Wednesday, July 9, 2014
Please share this Fraud Alert with colleagues, consumers, or other professionals in your area. If you have any questions about the Illinois SMP program, or to receive these Fraud Alerts directly, please contact Jason Echols, Healthcare Consumer Protection Coordinator at AgeOptions.
This document was supported in part by a grant (No. 90MP0163 & 90SP0061) from the Administration on Aging (AoA), Administration for Community Living (ACL), U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official AoA, ACL, or DHHS policy.
Fraud In The News
The following are current news articles about health care and fraud issues.
Health Care Fraud:
1. “Nation’s Largest Nursing Home Pharmacy Company to Pay $124 Million to Settle Allegations Involving False Billings to Federal Health Care Programs” (DOJ): http://www.justice.gov/opa/pr/2014/June/14-civ-670.html
Consumer Fraud:
2. “7 Telltale Signs of a Job Scam” (AARP): http://blog.aarp.org/2014/06/27/7-tell-tale-signs-of-a-job-scam/
3. “A Scam-Free Vacation” (FTC): http://www.consumer.ftc.gov/blog/scam-free-vacation
4. “The Hazards of Hoteling” (FTC): http://www.consumer.ftc.gov/blog/hazards-hoteling /
Dear SMP readers,
This week’s Fraud Alert contains information about a Medigap lead generator mailing, a report on CMS’ Fraud Prevention System, and a report on the national SMP Program for calendar year 2013.
Have a great week!
What you will find in this week’s Fraud Alert
· Medigap Lead Generators: Did Medicare Change January 1st?
· $210 Million of Improper Payments Found by CMS System
· National SMP Program Data for 2013
Medigap Lead Generators: Did Medicare Change January 1st?
Recently, an Illinois resident received a letter titled “Medicare Information Update” that asked for the his and his spouse’s date of birth and phone number. The letter stated that “As of January 1st, Medicare has made changes that affect you and your health care expenses… mean[ing] that you must pay even more towards your own health care.” The recipient of this letter did not respond because he knew that Medicare already has his information and does not contact beneficiaries in this way.
This letter is a type of marketing tool, known as a lead generator, which collects people’s names, phone numbers, and other information for a salesperson to follow up on. These lead generators often contain a notice in smaller print that this is not affiliated with any government agency or Medicare. This letter also had small print that said a representative may call. If you choose to return these cards, you will likely receive calls trying to sell you something.
The product being sold in this lead generator is Medicare Supplement Insurance or Medigap. Medigap is a private insurance plan that you can buy to help cover Medicare premiums, deductibles, and co-insurance costs. An insurance agent might call if you return this letter. The letter is accurate in saying that Medicare costs changed on January 1st, but the change that happened is just a cost of living adjustment to monthly premiums that happens every year and is a normal part of Medicare.
There is free, unbiased information available about Medigap plans from the Illinois Department on Aging’s Senior Health Insurance Program (SHIP). SHIP has volunteers that can help you choose a plan that is right for you. Call (800)252-8966 to find your local SHIP counselor. You could also find and contact the local senior service agency in your area at www.eldercare.org.
$210 Million of Improper Payments Found by CMS System
According to a recent report from the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), the Centers for Medicare and Medicaid Services (CMS) identified or prevented $210 million in improper payments during the second year of its Fraud Prevention System. As a result, CMS was able to take action against 938 providers or suppliers. The Fraud Prevention System uses predictive algorithms to look for billing patterns that are suspicious or potentially fraudulent. The system flags these claims before they are paid. To read the OIG report and the CMS press release follow this link: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-06-25.html
National SMP Program Data for 2013
Each year, the HHS OIG reviews and compiles data for the 54 SMP Programs across the United States and releases a report on this performance data. Nationally in 2013, there were 5,406 active SMP volunteers and 14,924 group education sessions conducted across the country. The Illinois SMP at AgeOptions is proud to be a part of this program, and we thank our volunteers and partners for helping us achieve this outreach in 2013. Read the OIG press release and full report here: http://oig.hhs.gov/oei/reports/oei-02-14-00140.asp
Jason B. Echols, MSW, Health Care Consumer Protection Coordinator
AgeOptions
1048 Lake Street, Suite 300
Oak Park, IL 60301
phone (708)383-0258 fax (708)524-0870
ageoptions.org
AgeOptions, the Area Agency on Aging of Suburban Cook County, is committed to improving the quality of life and maintaining the dignity of older adults and those who care about them – through leadership and support, community partnerships, comprehensive services, accurate information and powerful advocacy.
Fraud Alerts contain information about current scams taking place in Illinois, announcements and updates about programs or services related to health care and/or fraud protection, and links to news articles about health care and fraud topics. Please forward any recommendations or announcements that you would like to be included in a future Fraud Alert to .