Sheriff, banker address ‘Scamboree’ in Clinton

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Among the rip-offs facing seniors are the IRS scam and the grandparents scam, Henry County Sheriff Kent Oberkrom told a group at the Clinton Senior Center.
Both of these scams involve imposters phoning unsuspected consumers and trying to get money or personal information.
More than 40 seniors gathered at the Clinton Senior Center Friday to arm themselves against scammers and fraudsters at a “Scamboree” sponsored by the Missouri Senior Medicare Patrol (SMP).
In the IRS scam, fraudsters call a taxpayer and demand he give a credit card or other form of payment immediately – or face arrest by the local sheriff’s or police department.
“That’s not going to happen,” Oberkrom told the group. “The IRS will not call you, and the IRS will not use local authorities to collect back taxes.”
In what’s known as the grandparent scam, a fraudster will use Facebook or other sources to find out enough about the victims to pose as a friend of a grandchild or other relative. The scammer usually is frantic, telling the victims that the grandchild is in trouble – injured or in jail – and needs money immediately. The goal is to unnerve the victims and prompt them to send money without thinking through the situation.
People who receive such phone calls should hang up and report them, the sheriff said.
“If you get scammed, you should report it. These people can be caught. If you don’t report these things, we cannot alert more people about it,” he said.
The sheriff said authorities work with merchants who sell money-grams or gift cards to be on the lookout for seniors who unknowingly may be sending their money to scammers.
“We try to educate, and a lot of these things will get headed off,” Oberkrom said.
Oberkrom was one of several speakers at the Scamboree event.
Dave Garnett, Regional President of Hawthorn Bank, encouraged the audience to embrace technology as a more secure method of conducting financial transactions.
“Don’t be afraid of these things,” Garnett said of banking via debit cards and the Internet.
Federal regulations require banks to provide more protection to consumers who conduct business on the Internet and using debit cards than to those who use paper checks and cash. That means it’s easier to get money refunded if someone steals bank your account numbers.
“Your paper check actually does have information on it that would be useful to a scammer,” he said, pointing out at that each check has a routing and account number. “If you do use paper checks, don’t use your mailbox at home to send them; use the U.S. Postal Service mailbox so that it’s less likely those are going to be intercepted.”
The Scamboree event, co-sponsored by the senior center and Missouri SMP, is one of several statewide activities to help seniors protect themselves against fraud. The mission of the Missouri SMP is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report healthcare fraud, errors, and abuse through outreach, counseling, and education. For more information, call 888-515-6565.

SMP to present on health care journal on Feb. 22

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The Missouri Senior Medicare Patrol (SMP) will give a short presentation on how Medicare beneficiaries can keep track of their health care information and help prevent fraud.

The presentation will be 12:30 p.m. Feb. 22 in the dining room of the Warrensburg Senior Center, 445 E. Gay. It will be free and open to the public.

Participants will receive a free copy of the SMP Personal Health Care Journal, which helps seniors keep track of their health care information.

The journal has pages that help people keep track of appointments, providers, medica- tions, blood pressure and other health data, as well as questions to be answered, preventive screenings covered, and services received.

Keeping records makes it easier for consumers to compare medical bills to explanations of benefits and Medicare Summary Notices. That practice is key to detecting and preventing Medicare fraud and abuse, which costs an estimated $60 billion annually, according to the Na- tional SMP Resource Center.

“These fraud estimates, which break down to about $6.8 million an hour, make benefi- ciaries essential in fighting Medicare fraud and abuse,” said Rona McNally, Director of the Missouri SMP. “We believe the Health Care Journal is a powerful tool for seniors.”

To find out more, call the SMP at 888-515-6565.

January Fraud Prevention Fact: Take care of yourself!

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Happy New Year from the Missouri SMP! If you are like many folks, you have made some resolutions to take better care of yourself in this new year. Now more than ever, Medicare insurance can help you keep that promise.

According to the Centers for Medicare and Medicaid Services, millions of people with Medicare have taken advantage of expanded benefits. These include preventive services, cancer screenings, and yearly wellness visits. Many of these are available without additional costs to you.

One way you can stay healthy is to get disease prevention and early detection services. These include exams, shots, lab tests, screenings, monitoring, and counseling. If you take advantage of such services, your doctor can find health problems early when they are most treatable. Proper preventive medicine can keep you from getting some diseases as well.

