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.

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.

8 Senior Financial Scams You Should Never Fall For

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Austin Kilham provides this important information from seniorhomes.com

One day you get a call informing you that you’ve won a cash prize, or an invitation to buy into an investment that outperforms the market, or an email telling you that your medical insurer needs your insurance ID. Scenarios like these should raise red flags. While some of the time they may be legitimate, oftentimes these are scams.

As technology becomes more sophisticated, so too do unscrupulous scammers.

“The stereotype is that older adults have more money,” says Brandy Bauer, communications manager for economic security at the National Council on Aging. “That, coupled with the perception that seniors are in cognitive decline, means that older people are a target for economic exploitation.”

Falling victim to a scam can have real consequences. Seniors are often living on a fixed income and don’t have the time to recover and rebuild their savings should fraud lead to a large financial loss, says Bauer.

That said, for many of these scams to work, scammers want you to hand over your personal information. Knowing the red flags to look out for can help you avoid giving out the information they desperately need, protecting you and your assets from falling into the wrong hands.

“The key to avoiding many scams is to stay educated and to continuously monitor your accounts for suspicious activity,” says Liz Loewy, former chief of the elder abuse unit in the Manhattan District Attorney’s office who is now senior vice president for industry relations at EverSafe a service that helps protect seniors from fraud and identity theft.

When in doubt about whether an offer or request is legitimate, it’s best to have a trusted family member or friend take a look, Loewy says.

“It never hurts to have a trusted advocate serve as a second set of eyes,” she says.

What follows are some of the most common scams targeting seniors today.

1. Phone Scams
Scams that take place over the phone are one of the most common types to affect seniors. Some current schemes include people posing as IRS agents to collect personal information (the IRS does not contact you over the phone) and scammers pretending to be technicians from computer companies claiming to have detected a problem with your computer. With little way of verifying a caller’s identify, avoid giving out any personal information over the phone.

Once on the phone, it can be hard for many seniors to say no to caller requests. To avoid being put in an uncomfortable position in the first place, consider screening calls on cell phones and landlines with caller ID. If you don’t recognize the number, don’t pick up.

2. Medicare and Health Insurance Scams
Beware of people posing as medical professionals who request your medical information over the phone or online. Scammers can use your health insurance ID number and other personal information to fraudulently bill Medicare or insurance companies. In the meantime, you could get saddled with copays and percentage-based fees for care you never received.

Also be wary of companies selling durable medical equipment such as wheelchairs, and claims that they’re covered by Medicaid. Since Medicaid has strict rules about which agencies you can use to acquire medical equipment, oftentimes this type of equipment is not actually covered.

Don’t provide your medical information to anyone unless you are 100 percent sure you know who you’re talking to. Review your insurance statements regularly to spot any suspicious activity.

3. Internet and Email Scams
Watch out for pop-ups on your computer, phone or tablet that ask you to download things like virus protection software. Ironically, you may actually be downloading a virus that will mine your computer for personal data.

Similarly, you may receive official-looking emails telling you to download something or click on an unknown link. “Phishing” scammers often use this tactic, and once you click, the scammer is given a porthole into the information stored on your computer. What’s worse, sometimes simply opening these emails is enough to give scammers access to your data.

Before opening any emails, make sure they’re from a legitimate source that you recognize. In general, before entering any personal information online, look for a padlock symbol in your browser bar (near the URL) or a web address that includes HTTPS at the beginning of the URL. Any information you type into a website that includes these markers is encrypted and protected by the website.

4. Sweepstakes and Lottery Scams
Scammers may inform you that you’re the winner of a sweepstakes or lottery prize, and that all you have do to claim your prize is pay a processing fee or taxes upfront. They may go so far as to send a fake check for you to cash, knowing that it will take a few days for your bank to reject it. In the meantime, the fraudster can pocket your money and disappear.

5. Investment Schemes
Seniors managing their finances after retirement may encounter investments that sound too good to be true. That’s because a lot of the time, they are. Investments that purport to be a limited-time offer or claim returns that are higher than the market—think the Bernie Madoff pyramid scheme—should raise red flags for any investor. Make sure you fully understand any kind of investment you’re considering participating in.

