 Arlington County’s Virginia Insurance Counseling and Assistance Program
(VICAP) provides free, unbiased, one-on-one insurance counseling to Arlington County Medicare Beneficiaries, their families, friends and caregivers.
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A Caregivers Guide to Medicare
Tuesday July 25, 2023, | 10:00am - 12:00pm
About the Program:
If you are caring for an older adult or an individual who is ill or disabled, you are one of about 44 million Americans who are caregivers.
Join Arlington County's Virginia Insurance Counseling and Assistance Program (VICAP) to learn:
- What caregivers should know about Medicare
- Home health services covered by Medicare
- Resources for caregivers
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July is Disability Pride Month!
This month celebrates the Americans with Disabilities Act, signed into law on July 26th, 1990. Disability Pride Month honors, accepts, and recognizes the individuality and uniqueness of persons with disabilities as a part of human diversity.
According to the Centers for Disease Control (CDC), 61 million adults in the U.S. live with a disability. 2020 statistics show that in the state of VA, 37.7% of residents age 65 and older have a disability, with American Indian/Alaskan Natives and Blacks having the highest rates of individuals living with a disability. People living with a disability face greater challenges accessing health care, higher risks of depression and anxiety, and higher risk of participating in risky health behaviors such as smoking.
Did you know that people under age 65 are also eligible for Medicare if they have received Social Security Disability Insurance (SSDI) for at least 24 months? Certain Medicare eligible beneficiaries are able to join a type of Medicare Advantage Plan, called a “Special Needs Plan (SNP).”, designed to meet specific care needs. There are three types of SNP's:
- Chronic Condition SNPs (C-SNPs): For individuals with specific chronic conditions, such as cancer, dementia, diabetes, HIV/AIDS, stroke, End-Stage Renal Disease (ESRD), and certain neurologic disorders
- Institutional SNPs (I-SNPs): For individuals who live in an institution, such as a nursing home, long-term care skilled nursing facility (LTC SNF), intermediate care facility, or assisted living facility
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Dual Eligible SNPs (D-SNPs): For individuals enrolled in Medicare and Medicaid (dually eligible individuals)
To learn more about Special Needs Plans, Click here.
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Doctors Pay For Unsupported Diagnoses to Medicare Advantage Program
Senior Medicare Patrol | June 1, 2023
Complete Physician Services (CPS) and doctors Kenneth Wiseman and Steven Schmidt agreed to pay $1.5 million to resolve False Claims Act allegations that they caused the submission of false claims by misrepresenting the severity of illness and services rendered to increase reimbursement from the Medicare Part C (Medicare Advantage, or MA) and Part B programs. The government alleges that CPS submitted morbid obesity diagnosis codes to Part C where the diagnoses lacked medical support. Also alleged is that CPS’ submission of chronic obstructive pulmonary disease (COPD) diagnoses were not medically supported or supported by appropriate medical documentation in many instances. Read a Department of Justice press release.
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Dear VICAP Team,
My dad was misdiagnosed and received painful treatment. My family and I are very upset about his situation but are not sure how this can be resolved. What actions can Medicare beneficiaries take when they receive poor quality of care?
Dear Medicare Beneficiary,
I am so sorry to hear about your fathers situation. Concerns regarding the quality of care that a beneficiary receives from their provider can be directed to the Beneficiary and Family Centered Care-Quality Improvement Organization (BFFCC-QIO) for your area. The BFFCC-QIOs are made up of practicing doctors, health experts, and consumers meant to improve the quality of care for Medicare beneficiaries. They review complaints about the quality of care received by physicians, hospitals, skilled nursing facilities, home health agencies, and ambulatory surgery centers.
You may wish to file a quality-of-care complaint if you:
- You experience a medical mistake
- Develop an infection during a stay in a facility
- Receive the wrong treatment or care
- Run into barriers to receive the care you need
To file a quality-of-care complaint, you can call your QIO or submit a written complaint. Once the BFFCC-QIO receives your complaint:
- You should receive a call from them asking clarifying questions regarding your complaint and the contact information for you provider
- A physician matching the same specialty will review your medical record and assess if the care provided did or did not meet the medical standard of care
Please note that the review process may take a few months. Once complete, you and your doctor will receive a written notice and a notice by phone.
Click here to find the BFCC-QIO in your state or territory, or call 1-800-MEDICARE.
If you have a Medicare Advantage plan, you can make complaints regarding your quality of care to the BFCC-QIO, file a grievance, or do both.
 Contact the Arlington County VICAP team by phone or email:
703-228-1725
MedicareHelp@arlingtonva.us
This project was supported, in part by grant number 90SAPG0064, from the U.S. Administration for Community Living (ACL), Department of Health and Human Services (HHS). Points of view or opinions do not, therefore, necessarily represent official ACL policy
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