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Medicare enrollment brings fraud tales
Nearly 96,000 Georgians turn 65, qualify this year
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Avoid fraud

Keep an eye out for these signs of fraud on your Medicare statements:

• Charges for something you didn’t receive

• Being billed twice for the same visit or treatment

• Services that were not ordered by you or your doctor

If you are unsure about something on your statement and would like assistance, call GeorgiaCares at 1-866-552-4464, call 1-800-Medicare (633-4227) or go to www.mygeorgiacares.org.

Nearly 96,000 Georgians who’ve hit their 65-year-old milestone this year will qualify for Medicare open enrollment, which begins Saturday.

The seven-week period begins early this year and will run through Dec. 7.

With such a great number of citizens eligible for Medicare, the Coastal Regional Commission GeorgiaCares program is offering counseling and information to new Medicare beneficiaries in addition to sharing information about how to prevent fraud.

“I’ll tell you, it’s out there,” Liberty County Senior Center Director Chrislene Nelson-Taylor said about health-care scams.

Within the last couple of weeks, one of the seniors at the center showed Nelson-Taylor a letter addressed from Washington, D.C., from a company that claimed to lobby for Medicare — and the letter requested $12 per year to continue the lobbying efforts.

The company, whose name Nelson-Taylor could not remember and did not recognize, claimed to be the second-largest company under the AARP umbrella, she said. When such incidents occur, Nelson-Taylor works with an in-house Senior Citizens Inc. advocate who investigates the legitimacy of the claims.

The best way for seniors to protect themselves from potential predators is to seek knowledge on the topics, she said. They also should not be afraid to say no or admit when they don’t understand something, and they should seek help from others when unsure.

In fact, the Liberty County Senior Center has taken advantage of the counseling sessions offered by GeorgiaCares through the CRC, Nelson-Taylor said. The coordinator, Debra Vasquez, has visited to the center twice in recent months to share information about the benefits and protection.

“(The seniors) were thrilled because they felt comfortable, and they asked a lot of questions,” Nelson-Taylor said.

“Medicare fraud costs American taxpayers billions each year,” Vasquez said in a news release. “The good news is that Medicare consumers can join the fight by learning how to protect themselves, detect problems and report these problems to GeorgiaCares.”

“I have people that call me all the time and ask me what they should do in certain situations,” said Elise Stafford, chief long-term care officer with Coastal Manor Long Term Care in Long County.

While Stafford cannot recall any recent efforts, she does warn beneficiaries about giving their personal information to anyone who solicits them.

“I know several years back when Medicare Part D was first implemented, there were reports in the community of elderly people who had had representatives who were not really from Medicare — they were scam artists — who were going door to door to discuss personal information about their accounts,” she recalled. “That’s something that the elderly do not need to entertain. It’s not likely for a provider to send people out into the community to knock on doors.”

Beneficiaries should not give out information over the phone or to representatives who come door to door, she said. If someone does call or approach the elderly in their home claiming to be a Medicare or provider representative, they should call Medicare using the contact information on their official paperwork.

“With the elderly being such a vulnerable population, we need to make sure they’re not sharing their information with anyone unless they know that the person they’re talking to is a real provider,” Stafford said, adding that Medicare always uses free 1-800 numbers.

One of the best ways to prevent fraud, error and abuse is to protect all Medicare account numbers, according to the Georgia-Cares release. 

Beneficiaries also should be cautious of people who call or approach them with offers of free medical services and ask for Medicare account numbers, the release said.

Once someone has a Medicare number, he or she can bill Medicare for items under recipients’ names, which can create confusion with medical records and waste Medicare dollars.

Recipients only should give account numbers to providers or to organizations they have contacted directly to help with benefits. Beneficiaries also can call GeorgiaCares or Medicare if they are unsure whether an offer is legitimate.

Keeping track of service dates and times is another way to detect possible fraud, the news release said. Beneficiaries should review their summary notices and explanations of benefits and keep an eye out for services they did not receive, dates of service that are incorrect, unfamiliar providers and other incorrect information.

If you have questions about whether an offer is legitimate or if you need to report a problem on a billing statement, call Georgia-Cares at 1-866-552-4464, call 1-800-Medicare (633-4227) or go to www.mygeorgiacares.org.

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From the book 'Outliers' comes proof that good health is more than just genetics
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Friends Jim Young, left, Mike Natale, Jeff Natale and Ryan Kiernan were on Greenwich High School football team together and Jim and Mike were captains. Jim, who was the youngest in Sherry Young's family, was welcome in the homes of the other three boys who still had siblings around and grandparents near. - photo by Sherry Young
As I look back on my life and the lives of others, both personally and in the reading I have done, I am convinced of the necessity of positive human contact in our lives. We are doubly blessed when we are able to make good friends or are a part of a family where we are accepted and loved.

Malcolm Gladwell in his book Outliers tells of a time in the 1950s when Dr. Stewart Wolf met a physician who practiced in the area of Roseto, Pennsylvania. Roseto was settled by a group of Italian families from Roseto, Italy, who re-created their life again in America.

This was in the 1950s before drugs and measures to prevent heart disease became important. In their conversation the physician said, You know, Ive been practicing for 17 years. I get patients from all over, and I rarely find anyone from Roseto under the age of 65 with heart disease.

Wolf was surprised by these words as, It was impossible to be a doctor, common sense said, and not see heart disease.

Wolf enlisted the aid of a sociologist and friend John Bruhn to help him. They found, There was no suicide, no alcoholism, no drug addiction, and very little crime. They didnt have anyone on welfare. Then we looked at peptic ulcers. They didnt have any of those either. These people were dying of old age. Thats it.

They checked into diet, genetics and possibilities of something in the foothills of eastern Pennsylvania but nothing made sense.

What they found was that Rosetans visited one another, stopping to chat in Italian on the street, say, or cooking for one another in their backyards. (Researchers) learned about the extended family clans that underlay the towns social structure. They saw how many homes had three generations living under one roof and how much respect grandparents commanded. They went to Mass at Our Lady of Mount Carmel and saw the unifying and calming effect of the church. They counted 22 separate civic organizations in a town of just under 2,000 people. They picked up on the particular egalitarian ethos of the community, which discouraged the wealthy from flaunting their success and helped the unsuccessful obscure their failures.

What they found eventually convinced the medical establishment to look beyond the individual and understand the culture people are part of their friends, families and town they came from. They determined that the people we surround ourselves with and the values of the world we inhabit have a profound effect on who we are.

Likely, this study could have been done with other ethnicities. However, my family's experiences with the Italian families in Connecticut ring true to the study. Our hungry and growing sons, especially our youngest son, Jim, who was left home alone with two beady-eyed parents, all had some memorable experiences being fed and loved in the Cos Cob multigenerational families. Proof of the African proverb, It takes a village to raise a child.

We live in an age when the contact we have with people often is on the internet, and many of us live among strangers. Unless we make the effort to reach out, we will become isolated, especially as we age. The Rosetan study is proof that reaching out and communicating may be good for our health.
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