protect yourself from health care scams and frauds yourself from health care scams and frauds...
TRANSCRIPT
Protect Yourself fromHealth Care Scams and Frauds
Welcome
Why AARP is doing this presentation
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How Big is the Problem?
Government Accountability Office estimates10% of all health care spending came fromfraud and abuse
Centers for Medicare and Medicaid Servicesloses $65 billion to criminals each year
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Agenda
Scams related to the new health care law
How to spot
How to report
Fraud related to the health care system
How to spot
How to report
New anti-fraud enforcement measures4
Scams to Spot
“Help” getting the $250 doughnut hole rebate check
The Law:
It was a check for people in the doughnut hole
Came automatically
Didn’t have to apply
Scam:
“I’ll help you get your check”
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Scams to Spot
Selling “new” insurance
The Law:
Temporary coverage for those with no insurance
Coverage for young adults
Exchanges
Medicare
Scam:
Selling door-to-door, over the phone, or by email
Claiming to be government representative
Pushing new insurance not yet available6
Scam Red Flags
Need” new Medicare card
“Limited time offer” sales pitch
“Free information” post card
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Scam Safety Tips
No government representative sells insuranceover the phone or door to door or by email
Rely on official sources of information
Verify with whom you are dealing
Check the facts
Get it in writing
Don’t give out personal information
Check the licenses 8
Report Scams
State insurance department
State Attorney General
Local law enforcement
Medicare
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Get Questions Answered
State Health Insurance Counseling andAssistance Programs
www.Medicare.gov
www.healthcare.gov
www.aarp.org/getthefacts
www.aarp.org/medicare
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How Health Fraud Happens
“Up-coding”
Undelivered services
Paying kickbacks
Stealing identities
Mistreating patients
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Multi-Million Fraud Scheme
ATTORNEY GENERAL CUOMO ANNOUNCES ARRESTS INMULTI-MILLION DOLLAR MEDICAID FRAUD SCHEMERUN OUT OF THREE NEW YORK CITY DENTAL CLINICS
Defendants Allegedly Stole $5.7 Million From Medicaid FundNEW YORK, N.Y. (June 2, 2010)
The xxxx and xxxx paid recruiters, known as “flyer boys”, to bring Medicaidrecipients to the clinics, and paid the recipients to get treatment, whethermedically necessary or not. The Medicaid recipients were sometimes brought tothe clinics from homeless shelters, and were paid cash as well as gifts such as CDplayers and McDonald’s gift certificates. In terms of the “flyer boys,” the moreMedicaid recipients they brought in, the higher the pay.
The operation employed dozens of dentists who were often required to pay two thirdsof their Medicaid billings to the defendants. It is alleged that xxxx, a high-billingdentist in the clinics, actively exhorted the flyer-boys “to go out and get morepatients.”
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Worker Sentenced
Office of the Nevada Attorney General
FOR IMMEDIATE RELEASE
DATE: June 2, 2010
WORKER SENTENCED FOR MEDICAID FRAUD
…The investigation began in 2008 after information was obtained that personalcare aid services were not being provided to a Medicaid recipient. Medicaidhas a personal care aid program to keep people living independently in theirown homes by providing basic services, including bathing, dressing, housecleaning and meal preparation. Medicaid contracts with home carecompanies that in turn employ individuals to provide the actual day-to-daycare. The investigation developed information that xxx was not at a patient’shome for the time periods she claimed to be providing services.
District Court Judge Y sentenced xxx to 60 days in jail, suspended, 120 hours ofcommunity service, payment of $15,300.00 in restitution, penalties, andcosts, plus 5 years probation.
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Pharmacist Pleads Guilty
TRENTON, June 1, 2010: New Jersey Attorney General announces that aHoboken pharmacist pleaded guilty today for his role in a scheme todefraud the Medicaid program.
In pleading guilty, xxx, a pharmacist in charge at xxx Drugs, admitted that betweenJan. 1 and Oct. 9, 2009, he submitted claims to the Medicaid program forprescription drugs allegedly dispensed to Medicaid beneficiaries, even though theprescription drugs were never dispensed.
The investigation by the Medicaid Fraud Control Unit of the Office of the InsuranceFraud Prosecutor revealed that xxx accepted fictitious prescriptions fromundercover Detectives as payment for narcotic prescription drugs. xxx then billedand was paid by Medicaid even though the prescriptions were not filled ordispensed.
