FraudAlert! Helping keep the promise. April 2015 Volume 18, No. 9 Coalition of Wisconsin Aging Groups Elder Law Center From the Project Director. . . . . . . Kevin Brown Check out our website at www.wisconsinsmp.org Let’s Get Acquainted By Judy Steinke, Wisconsin SMP Volunteer Coordinator Wisconsin SMP (Senior Medicare Patrol) is delighted to introduce Judith Joslin-Crary of Beloit as this month’s featured volunteer. Judith was a dedicated AARP Fraud Fighter until that program ended in 2012, when she decided to join Wisconsin SMP to continue sharing the message of fraud prevention with seniors. Since she joined, she has given numerous presentations and provided outreach at many events in Rock and Dane Counties. Prior to retirement, Judith was an insurance specialist for St. Mary’s/Dean Ventures. She has an Associate Degree in Personnel Management and has also worked in the medical field as an aide, in medical records, and with Worker’s Comp. When asked why she volunteers, Judith’s response was: “I love helping people, especially seniors.” She is happy to be retired and have the time to help others. This is proven by the list of organizations that she is currently involved with: her church (with Hands of Faith and as an Elder); the Beloit Domestic Violence Shelter; Beloit Caritas; the Girl Scouts; Habitat for Humanity; and AARP (as an AARP Advocate). Judith is married and has three adult children and five grandchildren. She also has four adult step-children and five step-grandchildren. When not helping others, Judith’s hobbies include beading, traveling, reading, and visiting her family members. Thank you, Judith, for your dedication to helping others. Wisconsin SMP is very grateful to have you on our team! FRAUD ALERT! ● Coalition of Wisconsin Aging Groups Elder Law1 Center Wisconsin SMP In this issue: Let’s Get Acquainted with Judith JoslinCrary, SMP Volunteer Get Into the Act/Become a Wisconsin SMP Volunteer Aetna Fined $1 Million for Listing Pharmacies Incorrectly AIDS Healthcare Foundation Accused of Medicare and Medicaid Fraud WI BBB News Release New Medicare Cards to Omit Social Security Numbers DATCP Consumer Alert CFPB: “Phantom” Debt Collection Scheme Targeted Millions DOJ News Release Upcoming Wisconsin SMP Activities Published and distributed by the Coalition of Wisconsin Aging Groups Elder Law Center. This project was supported, in part by grant #90MP0187, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. EDITOR AND PROJECT DIRECTOR Kevin Brown This publication may be reproduced ONLY in its entirety. Permission to excerpt portions must be obtained prior to use. © 2015 CWAG. All rights reserved. 2850 Dairy Drive Madison, WI 53718-6742 608-224-0606 www.cwag.org kbrown@cwag.org Get into the Act/Become a Wisconsin SMP Volunteer By Kevin Brown, Wisconsin SMP Project Director Each May, the Administration for Community Living (ACL) celebrates Older Americans Month to recognize older adults for their contributions to our nation. The theme for Older Americans Month 2015 is “Get into the Act,” to focus on how seniors are taking charge of their health, getting engaged in their communities, and making a positive impact in the lives of others. The SMP (Senior Medicare Patrol) program has recognized the great value that older adults bring to our communities for a long time. There are more than 5,000 hard-working SMP volunteers who make presentations to groups and distribute materials at community events across the nation to educate Medicare beneficiaries, caregivers, and professionals about how to prevent, detect, and report healthcare fraud, waste, and abuse. These volunteers, most of whom are retired professionals, contributed over 105,000 hours of their time in 2013 to support the SMP program. Wisconsin SMP’s dedicated volunteers contributed nearly 553 work hours to our program last year. We have an excellent group of volunteers, but we are always looking for new ones so that we can spread our message of fraud prevention to more people around the state. On May 14, Wisconsin SMP will be hosting a workshop for new volunteers from 9:30 a.m. until 4:00 p.m. at the Platteville Public Library. We also will be conducting SMP volunteer trainings in other parts of the state in the summer and fall. The Wisconsin SMP Volunteer Training is an in-depth workshop that provides participants with a foundation of knowledge in four main areas: the SMP program, Medicare basics, and Medicare fraud, waste, and abuse basics; and common scams and fraud within specific Medicare services. If you would like to attend one of these sessions, please contact Wisconsin SMP Grant Manager/Trainer Will Armstrong at (800) 