network provider or failed to get a referral or prior authorization, you should appeal their denial. You should ask your doctor to provide medical documentation that the services you needed were emergency or urgently needed services. If you need assistance appealing the denial contact your State Health Insurance Assistance Program (SHIP). Medicare generally does not cover medical care that you receive while traveling outside the U.S. and its territories. However, Original Medicare and Medicare Advantage Plans must cover care you receive outside the U.S. in certain circumstances:Medicare will pay for emergency services in Canada if you are traveling a direct route, without unreasonable delay, between Alaska and another state, and the closest hospital that can treat you is in Canada.Medicare will pay for medical care you get on a cruise ship if you get the care while the ship is in U.S. territorial waters. This means that the ship is in a U.S. port or within six hours of arrival or departure from a U.S. port.In limited situations, Medicare may pay for non-emergency inpatient services in a foreign hospital (and any connected provider and ambulance costs). Your care is covered if the hospital is closer to your residence than the nearest available U.S. hospital. This may happen if, for example, you live near the border of Canada or Mexico.Some Medigap policies provide coverage for travel abroad. Medigap plans C through G, M, and N cover 80% of the cost of emergency care abroad. Check with your policy for specific coverage rules. Medicare Advantage Plans may also cover emergency care abroad. Contact your plan for more information about its costs and coverage rules. -Marci

Simple Fixes on Your Quest to Find Quick and Easy Vegetarian Recipes

If you love to have guests at your house, you must always be ready with various types of food that everybody will appreciate. You cannot expect that everyone will enjoy your delicious roasted chicken or pork. You must always anticipate receiving guests who are vegetarians and won’t eat anything else but vegetables. On your collection, you must include quick and easy vegetarian recipes to help you on this purpose.

If you are not a vegetarian, you may think that this is too tasking to handle. But you are mistaken. There are many ways for you to come up with simple treats that your vegetarian friends and relatives will surely appreciate and enjoy. The best thing about it is that you have considered their preferences and have actually done something about it. It is also not easy on their part to impose on what they want to have whenever they go and visit other houses. But you don’t want them to starve themselves while inside the premises of your home just because you didn’t prepare something for them.

Here are some quick fixes that you can apply when you are faced with this situation.

1. You can create salads on the spot. Pick out the fresh vegetable that you can include at this recipe, blanch them to achieve crispiness and put them out ready to be served. You must always have on your stock various dressings that can be used for this purpose. You must also have vinegars that are mostly used on salads for those who prefer such on their vegetable salads.

2. You can have your vegetable pre-cooked before the arrival of your guests. You can stock them on the freezer so that you will have lesser preparation time when your guests start to come in. You can also create vegetable soup before the date of the occasion and stock it on the freezer as well. Your efforts will surely go a long way, especially to your guests who are vegetarians.

3. Try using tofu on recipes that require meat. But make sure that you buy the fresh and new ones so that they will taste great once combined with your recipe. There are restaurants that are able to fake this quite good that you will not be able to determine that you are actually having tofu than real meat. If you will be able to formulate how this is done, you can have such meals served for everyone, even those people who are not really vegetarians.

4. You can serve fruits for snacks and desserts. This is healthy and will be loved by almost everybody. This will be appreciated by both adults and kids. You can get away by simply slicing the fruits that you’ve got. You can also mix them, create fruit salads or use them on juices.

5. You must also have some potatoes on your stock. You can never go wrong with such. If you have less time, you can just boil some and pour over tomato sauce on them. You have to make sure that before you do this, you have to wash the potatoes thoroughly. You can even use a clean brush to make sure that you get rid of all the dirt on its peel. If you have more time, you can mash them or bake some.

And that will do for your quick and easy vegetarian recipes.