https://youtu.be/cbbYH-uiPO4

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Influenza Hospitalizations Highest on Record, CDC Says

https://www.medscape.com/viewarticle/892240

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Nebraska first state to require all drugs reported to PDMP

http://www.healthcareitnews.com/news/nebraska-becomes-first-state-require-all-drugs-be-reported-prescription-monitoring-program

Nebraska Health Information Initiative CEO Deb Bass said the agency is trying to identify and avoid adverse medical effects to reduce readmissions.

Nebraska is the first state to require reporting of all dispensed prescription drugs to the Prescription Drug Monitoring Program.

Nebraska Health Information Initiative CEO Deb Bass said the move could save lives – not only for those taking opioids, but potentially for anyone prescribed drugs.

“We’re after those adverse medical effects,” Bass said. “Often readmissions are connected to improper medication usage, or

they didn’t get their medications filled. They didn’t take the medication as they were supposed to.

There are also individuals that have drug-drug interaction and they end up being re-hospitalized.”

The PDMP nationwide initiative took effect Jan. 1, 2018, and other states have also been advancing their health IT efforts to support drug monitoring.

The Indiana Scheduled Prescription Electronic Collection and Tracking program, or INSPECT, is compiling controlled substance information into EHRs statewide to make it easier to identify fraudulent prescriptions. INSPECT performs two critical functions, officials note. It maintains a warehouse of patient information for healthcare professionals, and it provides a critical investigative tool for law enforcement.

Bass said that if adverse medical events connected to improper use of medication were fewer or eliminated, it would generate significant savings. Moreover, she said, identifying risks for patients who struggle with their medication adherence and adding case management to the equation would help the patients.

“You can go in either direction here,” she said, but both would be extremely beneficial in the future bending of the cost curve.

NEHII partners with the Nebraska Department of Health and Human Services.

“They really are our state partners, and the state has to take the lead with this,” Bass said. “We deliver the technology and perform the work out in the field.”

The state partners are policymakers and administrators of the program, and they also work with NeHII on grant funding, as well as pharmacies and pharmacists.

“They deal on a regular basis with consumers that are asking t questions about medication protocol,” Bass said. “They understand that this can be a very helpful tool for prescribers rather than making frequent phone calls.”

NEHII and the Nebraska Department of Health and Human Services tapped Rockville, Maryland-based DrFirst to capture state prescription information and deliver it to its PDMP.

“NeHII is focused on sharing timely and accurate patient health information in a secure environment to improve patient care,” Bass said. “DrFirst is working closely with us to deliver the functionality we need to further enhance our PDMP, and provide a complete view of a patient’s prescription history and the ability to catch potential red flags, including adverse reactions and opioid abuse.”

There is this list of medications that are deemed “inappropriate” in the elderly

Beers revised: Drugs not to use in older adults

Just watch our “bureaucratic overlords” will use these medication databases and apply the “beliefs” in the Beers Criteria as to what medications many of us are allowed to take… it won’t make any difference if you have been taking them for years and never had any noticeable side effects and/or if side effects that happened with minor in comparison to the benefits of taking one or more medications together.

I have stated before that they are changing the nomenclature that their is no longer any addicts or opiate dependent people… everyone who is taking a opiate legally/illegally is suffering from the disease/condition of “opiate use/abuse disorder”.  Of course, these PMP can’t track someone using a opiate ILLEGALLY, but what about chronic pain pts that pass that 90 day threshold … are these new database going to start throwing RED FLAGS that a particular pt needs to be sent to REHAB ?

Could there be a RED FLAG thrown at the prescriber’s computer.. if there is a record of a benzo or muscle relaxant and opiate prescribed as being taken together and the prescriber’s computer system REFUSE/DENY sending the “offending prescriptions” to a pharmacy to be filled ?

IMO.. these BEERS CRITERIA are not much different than the CDC opiate dosing guidelines…. they are nothing more than guidelines/recommendation for healthcare professionals to be aware that there MAY BE SOME ADVERSE REACTIONS… as we all know… medical care should be individualized and “cookie cutter” treatment plans will not work for all pts.

How far away are we from there only being mostly a need for mid-level healthcare providers ( ARNP, NP, PA, Pharmacist) whose primary purpose is to collect symptoms, enter those into a computer and the artificial intelligence of the computer will produce a plan of treatment.. including medications ?