The best source to find out which of these services you need is your doctor or health care provider. You also may check online at medicare-dot-gov to find a two-year calendar of Medicare-covered tests and screenings.

As always, check your Medicare Summary Notices or Explanation of Benefits to make sure you received the services for which Medicare is billed. Report suspected Medicare fraud to 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.

Ambulance Company Owner and Brother Convicted in $6 Million Health Care Fraud Conspiracy

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Here is a news release that the Missouri SMP wants to share with our readers. Please be aware of scam artists and how they bilk Medicare. It affects us all.
Department of Justice
U.S. Attorney’s Office
Southern District of Texas

HOUSTON – Two brothers have been convicted on charges of conspiracy to commit health care fraud, health care fraud and money laundering, announced U.S. Attorney Kenneth Magidson.

Kevin Olufemi Davies, 29, and his brother Melvin Olusola Davies, 28, owned and operated KMD Healthcare Services Inc. (KMD) from their home in a gated townhouse community in Houston. As part of their guilty pleas, they admitted they used stand-in emergency medical technicians (EMT) who were not employees or affiliated with KMD to pass the state inspection necessary for enrollment in the Medicare program.

Medicare and Medicaid only pay for medically necessary ambulance services in vehicles designed and equipped to respond to medical emergencies and for patients who cannot be safely transported by any other means of transportation. Medicare also requires two individuals to staff ambulance transports, including at least one licensed EMT.

The brothers admitted that KMD transported Medicare beneficiaries in private passenger vans and that only one EMT was present. The EMTs wrote up ambulance “run sheets” even though the Medicare beneficiaries did not travel by ambulance and did not need ambulance services. The individuals transported were not bed bound, could walk and routinely used non-ambulance transport in their daily activities. One patient even walked to her own therapy session, but KMD billed Medicare $51,952 for her ambulance transportation.

The brothers admitted they paid a Houston physician $500 per medical necessity order in order to bill Medicare.

KMD billed Medicare, Medicaid and Tricare (another government health program) approximately $6,293,108 in false and fraudulent claims for ambulance services that were not provided and not medically necessary. They received at least $2,201,137 from Medicare, $219,924 from Medicaid and $16,735.29 from Tricare as payment for those claims.

The brothers have agreed to forfeit vehicles they purchased with the fraudulent health care proceeds, including a 2010 Porsche Panamera and a 2012 Mercedes Benz CLS. They have also agreed to pay full restitution to the health care programs.

U.S. District Judge Lynn Hughes accepted the pleas today and has set sentencing for March 13, 2017. At that time, the Davies face up to 10 years in federal prison on each count of conviction as well as a possible $250,000 fine. Both defendants have been in federal custody since their arrest on May 25, 2016, where they will remain pending that hearing.

The FBI, IRS – Criminal Investigation, Texas Office of the Attorney General’s Medicaid Fraud Control Unit conducted the investigation. Assistant U.S. Attorney Julie Redlinger is prosecuting the case.

Jury Finds Doctor Guilty in Largest-Ever Home Health Care Fraud

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Here is a story from Home Health Care News about one who got caught, but not before perpetrating nearly $375 million in health care fraud.

By Mary Kate Nelson | April 17, 2016

A Dallas physician and three home health agency owners have been found guilty of committing the nation’s largest home health care fraud involving a single doctor.

Jacques Roy, a 58-year-old physician from Rockwall, Texas, and three owners of Texas home health agencies—Cynthia Stiger of Dallas, Wilbert James Veasey, Jr. of Dallas and Charity Eleda of Rowlett—were found guilty on April 13 of conspiracy to commit health care fraud, stemming from their roles in an almost $375 million health care fraud scheme, the Department of Justice announced.

Roy, Veasey, Stiger and Eleda were each convicted by a federal jury on one count of conspiracy to commit health care fraud. Additionally, Roy was convicted on eight counts of health care fraud, two counts of making a false statement relating to health care matters and one count of obstruction of justice.

Veasey and Eleda were convicted on three and four counts of health care fraud, respectively, and Eleda was also convicted on three counts of making false statements for use in determining rights of benefit and payment by Medicare.

Roy has been in federal custody since his arrest on February 28, 2012. He owned and operated Medistat Group Associates, P.A., an association of health care providers that provided home health certifications and conducted home visits with patients. Veasey and Stiger, who owned and operated Apple of Your Eye Healthcare Services, Inc., and Eleda, who owned and operated Charry Home Care Services, Inc., were arrested on charges in the same indictment as Roy.

