Coverage Updates and Alerts From Medicare


Fraud Alert – Lidocaine Cream Prescriptions

Posted: 4/4/2018

Please be aware that some pharmacies and marketing companies may be using questionable practices to take advantage of you or even commit fraud. As a reminder, for your medications to be covered under your Peoples Health plan, they must be prescribed by your doctor.

Medicare recently let us know that certain pharmacies and marketing companies may be working together to fill false prescriptions for lidocaine creams and bill people who have Medicare for the costs. Lidocaine creams are medication used to reduce pain or discomfort caused by skin irritations or hemorrhoids. The false prescriptions were not written by the person’s doctor or requested by the person.

Here are some ways to protect yourself:

  • Never give your social security number, Medicare number or Peoples Health member ID number to anyone you don’t know over the phone. Remember, Medicare and Peoples Health already have this information and will not call and ask you for it.
  • Review the Explanation of Benefits that we send you each month. Let us know if you see any activity that you do not recognize.
  • Be on the lookout for any unfamiliar medications sent to you. This may happen when pharmacies send you medication that you never requested or when pharmacies automatically refill medications that you may have received in the past but no longer need.

If you notice any of the above or have other concerns, please let us know. You can report concerns about these activities to our Fraud, Waste and Abuse Hotline at 1-877-662-5894.

Coverage Updates

Medicare has revised the coverage rules for some healthcare procedures. To be covered, procedures generally must be received through a provider in your plan’s provider network, and some services may require prior authorization from Peoples Health.

New Start Date for the Medicare Diabetes Prevention Program

Posted: 12/6/2017
On Nov. 29, 2017, Medicare issued a memo clarifying that it is delaying the date the Medicare Diabetes Prevention Program is available to eligible beneficiaries. The program will be available beginning April 1, 2018. A description of the program is included in the 2018 Evidence of Coverage.

Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease

Posted: 9/7/2017
On May 25, 2017, Medicare began covering supervised exercise therapy for members when the therapy is referred by a physician. Members with intermittent claudication (leg cramping typically caused by obstruction of the arteries) are eligible when treatment is for symptomatic peripheral artery disease. Up to 36 sessions over a 12-week period are covered if certain conditions are met. A second referral is required for additional sessions.

Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Stenosis

Posted: 6/14/2017
On Dec. 7, 2016, Medicare began covering percutaneous image-guided lumbar decompression (PILD) for members enrolled in certain CMS-approved clinical studies and who have lumbar spinal stenosis. PILD is a noninvasive procedure that uses specially designed instruments to relieve lower back pain from the condition. To be covered, the surgery must be performed on or after the date above.

Percutaneous Left Atrial Appendage Closures

Posted: 6/6/2016
The Centers for Medicare & Medicaid Services issued a mid-year benefit update covering percutaneous left atrial appendage closures when the procedure is done for patients with non-valvular atrial fibrillation and according to an FDA-approved indication for the procedure with an approved device. The coverage applies for services received on or after Feb. 8, 2016. Coverage requires that patients have:

  • A CHADS2 score ≥ 2 or CHA2DS2-VASc score ≥ 3 (these scores are determined by a healthcare provider to help determine stroke risk)
  • A formal shared decision-making interaction—documented in his or her medical record—with an independent non-interventional physician using an evidence-based decision tool for oral anticoagulation medication in patients with non-valvular atrial fibrillation prior to left atrial appendage closures
  • A suitability for short-term warfarin but deemed unable to take long-term oral anticoagulation medication following the conclusion of the shared decision-making interaction


You can learn more about these coverage changes by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048. If you have received any of these treatments on or after the effective dates and would like to seek reimbursement, contact member services.