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https://www.natlawreview.com/article/opioid-crisis-emerging-false-claims-act-risk-trend

The government’s focus on the has been consistently expanding over the past year beyond manufacturers to reach prescribers and health care providers who submit claims to federal health care programs for opioid prescriptions. These efforts increasingly include investigations under the False Claims Act and administrative actions, in addition to the more traditional criminal approach to these issues.

With the Trump administration’s public health emergency orders, it is expected for the government’s enforcement activities, including those instigated by relators and their counsel, to grow in this area.

In Depth

For the past year, we have witnessed increasing governmental focus on the US opioid crisis. Pharmaceutical manufacturers and wholesale distributors have recently seen the most activity with lawsuits filed by almost every state, multiple municipalities and several Native American tribal nations seeking recovery of funds expended dealing with opioid abuse. The federal government, principally the US Department of Justice (DOJ) and the US Department of Health and Human Services Office of Inspector General (OIG), have begun to take actions that indicate their expanding focus on prescribers and health care providers who submit claims to federal health care programs for opioid prescriptions, as well as drug treatment and drug testing services. This activity is taking the form of criminal, civil, and administrative actions and claims audit efforts. With the Trump administration’s public health emergency orders, one can only expect to see the government’s enforcement activities, including those instigated by relators and their counsel, to grow in this area.

Medicare Strikeforce Activities

For years now, DOJ and OIG, with other partner law enforcement agencies, have used the summer months to stage significant orchestrated “takedowns.” This past July’s takedown was the first to feature, as described by OIG, “a large-scale federal and state partnership to combat health care fraud and the opioid epidemic.” This multi-agency, national enforcement operation is described by OIG as the largest in history, both in terms of the number of defendants charged and loss amount. More than 400 defendants in 41 federal districts were charged for their alleged participation in schemes involving more than $1.3 billion in false billings to federal health care programs. Of those subjects charged, 115 are medical professionals, with many of the charges involving improper or excessive prescription of opioids. Exclusion notices were served to 295 individuals (57 doctors, 162 nurses and 36 pharmacists) for conduct related to opioid diversion and abuse. The exclusion notices bar participation in, or submitting claims to Medicare, Medicaid and all other federal health care programs.

DOJ Activities

On January 30, Attorney General Jeff Sessions announced a surge of Drug Enforcement Administration (DEA) agents and investigators over the coming month and a half, focused on pharmacies and prescribers who are dispensing unusual or disproportionate amounts of opioid drugs. The DEA will examine distribution and inventory data reported to the DEA by prescription drug manufacturers and distributors for “patterns” and “outliers” for further investigation.

This follows Attorney General Sessions’ announcement on August 2, 2017, of the creation of the Opioid Fraud and Abuse Detection Unit, a new DOJ pilot program that aims to utilize data to identify physicians and pharmacies for investigation of their opioid prescription practices. This data analytics team is described as tasked with identifying physicians who are “writing opioid prescriptions at a rate that far exceeds their peers; physicians who have patients who died within 60 days of an opioid prescription; the average age of patients receiving these prescriptions; [and] pharmacies that are dispensing disproportionately large amounts of opioids.” As part of the program, DOJ will fund 12 assistant US attorneys for a three-year term to focus solely on investigating and prosecuting health care fraud related to opioid prescribers and pharmacies. These prosecutors will be based in Alabama, California, Florida, Kentucky, Maryland, Michigan, Nevada, North Carolina, Ohio, Pennsylvania, Tennessee and West Virginia.

Prosecutions are not limited to these jurisdictions. From Newark to New Orleans, there has been a noticeable uptick in the number of criminal convictions of physicians and pharmacists for opioid prescription practices. These cases further illustrate the “outlier”-driven approach the government is deploying to identify targets with higher than average prescription and dispensing rates for investigation.

The government’s efforts are also leading to civil cases as well. In 2017, two pharmacies paid $11.75 million and $2.175 million respectively, to settle False Claims Act (FCA) allegations predicated on the Controlled Substances Act, such as filling prescriptions that were incomplete, lacked valid DEA numbers or were for substances beyond various doctors’ scope of practice, and not keeping and maintaining accurate records for controlled substances. There have also been FCA settlements with physicians, clinics, wholesalers and manufacturers concerning opioid prescription issues.

