Closing racial and ethnic gaps in access to care

By Cara V. James, Director of the Office of Minority Health

Did you know that 31% of Hispanics are uninsured, compared to 12% of non-Hispanic whites?  Or that less than one-third of African American adults with diabetes receive the recommended services?  Or that fewer than 40% of American Indian and Alaska Native adults over 50 have gotten screened for colorectal cancer?

April is National Minority Health month. Although we continue to make strides in improving health outcomes, it’s clear that racial and ethnic minorities, low-income Americans, and other underserved populations still lag behind the general population.  Racial and ethnic minorities often have higher rates of serious diseases, are less likely to get preventive care, and have fewer treatment options and less access to quality health care. They’re also less likely to have health insurance than the general population.

The Affordable Care Act is improving access to care for minority populations and other underserved groups in a variety of ways. The Affordable Care Act fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country.  Beginning in January 2014, individuals under 65 with incomes below 133 percent of the federal poverty level will be eligible for Medicaid, so for the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state.  Medicaid and Children’s Health Insurance Program eligibility and enrollment will be much simpler and will be coordinated with the newly created Affordable Insurance Exchanges.

Starting in 2014, Affordable Insurance Exchanges will make buying health coverage easier and more affordable. These new Exchanges will offer one-stop shopping so individuals can compare prices, benefits and health plan performance on easy-to-use websites. Financial help will be provided to low-income populations, which will help ensure that all Americans have access to quality, affordable health coverage, even if they lose a job, switch a job, move, or become ill.

The Affordable Care Act is also improving access to preventive care services. Research shows that use of preventive services is traditionally lower for minority populations, but now all people with Medicare can get a range of recommended preventive serviceswithout paying part B coinsurance or meeting the deductible.  These include certain tests for breast, colorectal, and other cancers, diabetes, cardiovascular disease screening, and intensive behavioral therapy for obesity.  A new benefit, a yearly wellness visit with your qualified and participating doctor, has also been added, and is also available without part B cost sharing. These free preventive services can help reduce health disparities and give everyone the chance to enjoy better health and a better quality of life.

People with Medicare also get a 50 percent discount on covered brand-name drugs while in the prescription drug coverage gap (known as the “donut hole”), and by 2020, the donut hole will be closed. This change will help relieve the financial burden for millions of seniors and people with disabilities across the country.

The health of racial and ethnic minorities is one of the focus areas for the Office of Minority Health at CMS.  OMH works not only to serve as a resource and liaison within and outside of CMS, but to help improve CMS minority health data, report on CMS progress in reducing disparities, and represent minority health interests in all CMS activities.

The gaps in health outcomes won’t change overnight. But with free preventive services, yearly wellness visits, and more affordable prescription drugs, we’re helping to increase access to care, reduce health disparities, and strive for health equity.

7 Ways to Protect Yourself from Medical Identity Theft

Peter Budetti, MD, JD, Deputy Administrator for Program Integrity

Fraud affects everyone. We’ve said it before – but this time we’re not just talking about people with Medicare. As my colleague Dr. Shantanu Agrawal and I pointed out in a recent article in the Journal of the American Medical Association, physicians are also vulnerable to a type of fraud called “medical identity theft.”

Medical identity theft happens when a fraudster uses your unique medical identifiers to bill insurance for items or services that you never provided or prescribed. Examples of these medical identifiers could be your National Provider Identifier (NPI), Tax ID Number (TIN), and medical licensure information. You pay for this kind of fraud with increased financial liabilities – you may be expected to pay taxes on earnings you never received, or repay insurance companies for payments on items or services that you never provided. You may also become the physician of record for services you had nothing to do with.

How to Protect Yourself

1. Keep your medical information up-to-date. Report any changes to Medicare, Medicaid, and other insurance companies, such as opening and closing of offices and moving between group practices.
2. Review billing notices. Actively review your Medicare remittance notices to make sure there are no items or services listed that you didn’t provide, including payments to you for services you didn’t provide.
3. Protect your medical information. There are things you can do to better protect your information. For example, before giving out your medical identifiers to potential employers or other organizations, check them out to be sure they’re legitimate. Only give your information to trusted sources.
4. Train your staff. Make sure your employees know the proper way to use and distribute your medical information, such as on prescription pads, electronic health records, and on other important documentation.
5. Educate your patients. Patients are victims, too. Medical identity theft leads to higher insurance costs. Also, if patients are charged for items or services they never received, they may be denied in the future when they really need them. Tell patients to be on the lookout for fraudulent activity on their explanation of benefits statements, and how to report fraud when they see it.
6. Report any suspected medical identity theft. If you believe you may have been the victim of identity theft, call the CMS program integrity investigative contractor in your region,which you can find at this location: http://www.cms.gov/MedicareProviderSupEnroll/downloads/ProviderVictimPOCs.pdf You may also report any suspected cases of medical identity theft to the Office of the Inspector General.
7. Protect your prescription pads. Keep your prescription pads in a safe and secure environment, so they can’t be used by fraudsters to obtain prescriptions you never prescribed.

Medicare fraud and identity theft affects everyone. That’s why it’s very important for all of us to work together to stop it.