488-2596, ext. 311 or warmstrong@cwag.org. To learn more about upcoming activities and events planned for Older Americans Month or to find ideas about other things you can do to “get into the act,” go to ACL’s Older Americans Month website at www.acl.gov/olderamericansmonth. Aetna Fined $1 Million for Listing Pharmacies Incorrectly On April 2, the Centers for Medicare & Medicaid Services (CMS) fined Aetna $1 million for erroneously listing 6,887 pharmacies as in-network when they should have been listed as out-ofnetwork. According to CMS, Aetna listed these pharmacies as in-network for 2015 on its website, and the company’s customer service representatives relayed this incorrect information to consumers. “Beneficiaries that selected a plan based on its in-network pharmacies may have been misled by this incorrect information,” wrote Gerald J. Mulcahy, director of CMS’ Oversight and Enforcement Group, in a letter to Aetna. “The confusion created by errors in Aetna’s pharmacy network directory on their website led to disruption in the marketplace,” wrote Mulcahy. In early 2015, many Aetna customers went to a pharmacy they had been told was in-network “only to discover that the pharmacy was not in their plan’s network.” Thousands of consumers complained about Aetna’s prescription drug plans. CMS received 3,767 complaints against the company, which was five times greater than the average for all insurers that sell 2 Medicare Part D plans. The complaints against Aetna accounted for 33 percent of the total complaints CMS received. Medicare officials granted Aetna beneficiaries a special enrollment period so that they could drop their plans and re-enroll in a Part D plan offered by a different company. Aenta spokeswoman Kim Marcocci said, “Unfortunately, a select number of pharmacies were listed incorrectly in participating in some of Aetna’s Part D pharmacy networks. These issues were swiftly resolved, and the majority of pharmacies and our members were not affected by this situation. We strive to provide our members high quality coverage, with high satisfaction, at the best value, and take this matter very seriously.” Source: Hartford Courant (April 7, 2015) AIDS Healthcare Foundation Accused of Medicare and Medicaid Fraud According to a lawsuit filed in federal court in South Florida, the AIDS Healthcare Foundation (AHF) allegedly bilked Medicare and Medicaid out of $20 million dollars in 12 different states. Three former managers of the AHF, which is the largest supplier of HIV and AIDS medical care in the nation, allege that the company gave patients and employees kickbacks for patient referrals. Employees were allegedly given $100 bonuses for referring patients with positive HIV and/or AIDs test results to its medical facilities. According to the lawsuit, the kickbacks began in the company’s headquarters in California and then spread to several of its other locations across the country. At a 2013 leadership summit for the company, AHF President Michael Weinstein extolled referral kickbacks. The lawsuit alleges that Weinstein specifically directed staff to increase the patient referral bonus to $50 and to implement the referral incentive program across the country. Tom Myers, the AHF general counsel, denied that any kickbacks were paid and claimed that no laws were broken. He said that the company would fight the lawsuit and continue to provide care to thousands of HIV and AIDS patients throughout the country. “The federal government and the state of Florida had a chance to deal with this case … and they declined to get involved which I think speaks volumes to the merits of the claim,” said Myers. Jack Carrel of Louisiana, Mauricio Ferrer of Florida, and Shawn Loftis of New York, are the exmanagers who filed the whistleblower complaint. They were fired from the company after informing their supervisors about the alleged illegal kickbacks, even though their attorneys said they should have been protected under the False Claims Act. The AIDS Healthcare Foundation, which is based in Los Angeles, provides medical care to over 400,000 HIV and/or AIDs patients in 36 different countries. According to the AHF website, the company is at the forefront of an initiative to diagnose and treat an estimated 25 million individuals who don’t know they have HIV or AIDs. Source: CBS News (April 8, 2015) 3 Reprinted with permission of the Wisconsin Better Business Bureau April 1, 2015 Don’t Be an April Fool: Do You Fit the Profile of a Scam Victim? Much is known about the personalities of con artists and their methods, however, the Better Business Bureau Serving Wisconsin says consumers with certain character traits and