OIG Activities

In addition to the stunningly large number of exclusion notices issued in the July 2017 takedown, OIG is mobilizing its administrative and audit resources to address the opioid crisis. At the American Health Lawyers Association fall conference, Deputy Inspector General for Investigations Gary Cantrell stated that OIG would be evaluating cases for potential civil monetary penalty and exclusion actions in coordination with DOJ’s investigative efforts.

In the same month, OIG issued an unusual “data brief” document discussing its data analysis of Medicare Part D opioid prescriptions. OIG found (1) “one in three Medicare Part D beneficiaries received a prescription opioid in 2016”; (2) about 500,000 beneficiaries (excluding cancer and hospice patients) received high amounts of opioids (defined as an average morphine equivalent dose of greater than 120 milligrams per day or at least three months); (3) almost 90,000 beneficiaries are “at serious risk” who either received “extreme amounts of opioids” or appeared to be doctor shopping; and (4) about 400 prescribers had “questionable opioid prescribing patterns for beneficiaries at serious risk … these patterns are far outside the norm and warrant further scrutiny.” 

For the last four months, OIG has added new items to its audit Work Plan concerning opioids.

In October, OIG added an item to examine the US Food and Drug Administration’s (FDA) use of its the authority to require pharmaceutical companies to develop Risk Evaluation and Mitigation Strategies (REMS) when FDA determines that the risk of using a drug outweighs its benefit. According to OIG, FDA stated it would use the REMS program to “increase the number of prescribers who receive training on pain management and safe prescribing of opioid drugs in order to decrease inappropriate opioid prescribing.” OIG will review how FDA determined the need for opioid REMS and determine the extent to which FDA has held pharmaceutical companies with required opioid REMS accountable for REMS assessments. OIG will also determine the extent to which FDA has held opioid REMS sponsors accountable for REMS goals to mitigate risks of misuse, abuse, addiction, overdose and serious complications because of medication errors. This audit topic may spur FDA to increase the use of, and scrutiny of existing, REMS programs.

• In November, OIG said it would conduct an analysis of Medicaid beneficiaries to, similar to the Medicare Part D data brief, identify beneficiaries who received extreme amounts of opioids through Medicaid and those cases that appear to involve doctor shopping or pharmacy shopping, as well as prescribers associated with these beneficiaries.
• In December, OIG announced an audit of states’ use of funding from the Centers for Disease Control and the Substance Abuse and Mental Health Services Administration (SAMHSA) to prevent opioid abuse and misuse. This audit could spur certain states to increase their activities, which could include detecting suspect Medicaid spending on controlled substances.
• Also in December, OIG announced an audit of technology/information security (IT/IS) operations and opioid prescribing practices at five Indian Health Services (IHS) hospitals to determine whether (1) IHS’s decentralized management structure has affected its ability to deliver adequate IT/IS services in accordance with federal requirements, and (2) hospitals prescribed and dispensed opioids in accordance with IHS policies and procedures. This audit topic may be of interest to health systems, physician practices and pharmacies as a step to take to monitor a facet of their opioid dispending patterns and controls.
• In January, OIG stated plans to release a toolkit as a follow up to the data brief “to assist public and private stakeholders in addressing the opioid epidemic.” The toolkit will provide information on how OIG analyzed a large dataset of opioid claims to produce patient-level opioid data, as well as how it calculated Morphine Equivalent Dose (MED) levels for these patients. This toolkit could be a valuable resource for providers to analyze their own prescriber data, as well as provide relators’ counsel and prosecutors with similar abilities.

Attention to the opioid crisis shows no signs of decreasing. Various government agencies are devoting substantial resources to addressing opioid abuse, including investigating and pursuing prescribers, health care providers and manufacturers. Organizations should consider the extent to which opioid prescription issues and practices are addressed by the compliance programs’ risk assessment and auditing and monitoring functions. 

