Coverage Updates and Alerts From Medicare

Alerts

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 Compliance & Ethics HelpCenter at 1-800-455-4521.

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.

National Coverage Determination – Next Generation Sequencing

Posted: 7/3/2019
Beginning March 16, 2018, Medicare began covering diagnostic laboratory tests using next generation sequencing when the services are performed in a certified clinical laboratory. The services must be ordered by a treating physician and specific requirements must be met. These tests are sometimes used to predict risk associated with genetic variations and may be covered for those with recurrent, relapsed, refractory or metastatic cancer or advanced stages III or IV cancer.

Questions?

If you have questions about these coverage changes, or if you received any of these services on or after the effective dates and want to seek reimbursement, contact member services. You can also learn more about the 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.