April 2017 Fraud Prevention Fact

The Missouri SMP wants you to be a wise consumer when it comes to your everyday health care. That probably means avoiding health screenings offered by strangers in malls, church basements or trailer offices.

For example, Medicare pays for an Annual Wellness Visit every year. The visit includes a health risk assessment based on medical history, risk factors for depression, functional ability, falls risk, and cognitive function. These health issues are best discussed with your own personal physician.

The Senior Medicare Patrol has received reports that companies are using aggressive phone calls and flyers to advertise services available for a short time in a temporary location. They say they offer prevention screenings, and often offer additional tests, which have out-of-pocket costs. When the beneficiaries go to the temporary clinic, they are asked for their Medicare information. Without the beneficiaries’ knowledge, the clinic bills Medicare for the Annual Wellness Visit. When the beneficiary goes to his own doctor for that Wellness Visit, Medicare denies the claim because the mobile clinic has already charged for it. Medicare will pay for only one each year.

If you need a screening, always call your doctor first.  Always be wary of health providers that offer free screenings and ask for your Medicare number and insurance information.  Don’t give your Medicare or insurance information for a free service. You could wind up with expensive bills or tests you don’t need. And, if Medicare pays for something you don’t need, it may not pay later for services that you really do need.

If you suspect Medicare fraud or abuse, call the Missouri Senior Medicare Patrol at (888) 515-6565.  SMPs are funded through the U.S. Department of Health and Human Services, Administration for Community Living, Administration on Aging.

FTC Bans Cash Transfers

FTC Amends Telemarketing Rule to Ban Payment Methods Used by Scammers

 

Following a public comment period, the Federal Trade Commission has approved final amendments to its Telemarketing Sales Rule (TSR), including a change that will help protect consumers from fraud by prohibiting four discrete types of payment methods favored by con artists and scammers.

“Con artists like payments that are tough to trace and hard for people to reverse,” said Jessica Rich, Director of the FTC’s Bureau of Consumer Protection. “The FTC’s new telemarketing rules ban payment methods that scammers like, but honest telemarketers don’t use.”

The TSR changes will stop telemarketers from dipping directly into consumer bank accounts by using certain kinds of checks and “payment orders” that have been “remotely created” by the telemarketer or seller. These two payment mechanisms make it easy for unscrupulous telemarketers to debit bank accounts without consumers’ permission, and can make it difficult to reverse the transactions with consumers’ banks.

In addition, the amendments will bar telemarketers from receiving payments through traditional “cash-to-cash” money transfers – provided by companies like MoneyGram, Western Union, and RIA. Scammers rely on cash transfers as a quick, anonymous, and irretrievable method to extract money from consumer victims – once it is picked up by the recipient, the money is gone.

The TSR changes also will prohibit telemarketers from accepting as payment “cash reload” mechanisms – such as MoneyPak, Vanilla Reload, or Reloadit packs used to add funds to existing prepaid cards. Scammers use the cash reload mechanism to apply the funds to their own prepaid debit cards and disappear with the money. In 2015, major cash reload providers replaced cash reload mechanisms with a swipe reload process, a safer alternative not affected by the TSR amendments.

As detailed in the Federal Register notice announcing the Final Rule, the amendments address changes in the financial marketplace to ensure consumers remain protected by the TSR’s antifraud provisions, but are narrowly tailored to allow for innovations with respect to other payment methods that are used by legitimate companies. According to the statement of basis and purpose accompanying the notice, the final rule also will:

  • Expand the advance-fee ban on recovery services to include losses both in prior telemarketing and non-telemarketing transactions; and
  • Require that a description of the goods or services purchased must be included in the tape recording of a consumer’s express verifiable authorization to be charged.

In addition, the TSR amendments update several provisions related to the National Do Not Call (DNC) Registry to, among other things:

  • Expressly state that a seller or telemarketer has to demonstrate that it has an existing business relationship with, or has received an express written agreement from, a consumer it calls if the consumer’s number is on the DNC Registry;
  • Illustrate the types of burdens that deny or interfere with a consumer’s right to be placed on a seller’s or telemarketer’s entity-specific do-not-call list;
  • Specify that if a seller or telemarketer does not get the information needed to place a consumer’s number on its entity-specific do-not-call list, the seller or telemarketer is disqualified from the safe harbor for isolated or accidental violations; and
  • Emphasize that sellers are prohibited from sharing the cost of the fees to access the DNC Registry

The Commission vote approving publication of the notice in the Federal Register was 3-1, with Commissioner Maureen Ohlhausen voting no.

Chairwoman Edith Ramirez and Commissioners Julie Brill and Terrell McSweeny issued a Commission statement, which also was approved by a 3-1 vote, with Commissioner Ohlhausen voting no and issuing a separate statement, dissenting in part.

Most provisions of the final rule will become effective 60 days after publication.

The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC’s online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 2,000 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s website provides free information on a variety of consumer topics. Like the FTC on Facebook, follow us on Twitter, and subscribe to press releases for the latest FTC news and resources.

Koster announces settlement for Medicaid program

JEFFERSON CITY – Attorney General Chris Koster announced a settlement with two drug companies Wednesday that will return more than $630,000 to Missouri’s Medicaid program.

AstraZeneca Pharmaceuticals, a London and Delaware-based pharmaceutical manufacturer, and Cephalon, Inc, a Pennsylvania-based subsidiary of Teva Pharmaceuticals Industries, allegedly underpaid drug rebates owed to the states.

An anonymous complaint alleged that the companies improperly treated certain fees paid to wholesalers as “discounts,” in order to decrease the rebates paid to the states.

“Huge pharmaceutical companies like AstraZeneca and Cephalon must not be allowed to extend their profits by withholding money they owe to the states,” Koster said. “I am glad we are able to recover more than $630,000 for Missouri’s Medicaid program.”

Missourians can report suspected Medicaid provider fraud and abuse through the Attorney General’s Medicaid Fraud Hotline at 800-286-3932 or online at ago.mo.gov.

Avoid Becoming a Victim

After one Medicare beneficiary responded to an ad for a “free” back brace, she had second thoughts.
Research yielded information about a Medicare scam. With an uptick in unneeded medical equipment being authorized, consumers should be aware. Click here for an article that includes expert tips on how to avoid becoming a victim of Medicare fraud.

On the Front Lines

In the government’s crackdown against Medicare fraud, keeping up with the scoundrels is an endless challenge. The scams are getting larger and more sophisticated. And you never know where they are going to pop up next. Click here to read an article from AARP.

To learn how the Senior Medicare Patrol program helps beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse, click here.

Force Strikes Big

June 18, 2015Fire

A nationwide sweep led by the Medicare Fraud Strike Force results in charges against 243 individuals, including 46 doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings. CMS suspends providers using authority from the Affordable Care Act. This coordinated takedown is the largest in Strike Force history, both in terms of the number of defendants charged and loss amount. Click here to read a press release from HHS.

Fraud Cloaked as ‘Free’ Services

 

Pedicures, knee braces, and genetic testing: These are some of the many “free” products supplied to seniors unnecessarily that drain Medicare’s funds. When one Texas senior got suspicious, she contacted her local Senior Medicare Patrol. Click here to read a story that describes why “free” isn’t really free.

This website was supported in part by a grant No. 90-SP-0025 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.