If a doctor stops a pt’s opiate therapy… is this an admission that the prescriber has been providing – and charging insurance for – unnecessary medical services ? Should the pt file a complaint with the Medicare/Medicaid OIG office under the False Claim Act ?

it is very unusual that a opiate dependent chronic pain pt is healed to a point where they no longer need opiate therapy.  So if a prescriber is stopping a chronic pain pt’s opiate therapy… not necessarily because they are no longer in pain … but for some other reason… could all the time that the prescriber treated the pt for chronic pain and submitted bills to insurance be considered fraudulent  ?  And if a prescriber is doing this on all of his/her pts then there could be the possibility of a gross amount of fraudulent billing mounting into maybe HUNDREDS OF THOUSANDS OF DOLLARS…

Healthcare professionals seem to state over and over that they are protecting their licenses and the pt’s quality of life, well being, even their ability to function at some degree of “normal” or at least their previous “normal”.  At what point was the prescriber treating/charging for pt care that was no longer necessary?

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My name is xxxx.xxxxx & I have been on disability since 2005 due to chronic pain brought on by Degenerative Disc Disease, failed Lumbar Surgery, progressive spinal disc bulging and stenosis in both my Lumbar and Cervical spine, and Fibromyalgia. I have been on MS-Contin (100mg 3 times daily) for over 5 years and prior to this medication, I took meds that were just as strong, if not stronger. I also suffer from depression, generalized anxiety disorder, panic attacks, and Restless Leg Syndrome (which affects not only my legs, but my entire body), and within the last year I have developed seizures. I am currently in the testing process to see what is causing the seizures. I have had an MRI of my brain and it shows lesions in my frontal lobe. I have an appointment with a neurologist, but could not get in to see one until April 2nd. Due to the above conditions, I also take Alprazolam (Xanax–1mg twice daily as needed). I have been taking this medication on and off for well over 15 years for the anxiety disorder, panic attacks & restless leg/body syndrome. I have also found that if I take one as I feel a seizure coming on, it helps me to relax & makes for a smoother transition after the seizure passes. I am not in as much pain because I have not tensed up as much as I would normally have done if I had not taken the Xanax. It also shortens the seizure and nothing else has helped me except for the Xanax since these strange seizures have started. My Xanax is  prescribed by my psychiatrist, a completely different doctor than the one who prescribes my MS-Continue. My pain management doctor prescribes the MS-Contin. My dilemma is this:  After having Blue Cross & Blue Shield Federal Employee Health Insurance Basic Health Care & Pharmacy Program since 1/1/2008 & being prescribed these two medications together for most of that time, the Pharmacist at BCBS who’s in charge of my medications has denied my prescription for MS-Contin because I also take Xanax & this Pharmacist & the BCBS program has decided that I can’t take both of them together because it’s too dangerous. Mind you, they didn’t deny the much less expensive Alprazolam, which I could probably buy without the help of insurance for less than $20 per month, they’ve denied the Morphine Sulfate ER 100Mg (qty of 84 per month), which I now must pay (out of pocket) $170.00 per month! My pain management doctor tried to appeal this ruling & I was denied for a second time. Do you have any advice for me? Do I have any legal recourse over Blue Cross? If I start paying for my Xanax without using insurance will Blue Cross still know I’m getting it & continue to deny paying for my MS-Contin? I truly do need both of these medications! I’m not one of those drug shoppers who doctor shop trying to find places to get prescriptions for pain pills! I am truly in need! I had an appointment yesterday with a spine specialist because I have lesions on my spine that have grown since my last MRI & he is sending me for a bone scan & a CT scan. He told me, after looking at my MRI film, not to let any surgeon talk me into surgery because my spine is so bad that no amount of surgery will ever fix me. My only option is to live the rest of my life under the care of a caring Pain Management Physician who will prescribe the necessary medications to keep me as pain free as humanly possible & once I find a combination of meds that work for me I should stay the course and follow my doctor’s orders! How am I supposed to do that when my insurance company thinks they know me better than my doctor does? I thought I lived in America, but it’s starting to feel less like America and more like Russia or China. 

Is this just a way for the insurance company to SAVE MONEY by denying a pt their necessary medication by using very poor clinical data to justify their decision or they setting the pt up for some problems because the DEA considers it a RED FLAG for a pt to pay cash for a controlled substance when they have insurance… probably doesn’t make any difference to the DEA bureaucracy that the pt’s insurance won’t pay for the medication ?

Apparently BS/BS Federal has appoint a Pharmacist who doesn’t have prescriptive authority – to make medical decision probably based on some academic studies that suggests that there is the POTENTIAL for serious medication interaction… However, many of these academic studies have been concluded by what addicts have done in the past and had “bad outcomes”… In this particular incident, the pt had been taking the two medications for several years without any adverse events… so – IMO – anyone making a decision based on some academic data, that did not come from similar situations… is highly inappropriate and will adversely affect the pt’s quality of life.

