Fraud timed to reform

Chicago Tribune reports:

“Experts who study scams and frauds know these illicit schemes are often built around big news stories, such as health care reform’s passage. That’s why it shouldn’t be a shock that law enforcement agencies and senior advocates are bracing for a wave of frauds leveraging confusion about the Affordable Care Act.

“We saw a reported spike immediately after the passage of the law, because it was in the news,” says Sally Hurme, senior project manager, health education and outreach, for Washington, D.C.-based AARP. “And we know the scamsters read the papers, and follow the headlines, to determine what sounds like news and is top of mind on the part of people they’re planning to go after.

“Right now, we’re in the trough of the wave, and getting ready for scams to surge again as we get into 2013, and the formation of the (state medical insurance) exchanges that will become available in 2014.”

In many of its manifestations, fraud based on health care reform is a kind of medical identity theft. Like regular identity theft, medical identity theft occurs when perpetrators use someone’s identity to commit fraud. Instead of a Social Security number, it is often a Medicare or Medicaid number that is stolen.

How fraud occurs

Two major schemes have come to the attention of Oak Park’s Age Options, the Area Agency on Aging of Suburban Cook County. The first is a fraud in which older people are told that as a result of health care reform, they will need a new Medicare card, health care consumer protection coordinator Erin Weir reports. The pitch is in order to send a new card, the would-be victim needs to provide his or her Medicare number. With that number, the fraudster can bill the government for Medicare services never provided, Weir adds.

Often perpetrators will use the name “ObamaCare” rather than the term Affordable Care Act when referring to health care reform. This is a very evident red flag. “Anything legitimate will not use that term,” Weir says.

Because your Medicare number is either yours or your spouse’s Social Security number, criminals who obtain your Medicare number can not only bill Medicare fraudulently, but can also use the number to commit identity theft and possibly open accounts in yours or your spouse’s name, Weir says.

In a second type of scheme, perpetrators offer services they claim are free, either involving medical equipment or home health care, Weir says.

“They will say that because of health reform, they can offer these free services,” she adds. “It’s a ruse to get (an older person’s) insurance information. And in fact, the services are not free. They will end up collecting insurance information, and will bill for thousands of dollars of services that never occurred.”

This fraud typically plays out when the fraudsters send a house cleaner or someone checking blood pressure to the victim’s home. “They will bill instead for thousands of dollars in skilled nursing or physical therapy services,” she says. “We as taxpayers are paying for services that were never performed.”

Monitoring fraud AARP has monitored different scams and frauds that often trade on some widely publicized element emerging from health care reform.

For instance, the Affordable Care Act includes a provision allowing young adults to remain on their parents’ group or family health plans to age 26, instead of being dropped at 21, Hurme says. “We saw insurance salespeople selling ‘young adult insurance’ as if it were regulated or a provision that emerged from the Affordable Care Act,” she says. “Consumers may have gotten insurance, but it had nothing to do with what the Affordable Care Act was providing.”

Once state health insurance exchanges are unveiled under the Affordable Care Act starting in 2014, Hurme and colleagues anticipate fraudsters building on confusion about this new way to gain insurance. “The states will be doing their best to explain how to get various levels of insurance,” she says. “But there will be resulting confusion, and if they as marketers can grab someone away from legitimate sources to their own insurance programs, they’ll do it.”

Take steps now

To avoid falling prey to frauds built around health reform, Hurme urges three steps. First, never give out your Medicare or Social Security numbers. Second, remember if someone calls or visits your home asking for verification of Medicare or Social Security numbers or bank accounts, it’s a red flag signaling medical identity theft “or plain vanilla identity theft,” she says. Third, review and verify either your Medicare Summary Notice or, if you have employer-provided insurance, the Explanation of Benefits. “Whenever you get those documents, review them to ensure you actually got those health care services for which Medicare or your employer’s insurance is being billed,” she says.

Visit to access the Medicare Summary Notice Decoder, an explanatory walk through a Medicare Summary Notice, explaining all the information on your statement, Hurme says.

Finally, if you experience something you believe is a fraud or scam, call your local Senior Medicare Patrol office to report the incident, Weir urges. In Illinois, that office is Age Options, at the toll-free number 800-699-9043.”