6. Asset Recovery Scams
An insidious and increasingly common scheme, asset recovery scams target older adults who have already been the victim of a scam. For example, a perpetrator might contact a senior taken in by a timeshare scam, promising to help the senior recover some of their lost money. The scammers then collect personal information from the senior that gives them access to the senior’s finances — victimizing them twice.

7. Social Media Scams
Increasingly, seniors are on social media, and that means a lot of their personal information is readily available to the public. If you’re on social media, scammers may find photographs of friends and family members, gathering names and other information. Then they contact you, claiming that one of the people you know is in some kind of financial trouble and needs you to send them money. Protect your information on social media by changing privacy settings so that only family and friends can view your profile.

8. Charity Scams
During the end of the year, the holiday season, or after a well-publicized disaster, some scammers try to take advantage of seniors’ charitable instincts by soliciting money for bogus organizations. Before giving, make sure to vet all charities to make sure they are legitimate and that your money will actually go to help those in need.

Social Security issues phone fraud alert

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FOR IMMEDIATE RELEASE
March 29, 2016
Social Security Inspector General Patrick P. O’Carroll is warning citizens to be aware of phone calls from unknown people who claim to have information about a citizen’s application for disability benefits and offer assistance with the citizen’s claim.  The Office of the Inspector General (OIG) received a report from a Maryland citizen who recently received several of these phone calls, even though the citizen had not applied for disability benefits.
The callers appear to be “phishing” for personal information—such as Social Security numbers or personal financial information—from unknowing citizens, who possibly have applied for disability benefits and thus might be inclined to provide information to the caller in furtherance of his or her claim.  One person, who had not applied for disability benefits, reported recently receiving three unsolicited calls from a caller named Scott from a phone number with a 301 area code.

Scammers spoofing FBI phone numbers to fool victims

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Please click on this link to see the latest from the FBI regarding scammers on the phone.

SCAMMERS SPOOFING FBI PHONE NUMBERS TO FOOL VICTIMS 3.18.16

‘Are You Smarter Than a Scam Artist’ scheduled for Rich Hill, MO

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RICH HILL — The Missouri Senior Medicare Patrol (SMP) will present “Are You Smarter Than a Scam Artist?” to highlight Fraud Prevention Month.  The fun, interactive game will be presented at 10:30 a.m. Friday, March 11, at the Kern Senior Center, 613 Park Avenue, in Rich Hill.

The presentation explores some of the most common scams that fraudsters are likely to perpetrate. The Missouri SMP is highlighting March as International Fraud Prevention Month. The SMP program, also known as Senior Medicare Patrol program, helps Medicare and Medicaid beneficiaries prevent, detect, and report health care fraud.

In doing so, the program helps older people and promotes integrity in Medicare. In Missouri, the program has 80 volunteers, most of whom are Medicare beneficiaries themselves and are thus well-positioned to assist their peers.

If you would like to know more about the program, call Roary Hutt at 1-800-748-7826. If you believe you may have been the victim of healthcare fraud, contact the Missouri SMP hotline at 888-515-6565.

The Missouri SMP is operated in Missouri by Care Connection for Aging Services in partnership with the Missouri Association of Area Agencies on Aging. SMPs are funded through the U.S. Department of Health and Human Services, Administration for Community Living, Administration on Aging.

 

 

 

 

Missouri SMP publishes March fraud prevention fact

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The Missouri SMP is publishing monthly Fraud Prevention Facts to remind people of the most recent scams and the ways to protect themselves against them. Here is the March 2016 Fraud fact.

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.

The Grandparent Scam, 
Don’t Let It Happen to You

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You’re a grandparent, and you get a phone call or an e-mail from someone who identifies himself as your grandson. “I’ve been arrested in another country,” he says, “and need money wired quickly to pay my bail. And oh by the way, don’t tell my mom or dad because they’ll only get upset!”

This is an example of what’s come to be known as “the grandparent scam,” yet another fraud that preys on the elderly, this time by taking advantage of their love and concern for their grandchildren.