behaviors may be more prone than others to becoming a victim. Young people – from adolescents to college students – are potential victims because although they may understand the workings of sophisticated scams, they often do not take the necessary precautions to protect themselves, particularly when using computers and smart phones. They also may share too much information on social media sites. It is also well-established that the elderly are prime targets for fraud because they may be too trusting and may not understand some of the ways scammers can trick them into handing over personal and financial information. But age alone does not determine who will most likely become a victim. The other two determining factors are personal values and behavior. Here are some of the traits common among scam victims: They take someone at their word – Victims tend to not do their homework, ask questions, or check with BBB before signing a contract or putting down a deposit. They are afraid of being rude – They don’t want to hang up the phone or shut the door, even if they are not interested in whatever the peddler is selling. They don’t recognize common high pressure tactics – These include persuasion, “time-limited” offers, calls to action to “do it now” or pestering over the telephone or at the front door. They don’t protect their personal information – They don’t lock up or shred their documents. They use the same password for every account. They let themselves get emotional – They are often motivated by fear, greed, romance, a sense of urgency, or excitement. They are easily moved to respond to threatening phone calls or emails, fake charities, lotteries, and investment scams. They don’t read the fine print – Some individuals and websites are hoping that consumers don’t find or read fine print, which may contain restrictions that put them at a disadvantage or make a product or service all but useless. They act impulsively – They download files, click on pop-up ads, sign up for trial offers, click on links and open emails from unknown senders. They are vulnerable – They may have recently lost their job or have increased debt and therefore place hope in work-at-home offers and phony employment offers through which they can lose money or be coerced into giving up personal information that will be used for identity theft. They are embarrassed – They won’t tell anyone about being scammed nor report it to the proper authorities, so that the perpetrator gets away and the scam continues. Criminals who commit these kinds of fraud are typically very polite, will lavish praise upon their victims, use a convincing pitch or hard luck story, or falsely claim they are affiliated with the government, police, or even the Better Business Bureau. 4 Knowledge is the ultimate tool to prevent becoming the victim of a scam: Take preventative measures. Add your home telephone number to the state and federal Do Not Call registries (www.donotcall.gov or 1-888-382-1222; FTC and http://datcp.wi.gov/Consumer/No_Call/ or 1-866-966-2255 for Wisconsin). This is no guarantee that unscrupulous telemarketers won’t call, but it can dramatically reduce the number of solicitations. If you do register, and they do call, you can report the violation. Be skeptical. Err on the side of caution when anybody calls or emails asking for your personal or financial information. No legitimate caller will ask for credit card numbers, your Social Security number, date of birth or any other personal information. Be realistic. You cannot win a lottery you did not enter (and, foreign lotteries are illegal), never pay for anything that is offered as “free,” and just because you’re told about a great investment opportunity, don’t make any quick decision. Seek expert advice and check on the company or individual first. Remember, if something sounds too good to be true, it probably is. New Medicare Cards to Omit Social Security Numbers Earlier this month, President Obama signed a bill that will end Medicare’s practice of using Social Security numbers on Medicare cards. Medicare officials have up to four years to begin issuing cards with new identifiers and an additional four years to reissue Medicare cards to current beneficiaries. The Government Accountability Office has advised Medicare to end its practice of printing Social Security numbers on its cards since 2004, but, until now, no actions have been taken to address this issue. Most private health insurance companies have long since stopped using the numbers to identify individuals, and the federal government even prohibits private insurers who are under contract with Medicare from using Social Security numbers