During the six-week-long trial, the government presented evidence that Roy, Veasey, Stiger and Eleda engaged in a large-scale, sophisticated health care fraud scheme during which they schemed together and with others to defraud Medicaid and Medicare through agencies they controlled or owned.

Veasey, Stiger and Eleda, as part of the conspiracy, worked with others to improperly recruit people with Medicare coverage to sign up for Medicare home health care services, the DOJ said. Eleda recruited patients from a homeless shelter in Dallas, at times paying recruiters $50 per beneficiary they found and directed to her car parked beyond the shelter’s gates. Eleda and other nurses would falsify medical documents to make it seem as though those beneficiaries qualified for home health care services that were actually medically unnecessary. Eleda and the nurses also prepared Plans of Care (POC) that were not medically necessary, and these POCs were delivered to Roy or a different doctor working under his direction at Medistat.

Roy, then, instructed his staff to certify these POCs, which indicated to Medicaid and Medicare that a physician, usually Roy, had reviewed the treatment plan and found it medically necessary. That certifying doctor, usually Roy, certified that the patient needed home health services, which were only allowed to be provided to those individuals who were homebound and required skilled nursing, among other things. This process was repeated for thousands of POCs, and Medistat’s office actually had a “485 Department,” essentially a “boiler room” to affix fraudulent certifications and signatures, the DOJ said.

Once an individual was wrongly certified for home health care services, Eleda, nurses who worked for Veasey and Stiger, and other nurses falsified visit notes to make it seem as though skilled nursing services were being provided and remained necessary. Roy would also visit the patients, perform unnecessary home visits, and then order medically unnecessary services for the recruited beneficiaries. Then, under Roy’s orders, Medistat employees would submit fraudulent claims to Medicare for the certification and recertification of unnecessary home health care services and additional unnecessary medical services.

The scope of Roy’s fraud was huge: Medistat processed and approved POCs for 11,000 unique Medicare beneficiaries from over 500 different home health agencies, the DOJ said. Roy entered into informal and formal fraudulent arrangements with Charry, Apple, Ultimate and other home health agencies to guarantee his fraudulent business model worked and that he maintained a steady stream of Medicare beneficiaries.

Sentencings for those found guilty are scheduled for this fall, the DOJ said. Each health care fraud and conspiracy count carries a maximum statutory penalty of 10 years in federal prison and a $250,000 fine. The obstruction of justice count and each false statement count carry a maximum statutory penalty of five years in federal prison, as well as a $250,000 fine.

Three additional defendants who had been charged in the case—Cyprian Akamnonu and his wife, registered nurse Patricia Akamnonu, and Teri Sivils—each pleaded guilty before trial to one count of conspiracy to commit health care fraud. Sivils, who was the office manager at Medistat, pleaded guilty in April 2015, and is expected to be sentenced in June. Cyprian and Patricia Akamnonu, who owned Ultimate Care Home Health Services, Inc., are now each serving a 10-year federal prison sentence. They were also ordered to pay a $25 million fine.

Health Care Fraud and Abuse Control Program Protects Consumers

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This fact sheet comes from the U.S. Department of Justice.

The Affordable Care Act Has Helped the Government Fight Fraud, Strengthen Health Insurance Programs, Protect Consumers, and Save Taxpayer Dollars

The Obama Administration is committed to reducing fraud, waste, and abuse across the government.  Since 2010, the U.S. Department of Health & Human Services, Office of Inspector General (HHS OIG), the Centers for Medicare & Medicaid Services (CMS), and the U.S. Department of Justice (DOJ) have been using powerful, new anti-fraud tools to protect Medicare and Medicaid by shifting from a “pay and chase” approach toward fraud prevention. Through the groundbreaking Healthcare Fraud Prevention Partnership, stronger relationships have been built between the government and the private sector to help protect all consumers.

These focused efforts are successful.  In Fiscal Year (FY) 2015, the government recovered $2.4 billion as a result of health care fraud judgements, settlements and additional administrative impositions in health care fraud cases and proceedings.  Since its inception in 1997, the Health Care Fraud and Abuse Control (HCFAC) Program has returned more than $29.4 billion to the Medicare Trust Funds.  In this past fiscal year, the HCFAC program has returned $6.10 for each dollar invested.

The Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative between HHS, OIG, and DOJ, has played a critical role in the fight against  health care fraud.

A key component of HEAT is the Medicare Fraud Strike Force – an interagency task force teams comprised of OIG and DOJ analysts, investigators, and prosecutors who target emerging or migrating fraud schemes, including fraud by criminals masquerading as health care providers or suppliers.

Since 2007, the Medicare Fraud Strike Force has charged over 2,536 individuals involved in more than $8 billion in fraud.  Many of these charges have resulted from coordinated, multi-district national takedowns. In June 2015, the Medicare Fraud Strike Force conducted its largest ever nationwide health care fraud takedown, which, for the first time, involved non-Strike Force participants and resulted in charges against a record 243 individuals for approximately $712 million in false Medicare and Medicaid billing.  Since its inception, the Medicare Fraud Strike Force has maintained a conviction rate of approximately 95 percent and an average term of incarceration of more than four years.

Another powerful tool in the effort to combat health care fraud is the federal False Claims Act.  In 2015, DOJ obtained over $1.9 billion in settlements and judgments from civil cases involving fraud and false claims against federal health care programs such as Medicare and Medicaid.  Since January 2009, DOJ has recovered more than $17.1 billion for the federal government in cases involving health care fraud.  In many of these cases, the department was instrumental in recovering additional billions of dollars for state health care programs.

Other steps the administration has taken to fight fraud include:

State-of-the-Art Fraud Detection Technology:  HCFAC funding also supported HHS OIG’s continued enhancement of data analysis capabilities for detecting health care fraud.  HHS OIG continues to use data analysis, predictive analytics, trend evaluation, and modeling approaches to better analyze and target oversight of HHS programs.  Analysis teams use data to examine Medicare claims for known fraud patterns, identify suspected fraud trends, and calculate ratios of allowed services as compared to national averages; new analytic tools and methods are being developed to perform more innovative and complex data analytics.  Combining the expertise of HHS OIG agents, auditors, and evaluators, as well as our HEAT partners, with data analytics and traditional investigative skills has fostered a highly effective model for fighting health care fraud.

Since June 2011, CMS uses the Fraud Prevention System (FPS) on all Medicare fee-for-service claims on a streaming, national basis.  Similar to the fraud detection technology used by credit card companies, FPS applies predictive analytics to claims before making payments in order to identify aberrant and suspicious billing patterns.  CMS uses leads generated by FPS to trigger actions that can be implemented swiftly.  Early results from FPS show significant promise.  Since 2011 the FPS identified savings (certified by HHS OIG) associated with these prevention and detection actions were $820 million.[1]  This resulted in more than a 10-to-1 return on investment for the first three years of implementation.

Enhanced Provider Screening and Enrollment Requirements:  Provider enrollment is the gateway to billing the Medicare program, and CMS implemented new critical safeguards in efforts to better screen providers enrolling in the Medicare program.  The Affordable Care Act required CMS to revalidate all existing 1.6 million Medicare suppliers and providers under new risk-based screening requirements.  As a result of revalidation and other proactive initiatives, CMS deactivated more than 500,000 enrollments meaning,  billing privileges were stopped for these providers but may be restored upon the submission and approval of an updated enrollment application. CMS also revoked more than 34,000 enrollments meaning, these providers were barred from re-entering the Medicare program for one to three years.  These enhanced screening and enrollment requirements have led to more than $2.4 billion in estimated Medicare savings since 2010.

In May 2014, CMS issued a final rule that requires prescribers of Part D drugs to enroll in Medicare and undergo screening.  In December 2014, CMS issued a final rule that provides additional authority to remove bad actors from the Medicare program, including providers affiliated with outstanding Medicare debts and providers that have a pattern or practice of abusive billing.

Health Care Fraud Prevention Partnership (HFPP):  The Obama Administration has joined with private insurers, states, and associations in the HFPP to prevent health care fraud on a national scale.  To detect and prevent payment of fraudulent billings, HFPP participants exchange information and best practices across the public and private sectors.  Since 2013, the HFPP has conducted eight studies that enabled partners, including DOJ, HHS-OIG, FBI, and CMS, states, private plans, and associations to take substantive actions, such as payment system edits, revocations, and payment suspensions to stop fraudulent payments and improve the government’s collective forces against fraud, waste, and abuse.