The grandparent scam has been around for a few years—our Internet Crime Complaint Center (IC3) has been receiving reports about it since 2008. But the scam and scam artists have become more sophisticated. Thanks to the Internet and social networking sites, a criminal can sometimes uncover personal information about their targets, which makes the impersonations more believable. For example, the actual grandson may mention on his social networking site that he’s a photographer who often travels to Mexico. When contacting the grandparents, the phony grandson will say he’s calling from Mexico, where someone stole his camera equipment and passport.

Common scenarios include:

A grandparent receives a phone call (or sometimes an e-mail) from a “grandchild.” If it is phone call, it’s often late at night or early in the morning when most people aren’t thinking that clearly. Usually, the person claims to be traveling in a foreign country and has gotten into a bad situation, like being arrested for drugs, getting in a car accident, or being mugged…and needs money wired ASAP. And the caller doesn’t want his or her parents told.

Sometimes, instead of the “grandchild” making the phone call, the criminal pretends to be an arresting police officer, a lawyer, a doctor at a hospital, or some other person. And we’ve also received complaints about the phony grandchild talking first and then handing the phone over to an accomplice…to further spin the fake tale.

We’ve also seen military families victimized: after perusing a soldier’s social networking site, a con artist will contact the soldier’s grandparents, sometimes claiming that a problem came up during military leave that requires money to address.

While it’s commonly called the grandparent scam, criminals may also claim to be a family friend, a niece or nephew, or another family member.

What to do if you have been scammed: The financial losses in these cases—while they can be substantial for an individual, usually several thousand dollars per victim—typically don’t meet the FBI’s financial thresholds for opening an investigation. We recommend contacting your local authorities or state consumer protection agency if you think you’ve been victimized. We also suggest you file a complaint with IC3, which not only forwards complaints to the appropriate agencies, but it collates and analyzes the data—looking for common threads that link complaints and help identify the culprits.

And, our advice to avoid being victimized in the first place:

  • Resist the pressure to act quickly.
  • Try to contact your grandchild or another family member to determine whether or not the call is legitimate.
  • Never wire money based on a request made over the phone or in an e-mail….especially overseas. Wiring money is like giving cash—once you send it, you can’t get it back.

Additional Resources:

File a complaint with IC3

Federal Trade Commission

Financial Fraud Enforcement Task Force

American Association of Retired Persons


 

Don’t Mess with Martha!

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It’s another hot summer day and Martha is busy with her daily chores when she hears the phone ring.

She answers with a pleasant “Hello.” A man on the other end of the line says, “Is your name Martha?” “Yes, it is,” she said.

The man goes on to explain that he is calling about a new Medicare card that is being mailed out to all beneficiaries and he needs to verify her correct name and address. Martha spells her name out to make sure he gets it down correctly and then verifies that her address is also correct.

The man thanks her and then says; “Tell me the name of your bank.”

Martha is quick to reply, “Sorry I don’t give out my bank information.”

The man replies, “But I need it to verify your information so we will be able to send out your new Medicare card.”

Martha asks, “Are you from the government? “

The man answers, “Yes.” “Well,” Martha says,” I never received any information from the government saying that I would be contacted asking for this information.”

The man answers,” I still need your bank information.” Martha starts to really get suspicious at this point and asks the man if he has a supervisor.  He responds with a yes. She goes on to tell the caller that she has already had experience with people like him and she is not giving him any more information. The man was silent on the other end of the phone, and then he hung up.

Even at 85 years young, you can’t fool Martha!

Martha handled that call perfectly. Here at the Missouri SMP (Senior Medicare Patrol) we educate seniors on how they should protect their personal information from fraudsters trying to steal their identity.” Protect, Detect, and Report” is our motto. That is exactly what Martha did. During that phone conversation with the fraudster she first protected her personal information by not giving out her bank information, then by asking questions of the caller she detected that he was running a scam. Her next call was to report the scam to the Missouri SMP to alert others of the potential scam.

This article is based on an actual call that an older adult received. Name was changed for privacy.

If you have questions or concerns contact the Missouri SMP at 888-515-6565.

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.