Since these types of issues are literately EXPLODING… there is one avenue of action that these self-appointed medical experts may not even expect.  If the decisions and actions of these entities cause the pt’s quality of life (QOL) goes in the crapper and the pt becomes house, chair,bed confined… there is a possibility of suing for https://www.legalmatch.com/law-library/article/limits-on-damages-for-loss-of-society-companionship–consortium.html 

They will be expecting law suits for MAL PRACTICE but not being sued by the spouse and family…  In this particular case, being the insurer of Federal employees there is probably hundreds or thousands of other pts in the same situation… which could be the basis of a class action.  Attorneys look for large number of people harmed and “deep pockets” from the entity that caused it.

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Ohio imposing new rules on distributors to battle opioid epidemic

http://www.cantonrep.com/news/20180201/ohio-imposing-new-rules-on-distributors-to-battle-opioid-epidemic

Citing “vague and inconsistent” federal reporting standards, Ohio will require drug distributors to report and halt suspicious orders of prescription painkillers in hopes of further reducing opioid addiction and deaths.

The state’s proposed rules, expected to take effect in three to four months, would require drug distributors to detect — and not ship — suspicious orders of opioids to pharmacies and hospitals, such as orders that are large when compared to past purchases.

Ohio Board of Pharmacy officials and Gov. John Kasich outlined the proposal at a Thursday press conference at the Statehouse while admitting much still needs to be done to rein in street sales of opioids fueling an ever-increasing number of overdose deaths.

The more than 500 state-licensed drug distributors and wholesalers will be required to report more-detailed information to the state for analysis to flag distributors and pharmacies that may attempt to sidestep the new rules. Violations could lead to the loss of distributors’ state license.

The rules, which are being posted for public comment and feedback from distributors, would deem any opioid order in excess of 5,000 doses a month as suspicious and require further scrutiny.

A Cardinal Health, based in suburban Columbus, is one of the country’s largest distributors. A spokesman said in a statement, “We look forward to working with the governor and Board of Pharmacy on these important rules. We take our role in the supply chain seriously and as such we operate a state of the art system to prevent the diversion of opioids from legitimate medical use.”

Reporting requirements for pharmacies and physicians and limits on opioid prescriptions have reduced the amount dispensed by 20 percent from 2012 to 2016 while also reducing deaths,

but the availability of street drugs, particularly deadly fentanyl, remains alarming, Kasich said.

“The time has come for our communities to work to kill this devil that lurks on our streets, in our schools and in our communities,” the governor said of illicit opioid sales.

Drug overdoses, largely from opioids, killed 4,329 people in Ohio in 2016, a 24-percent increase over 2015 and the second-highest death rate in the nation, according to federal figures.

As part of the battle to fight opioid abuse and availability, a law that took effect Sept. 1 placed limits on the pain-pill prescriptions written by Ohio physicians, dentists and others. The new requirements limit patients to a seven-day supply of opioids — five days for minors — for the treatment of short-term pain. Refills can be prescribed only if physicians or other medical professionals document the need for extending pain-relief medication.

Prior to the law, voluntary guidelines cut the number of overdose deaths from opioid prescriptions from 667 in 2015 to 564 in 2016. State officials say 80 percent of those who died from drug overdoses in 2016 previously had received legally prescribed opioids.

Joined by several cities and counties in separate actions, the office of Attorney General Mike DeWine is suing five drug manufacturers for improperly peddling and profiting from opioid sales. Talks have started with some of the companies about a potential settlement to generate funds for opioid education and treatment.

DeWine has indicated he may sue drug distributors, but still is reviewing the matter, spokesman Dan Tierney said.

The attorney general was “encouraged” after attending a hearing in federal court in Cleveland on Wednesday before a judge working to broker a settlement of more than 200 opioid-related lawsuits filed by counties and municipalities against drug manufacturers and distributors.

“While our office is confident we will prevail in our lawsuit should it proceed to trial in Ross County, the process underway in federal court in Cleveland is notable in that it is seeking to provide substantive help to governments dealing with the opioid epidemic through reaching a settlement sooner,” Tierney said.

