FRAUD ALERT
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-civ670.html
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
Consumer Fraud:
2. “7 Telltale Signs of a Job
Scam” (AARP):
http://blog.aarp.org/2014/0
6/27/7-tell-tale-signs-of-ajob-scam/
3. “A Scam-Free Vacation”
(FTC):
http://www.consumer.ftc.g
ov/blog/scam-freevacation
4. “The Hazards of Hoteling”
(FTC):
http://www.consumer.ftc.g
ov/blog/hazards-hoteling
(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/Pressreleases/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
jason.echols@ageoptions.org
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 jason.echols@ageoptions.org.