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.

April 2017 Fraud Prevention Fact

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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.

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.

Why does Medicare keep calling?

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The Missouri SMP receives several complaints a week just like this one:

“I just received a call today from the Medicare Diabetic Supply Company (an 800 number that was blocked out on caller ID), asking about my diabetes supplies.  (I don’t have diabetes nor does anyone else in my household.)  She asked if I had a red, white, and blue Medicare card.  I said yes, and she said she would have someone call me to arrange delivery of free supplies.  This is a waste of our tax dollars.  I asked for the phone number of the company and she declined but said someone would call me.”

Sometimes the reports vary slightly, and the name of the company has been changed, but the story remains the same – telemarketers are calling seniors, representing themselves as Medicare and trying to get personal information such as Medicare numbers and bank account information by offering unnecessary medical supplies.

In order to keep your information safe and be able to access the services and supplies you need, keep in mind the following:

  • Suppliers are prohibited from making unsolicited phone calls, emails, and personal visits to Medicare beneficiaries unless:
    • The beneficiary has given written permission.
    • The supplier has furnished an item to the beneficiary.
  • If you make a call to order supplies or ask about a service, it is ok to give your account information – you placed the call.  However, if the call was made to you, do not provide your information.  Medicare, your bank, your insurance company, and your medical providers have your information and are not allowed to call you and ask for it.
  • It is best to get a prescription from your doctor before receiving any medical supplies or services and to only receive services ordered by your doctor.

If you feel that you have given your information in error or if you have additional questions, please call the Missouri SMP (Senior Medicare Patrol) toll-free at 1-888-515-6565.  SMP Volunteers have been trained and are available to assist you with questions and concerns regarding Medicare and Medicaid fraud and abuse at no cost to you.

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.