Senior Medicare Patrols:  The Obama Administration has expanded funding for Senior Medicare Patrols (SMP) – groups of  volunteers who educate and empower their peers to identify, prevent, and report health care fraud.  In 2014, the  SMP projects had a total of 5,249 active volunteers.  These volunteers conducted 202,862 one-on-one counseling sessions and 14,692 group education sessions.  In total, 452,714 beneficiaries attended these group education sessions.  The projects also reported conducting 110,615 media airings (e.g., print, radio, television, or electronic) to provide education about fraud and the services of the project.  Additionally, the projects reported conducting 12,417 community outreach education events.  Local SMP offices provide assistance when issues are identified, ensuring that mistakes are corrected and suspected fraud is referred to the appropriate authorities.  Since the program’s inception 18 years ago, $122 million in total estimated savings to Medicare and Medicaid is attributable to SMP projects.

 


[1] Note that a portion of the total FPS savings is comprised of payments prevented due to provider revocations. This amount is a subset of the $2.4 billion total prevented payments from revocations reported in section ‘Enhanced Provider Screening and Enrollment Requirements’ of this report.  Therefore, comparison of these two metrics may result in double-counting

Dallas-area doctors charged for roles in $13.4 Million Medicare fraud scheme

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This is being shared from the Healthcare Finance Website

By Beth J. Sanborn, Managing Editor

Two Dallas-area doctors have been charged, according to a superseding indictment that was unsealed Friday, for their alleged participation in a $13.4 million health care fraud scheme that bilked Medicare for millions.

Dr. Kelly Robinett, 66, of Denton County, Texas and Dr. Angel Claudio, 60, of Hood County, Texas were each charged with one count of conspiracy to commit healthcare fraud. They were also charged with multiple counts of health care fraud, announced the U.S. Attorney’s office.

Robinett owns Boomer Housecalls, which is based in Frisco, Texas.  Claudio, a medical doctor, works for Dallas-based Texas Medical Housecalls, the U.S. Attorney’s office said.

Patience Okoroji, 57, of Dallas County, Usani Ewah, 58, of Dallas County, Kingsley Nwanguma, 45, of Dallas County and Joy Ogwuegbu, 39, of Collin County who are charged in the current indictment, were also charged in a previous indictment that did not include the doctors.

Authorities said Okoroji and Ewah co-owned Timely Home Health Services Inc. (Timely), where Okoroji was an administrator and licensed vocational nurse. Ewah was the director of nursing and a registered nurse for Timely, Nwanguma was a licensed vocational nurse for Timely and Ogwuegbu was its former director of nursing.

The allegations accuse Robinett and Claudio of falsely certifying beneficiaries for home health care when the patients weren’t actually under their care and did not qualify for home health services. The defendants allegedly billed Medicare approximately $13,434,550 based on false home health certification signed by doctors, including Robinett and Claudio, as well as  false and fraudulent claims for home health services, said the U.S. Attorney’s office.

 

New Alert System Scheme Targets Seniors

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“Help, I’ve fallen and I can’t get up” is a well known phrase that we have heard over and over on the radio and television that advertises an alert product for seniors living alone.  This product can most certainly be a life saver, but it is also easy for schemers to market sound alike products that are actually a bad deal.

Recently, a new scheme targeting seniors has come to light that appears to be a ruse to possible Medicare fraud.  The senior receives a phone call about an alert system that is free for six months, and then it is only $10 a month.  Sounds like a good deal and it certainly beats out the well known national competitor, but with all things too good to be true, is it a real deal?  How does it work?

First, they want to send someone to your home to discuss the system with you.  Then at the appointment, they turn the tables and want to provide you a back brace and a knee brace that will be “free” from Medicare. “This is a good example of how someone can steal money from the Medicare system,” states Barbara Parrott McGinity, Program Director for the Texas Senior Medicare Patrol.  “They offer a simple item, tell you we will get your doctor to approve it, and since Medicare pays for it, why not get it?”

Prior to receiving medical supplies or services, you should have a discussion with your physician about what is best for you.

What can you do to protect yourself and your Medicare benefits?

If you really think you are interested in receiving a service, you should talk to a reputable supplier in your area.  Be very cautious about allowing uninvited salespersons into your home. It might be a good idea to invite a trusted family member or friend to be with you during a sales presentation.  More importantly, please call the Missouri SMP (Senior Medicare Patrol) at 1-888-515-6565 with any questions or concerns.

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.