Improper Billing Resources for Medicare Enrollees in the Qualified Medicare Beneficiary Program

Improper Billing Resources for Medicare Enrollees in the Qualified Medicare Beneficiary Program

Medicare enrollees who are in the Qualified Medicare Beneficiary (QMB)
program—a Medicaid program that pays for Medicare costs—should not be
billed for healthcare costs, with a few exceptions. Unfortunately, QMB enrollees often face
medical bills that are issued to them improperly.

Improper billing (also sometimes referred to as “balance billing”) occurs when doctors,
hospitals, or other providers charge beneficiaries with both Medicaid and Medicare for copays, co-insurance, or deductibles.

Patients who have both Medicaid and Medicare (including Medicare Advantage) should never
be charged for services covered under Medicaid or Medicare. Billing for covered services is
illegal under both federal and state law.

QMBs whose provider will not stop billing them for items and services that Medicare covers
can contact 1-800-MEDICARE. Consumers can also submit complaints about their debt
collection issues by contacting the Consumer Protection Financial Bureau at (855) 411-2372.

Legal Services of Long Island’s Senior Citizen Law Project provides legal representation, advice, and
referrals to Nassau County seniors in matters involving housing, health care, and social security. The Project
also assists with wills, power of attorney and health care proxy forms, pooled trusts, Medicaid planning,
consumer debt, and utility shut-offs.

With specific funding from the Nassau County Office for the Aging, the Project assists Nassau County seniors
age 60 and older who have a legal issue that meets our priority guidelines.

Telephone consultations assist clients with problem analysis, information, and referral. Individual cases are
accepted for representation after case evaluation. Special visits can be arranged for those who are
homebound, in-hospital, or nursing home residents.

In addition to the “Helpline” and legal representation, the Project collaborates with Senior Citizen social
agencies, provides training, and participates in community information events that target seniors. Nassau
residents can call 516-292-8100