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Former State Employee ChargedIn “Double-Dip” SchemeTo Defraud Medicaid
May 27, 2010 -- … According to the arrest warrant affidavit, Mr. xxxx was afull-time employee of the Connecticut Department of DevelopmentalServices while also engaged in private practice as a licensed clinical socialworker.
A 2007 DSS audit disclosed that Mr. xxxx had billed the Medicaid programfor professional services he claimed to have rendered during the sametime that he was being paid for his work as a state employee, thewarrant alleges.
Between January 2006 and December 2007, Mr. xxxx collected his statesalary and also submitted claims to Medicaid for private professionalservices totaling $166,798.99.
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AG's Office Gets 4 Indictments forMedicaid Fraud
Sunday, May 02, 2010
(ALBUQUERQUE)---New Mexico Attorney General GaryKing's Medicaid Fraud and Elder Abuse (MFEA) Divisionsucceeded in obtaining grand jury indictments on 26 felonycharges against three individuals and one business in analleged long-term Medicaid fraud scheme.
… Defendant xxx is accused of fraudulently billing the NewMexico Medicaid program for counseling services she neverprovided. She allegedly billed the state for 54 hours ofcounseling in a single day.
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AG’s Medicaid fraudinvestigators recover for NC
Release date: 4/28/2010
…xxx previously worked as an officer manager for xxx, a company that providesambulance services. Investigators discovered that from 2006 to 2008, xxxunlawfully billed Medicare and Medicaid for more than $650,000 bysubmitting false claims for ambulance trips to take clients to and fromdialysis treatments. Patients were usually transported to routine dialysistreatments by van, but xxx repeatedly falsified trip records and relateddocuments to make it appear that patients needed to be taken by ambulancefor medical reasons. …
On March 23, a United States District Court judge sentenced xxx to 46 monthsin prison followed by three years of supervised release. Under a pleaagreement, xxx will also pay $677,272 in restitution to Medicare andMedicaid.
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Missouri AttorneyGeneral’s Press Release
March 23, 2010
Koster says Joplin dentist sentenced for 13 felony counts ofMedicaid fraud --must repay state $550,000—
Xxx submitted fraudulent billings for procedures such as x-rays, rootcanals, and resin-based composite restorations he did not perform.
Xxx tried to conceal his false claims by creating false dental records,physically cutting off portions of dental records and taking x-raysfrom one patient's file and putting it in another. xxx came underinvestigation because a citizen reported her suspicions that he wascommitting fraud.
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What You Can Do
Stay smart about your health care
Read your billing statement
Guard your insurance identification
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What You Can Do
Ask:
Are there charges for something you didn’t get?
Are there charges for services that are not medicallynecessary?
Were you billed for the same thing more than once?
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What You Can Do
Contact the provider—it might be an innocentmistake
Report to authorities—it might not!
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Tips to Avoid Fraud
Keep your personal medical information fromthe wrong hands
Only carry your Medicare card when youare going to a doctor’s appointment, ahospital or clinic, or pharmacy
Never sign blank insurance claim forms
Be alert to “free” medical services
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What Will You Do?
You get an offer for a free three-day trip to LasVegas if you go to a clinic to get a freediagnostic test.
You will:
a)Make an appointment
b)Hang up
c) Report the fraud
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What Will You Do?
You get a call from a medical supply companysaying that Medicare made a mistake inpayment. The company wants your SocialSecurity number and bank accountinformation so they can transfer funds to youraccount.
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What Will You Do?
You will:
a)Give your bank account number
b)Hang up
c) Report the fraud
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Where to Report
MedicareCall: 1-800-MEDICARE (1-800-
633-4227)
Report fraud to the InspectorGeneral
• email: [email protected]
• Call: 1-800-HHS-TIPS / (1-800-447-8477)
• www.stopmedicarefraud.gov
Senior Medicare Patrol (SMP)
[enter state number]
Your Insurance Company’sFraud Division
Phone number on EOB
State Attorney General
[enter state number]
State Insurance Department
[enter state number]
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Fraud Enforcement
HEAT - Health Care Fraud Prevention andEnforcement Action Team
Double size of Senior Medicare Patrol
More inter-agency cooperation
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THANK YOU!!
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