on their insurance cards. Congress was motivated to act for two primary reasons: the rapid increase of electronic health records and a number of recent cyberattacks, such as the Anthem data breach. The bill allocates $320 million over four years to implement the changes. The money will come from Medicare trust funds and beneficiary premiums. Currently, over 4,500 individuals sign up for Medicare each day. By 2025, an additional 18 million people are expected to qualify for Medicare, which would bring the program’s total enrollment to 74 million individuals. New beneficiaries are often surprised to learn that Medicare uses their Social Security number to identify them. Paula L. Ercolini, a Medicare beneficiary in Sharpsburg, Georgia, wishes that her Medicare card did not have her Social Security Number on it. “The Social Security number has the potential to open up your files, your life to hackers and thieves,” she said. “But you almost have to provide it when you go to new doctors. They won’t see you if you don’t.” Ann Rossie, a former Social Security claims representative who lives in Seattle, said, “Changing to another number will be a humongous job. But Medicare needs to recognize the terrible impact on anybody whose identity is stolen. It destroys your self-esteem, and it can take years to re-establish your identity and credit.” Source: New York Times (April 20, 2015) 5 Reprinted with permission of the Wisconsin Department of Agriculture, Trade and Consumer Protection April 28, 2015 DATCP Consumer Alert: Free Money? There’s No Such Thing MADISON – Free money sounds great. But if someone calls out of the blue telling you that you have been awarded thousands of dollars in a “free government grant,” don’t believe it – especially when the caller asks for your banking information. A grant phone scam may currently be targeting the 608 area code, and the Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP) is asking residents to be on the lookout for these fraudulent calls. Grant scams, whether unsolicited phone calls or through classified ads claiming to offer free money (and providing a toll-free number to call), typically begin with: A claim that your application for a grant is guaranteed to be accepted and that you will never have to pay back the money. A backstory about receiving the grant for paying taxes on time, having a clean criminal record and voting regularly. Other ploys include grants to pay for education costs, home repairs, business expenses or unpaid bills. A request for checking account information in order to establish a “direct deposit” of the grant funds or to cover a one-time “processing fee.” In actuality, the scammer is looking to drain your account. A phony reference number for the grant application. Many standard phone scam tips apply for grant scam attempts: Never give out personal or banking information on an unsolicited call. Scammers can “spoof” their call information, making your caller ID display read however they wish. Never trust the phone number or company name that displays on the caller ID if you think it may be a scam call. To add legitimacy to the ploy, a crook may have some basic information about you on hand when they call, such as your name, address and age. Remember that this is publicly accessible information. For additional information or to file a complaint, visit the Consumer Protection Bureau at http://datcp.wisconsin.gov, send an e-mail to datcphotline@wisconsin.gov or call the Consumer Information Hotline toll-free at 1-800-422-7128. CFPB: “Phantom” Debt Collection Scheme Targeted Millions A lawsuit filed by the Consumer Financial Protection Bureau (CFPB) alleges that a Georgia firm called millions of consumers attempting to collect on “phantom” debts and scammed consumers by citing personal information purchased from payday loan lead generators. The suit, filed against Universal Debt and Payment Solutions and several other related companies, alleges that fraudsters 6 would call consumers claiming to work for employers with names like the “LRS Litigation Group,” “Worldwide Requisitions,” and “Arbitration Resolution,” and tell victims they might face jail time if they did not immediately pay the phantom debt. To add credibility to their claims, the callers would reference personal information, including bank account numbers, which had been purchased from data brokers. “Our lawsuit asserts that consumers were harassed, threatened, and deceived as part of a reprehensible scheme to collect debt that was not even owed,” said CFPB Director Richard Cordray. “We are taking action against the many parties that allegedly contributed to this phantom debt collection operation. The ringleaders of the scheme, the telemarketing company that broadcast millions of robo-calls, and the companies that processed the payments should all be held accountable for taking advantage of vulnerable consumers.” In one example mentioned in the lawsuit, a consumer received a threatening call while he was asleep. “The caller stated that he had a ‘restraining order against (the consumer) to appear in court if I didn’t settle with them.’ The caller said the consumer had 24 hours to pay $500 on a $1,600 debt to Bank of America, or the collector would ‘contact (the consumer’s) employer to levy (his) wage, and they were also contacting the local police to serve papers,’” alleges the lawsuit. “According to the complaint, because he was scared, the consumer provided his bank card information. After making the payment, the consumer’s wife informed him that they had never done business with Bank of America.” The CFPB lawsuit also identified several service providers in the lawsuit, including Global Payments, which processed the debt collector’s credit card payments. The CFPB alleges that the “payment processors provided substantial assistance … enabling the Debt Collectors to accept payment by consumers’ bank cards when the Payment Processors knew, or should have known, that the Debt Collectors were engaged in unlawful conduct.” Another company that the CFPB named in the lawsuit was Global Connect, LLC because it enabled the agents to initiate millions of calls even though “it knew, or should have known, that the messages it broadcast for the Debt Collectors were unfair or deceptive, and materially contributed to the Debt Collectors’ scheme.” Source: Credit.com (April 9, 2015) Reprinted with permission of the U.S. Department of Justice April 21, 2015 Government Sues Skilled Nursing Chain HCR ManorCare for Allegedly Providing Medically Unnecessary Therapy The government has intervened in three False Claims Act lawsuits and filed a consolidated complaint against HCR ManorCare alleging that ManorCare knowingly and routinely submitted false claims to Medicare and Tricare for rehabilitation therapy services that were not medically reasonable and necessary, the Department of Justice announced today. ManorCare is one of the nation’s largest healthcare providers, operating approximately 281 skilled nursing facilities (SNFs) in 30 states. 7 “The Department of Justice is committed to ensuring that healthcare providers who pressure their employees to provide medically unnecessary services to Medicare beneficiaries and Tricare recipients solely to increase their own profits are held accountable,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division. “We will not relent in our efforts to stop these false billing schemes and recover funds for federal healthcare programs.” The government’s complaint alleges that ManorCare, which is owned by The Carlyle Group, exerted pressure on SNF administrators and rehabilitation therapists to meet unrealistic financial goals that resulted in the provision of medically unreasonable and unnecessary services to Medicare and Tricare patients. ManorCare allegedly set prospective billing goals designed to significantly increase revenues without regard to patients’ actual clinical needs and threatened to terminate SNF managers and therapists if they did not administer the additional treatments necessary to qualify for the highest Medicare payments. ManorCare also allegedly increased its Medicare payments by keeping patients in its facilities even though they were medically ready to be discharged. “We strive for a system whereby health care providers provide reasonable and necessary services without overbilling Medicare for unreasonable and unnecessary services” said U.S. Attorney Dana J. Boente of the Eastern District of Virginia. “We will continue our robust investigations of the companies operating in this important sector of our economy.” “We want to ensure that taxpayer dollars are used to pay for health care for Americans that need it, not to unjustly enrich health care companies,” said U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan. “Medical providers will be held accountable when they exploit patients for profit by subjecting them to therapies they don’t need and then billing Medicare for reimbursement.” “Today’s action is the result of a robust investigation into alleged false billings submitted to Medicare and Tricare for rehabilitation therapy services that were not necessary for patients,” said Assistant Director in Charge Andrew G. McCabe of the FBI’s Washington, D.C., Field Office. “Healthcare fraud is a top priority for the FBI and