Someone needs to do the MATH on 5000 doses/month purchased by a pharmacy/month.. the average dose of Norco 10 is ONE TABLET FOUR TIMES DAILY… so any pharmacy filling more than 10 prescriptions PER WEEK would be exceeding this ARBITRARY MONTHLY LIMIT

Ohio has a population of 11.6 million.. so using conservative average estimates… Ohio would have 600,000 chronic pain pts are are 24/7 dependent on a opiate. and another 3+ million of chronic pain pts that have AT LEAST a “as needed” need for opiates to treat their pain.

On the other side of the coin… a dose of FENTANYL patch … a pt will only use 10 doses/month… so 5000 doses of Fentanyl would cover the needs of 500 pts for a month but 5000 Norco doses would only cover the needs of 40 + pts.  Some very busy pharmacies will dispense 5000 Norco doses EVERY DAY.

Then there are reports out of Ohio where 99% of the OD’s … illegal Fentanyl showed up in toxicology 

Dayton Ohio area: 99% of opiate OD’s tested positive for ILLEGAL FENTANYL ANALOG

And how is restricting opiate distribution from wholesalers going to address the illegal opiates that are flooding the streets in Ohio ?

Since it seem apparent that this new  law could be in violation of the Americans with Disability Act… since a lot of the restriction are focused directly at the millions of Ohio pts who have a valid medical need for opiates.

One thing that my money is on is that the ACLU will NOT GIVE A SHIT about all of these civil rights and human rights being denied by the state of Ohio.  Since violation of the civil rights of chronic pain pts has never been part of their agenda.

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I received this from my Part D provider – as part of larger mailing.  Notice the first paragraph and YOUR FEDERAL CIVIL RIGHTS when it comes to prescriptions filled under the Medicare Part D program as well as Medicaid. While I am not an attorney, these same rights should apply to all services provided to Medicare/Medicaid folks and billed to those two entities.

If a pharmacist refuses to fill a  prescription… then the pharmacist must have FACTS that the person presenting the prescription is trying to obtain a controlled substance for non-valid medical needs – which is illegal.  So a pharmacist that just refused to fill the prescription and returns it to the patient… is possibly violating the Controlled Substance Act (CSA) for not confiscating the illegal prescription and/or not calling the police and having the person arrested for trying to fill a controlled substance prescription for a non-valid medical need.  Floating around in this area is probably unprofessional conduct… which is a violation of the state’s pharmacy practice act.

If the Pharmacist returns the prescription to the person and that person is able to get a pharmacist at another store.. then we face the situation that one pharmacist either filled a “bad prescription” or one pharmacist discriminated against the pt for refusing to fill a prescription.  Recently, I have seen where pts are stating that Pharmacist have moved from the excuse of “I’m not comfortable” to “I don’t have inventory”… all pharmacies are required by Federal/State law to maintain a perpetual inventory on all C-II’s..  It should be able to determine what inventory was on hand for a particular C-II on any date/time.  Many pharmacies – mostly independents – can get a C-II order from the wholesaler 5 days a week and many chains only get C-II orders weekly.  I know that the Indiana Pharmacy Practice act has a mandate that pharmacy are required to stock medications “commonly used in the store’s market place”…

Would the board of pharmacy investigate a complaint from a pt that a pharmacy is violating that part of the practice act… “I’m out of stock” on a routine basis.. I don’t know… IF a pt could get them to investigate if inventory on hand on a particular day/time that the pt was denied having a prescription filled… then by violating the state’s pharmacy practice act.. would be a step forward in proving that the pt was discriminated against because of the medication that they need to treat their handicap.

What if a pt goes to a pharmacy and hands over a handful of prescriptions and the pharmacy is glad to fill all the non-controlled Rxs but “conveniently”  “out of stock ” of any controls the pts needs. A pharmacy is never going to have on hand medications for a prescriptions presented 100% of the time, but most pharmacies can get non C-II’s within a couple of days at most.

This civil rights issue.. could it be used to challenge the formulary of the part D provider… especially when they stop covering a particular class of medication and/or apply quantity limits on a particular class of medication and/or medications that treat a particular category of disease states ( ie pain management)

In this letter it directs the pt to file a grievance with the part D provider.. is that like filing a complaint/grievance with the fox because all the chicken in the hen house are dead ? There is a complaint process at the Federal level for Medicare/Medicaid by calling 800-MEDICARE or www.cms.gov

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