we will continue to work closely with federal, state and local law enforcement partners to address vulnerabilities, fraud and abuse in the healthcare industry.” The three consolidated lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery. The False Claims Act permits the government to intervene in such lawsuits, as it has done in these cases. A defendant that violates the False Claims Act is liable for three times the government’s losses plus civil penalties. The government’s intervention in these matters illustrates its emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $24 billion through False Claims Act cases, with more than $15.3 billion of that amount recovered in cases involving fraud against federal health care programs. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement, including the conduct described in the United States’ complaint, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477). 8 These matters were investigated by the Civil Division’s Commercial Litigation Branch; the U.S. Attorney’s Offices for the Northern and Southern Districts of Iowa, Eastern and Western Districts of Michigan, Northern and Southern Districts of Ohio, Eastern District of Pennsylvania and Eastern District of Virginia; the Department of Health and Human Services’ Office of Inspector General; the Department of Defense’s Office of Inspector General; the Defense Health Agency; the Medicaid Fraud Control Units of the California Attorney General’s Office, Delaware Department of Justice, the Florida Attorney General’s Office, Illinois State Police, Iowa Department of Inspections and Appeals, the Maryland Attorney General’s Office, the Michigan Attorney General’s Office, the Ohio Attorney General’s Office and the Virginia Attorney General’s Office; the National Association of Medicaid Fraud Control Units; and the FBI. The cases are captioned United States ex rel. Ribik v. ManorCare, Inc., et al., Case No. 1:09cv13CMH-HCB (E.D. Va.); United States ex rel. Slough v. HCR ManorCare, et al., Case No. 1:14cv1228 (E.D. Va.); and United States ex rel. Carson v. HCR ManorCare, et al., Case No. 1:11cv1054 (E.D. Va.). The claims asserted against ManorCare are allegations only, and there has been no determination of liability. Upcoming Wisconsin SMP Activities Date Activity County May 5 May 7-8 May 8 May 12 May 13 May 13 May 14 May 14 May 16 May 18 May 18 May 19 May 27 June 2 June 2 June 3 June 10 June 11 June 15 June 16 June 16 SMP Presentation-St. Nazianz Nutrition Site WVCA Annual Conference-Appleton SMP Booth-Multicultural Senior Health Fair-Madison SMP Presentation-Cedar Ridge Apts.-West Bend SMP Presentation-Valders Nutrition Site SMP Booth-Attic Angel Health Fair-Middleton SMP Volunteer Foundations Training-Platteville SMP Presentation-AASC WI Chapter Mtg.-Chippewa Falls SMP Booth-Safety Fair-Plover SMP Presentation-Manitou Manor Nutrition Site SMP Booth-Wisconsin Alzheimer’s Conference-Lake Delton SMP Presentation-Kenosha YMCA Dining Site SMP Presentation-ACFE Milwaukee Chapter Meeting SMP Booth-Senior Americans Day-Eau Claire SMP Presentation-St. Nazianz Nutrition Site SMP Presentation-Segoe Terrace Apts.-Madison SMP Presentation-Valders Nutrition Site SMP Booth-Fox Cities Senior Living Show-Neenah SMP Presentation-Manitou Manor Nutrition Site SMP Booth-Ozaukee County Senior Conference-Grafton SMP Booth-2015 Senior Health Fair-Manitowoc Manitowoc Outagamie Dane Washington Manitowoc Dane Grant Chippewa Portage Manitowoc Sauk Kenosha Milwaukee Eau Claire Manitowoc Dane Manitowoc Winnebago Manitowoc Ozaukee Manitowoc We are always looking for opportunities to support our colleagues in the aging network. Please contact Wisconsin SMP and let us know about upcoming events in your area. 9 Wisconsin SMP Coalition of WI Aging Groups 2850 Dairy Drive Ste. 100 Madison WI 53718 ATTENTION: All of You with Email… In an effort to save paper, postage and be “volunteer friendly,” we will email issues of the Fraud Alert! to those who have email. Please contact Kevin Brown at kbrown@cwag.org and give him your email address to add to our list. Thank you! For more information, contact: Kevin Brown, SMP Project Director Coalition of Wisconsin Aging Groups Elder Law Center 2850 Dairy Drive – Suite 100 Madison, WI 53718-6742 Phone: 800/488-2596 608/224-0606 Email: kbrown@cwag.org You can also access our publication by visiting our web site www.wisconsinsmp.org Or you can visit the Coalition of Wisconsin Aging Groups web site www.cwag.org Click on Publications then click on Wisconsin Senior Medicare Patrol (SMP) and scroll down and click on the edition you wish to view.
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