Notes to State Offices: This is a presentation that should take about 30-40 minutes for staff or lead volunteers to use. You should adapt the Welcome slide to fit your event’s circumstances. You may want to replace slides 11-17 with state-specific headlines or press releases about cases in your state. Of cut to a couple of examples if you need to save time. Note on slide 27 you will want to include the contact information for the specific state agencies 1
Welcome to this discussion of the “Health Care Scams and Frauds.” We are glad you could join us today. •Thank co-sponsors •Introduce guests •Introduce presenters You undoubtedly have heard about the problem of fraud in the health care system, as well as scams that are cropping up. Scam artists are already taking advantage of uncertainties about the new law to try to rip you off. Today we are planning on talking about both scams that could be targeting you and fraud that is taking place within the entire health care system, including fraudulent activities aimed at Medicare, Medicaid, and insurance companies. 2
How big is the problem of health care fraud? Waste, fraud and abuse appear in all segments of the health care system and in all areas of the country. The way the heath care system is designed makes it particularly vulnerable to fraud and that activity is particularly difficult to control. Why? Most health care providers are paid based on a set fee for a specific service through a highly automated claims processing system. Billions of annual claims are paid to hundreds of thousands of providers by more than a 1000 payers. Mistakes can happen, but intentional fraud happens, too. In a 2009 report the Government Accountability Office estimated that approximately 10% of all health care spending – or about $100 Billion -- came from fraud and abuse. The Centers for Medicare and Medicaid Services estimates that we—all those who have paid into the Medicare trust funds all our lives—are losing about $65 billion to criminal fraud each year. $65 billion in Medicare fraud would go a long way to extend the security of the Medicare program and even add more benefits. Health care fraud can also mean that people get stuck with bad equipment, they are given the wrong drugs, they get inappropriate or untimely care – all affecting their health and well-being. 3
During today’s presentation [our AARP consumer experts] are going to talk to you about what you can do to spot and stop scams and frauds. We’ll point out to you what the new scams look or sound like so you can avoid getting taken. We’ll also let you know what you can do to stop these scams from reaching your friends and neighbors and how and where to report your concerns. We will talk about fraud that is happening in the larger health care system. We’ll help you understand how you can spot possible fraud on your Medicare Summary Notice or Explanation of Benefits. You are a necessary participant in the national effort to control fraud by reporting it. We’ll tell you how. Finally, we will explain some of the measures added in the new health care law to strengthen enforcement efforts to stop the crime wave. 4
Just like they always do, the scam artists read the headlines. They take just a bit of the news and twist it to their needs. Any time there might be some confusion about something in the news, it’s just the situation the scammers love to exploit. Let me explain just a few of the scams we have already seen: •$250 rebate check •Yes, people who fell into the Medicare Part D prescription drug coverage gap – AKA the doughnut hole—got a check from Medicare. [When your total drug costs exceed a certain amount ($2,930 in 2012), you fall into the doughnut hole. While in this coverage gap, you pay the full price of your drugs, as well as your premiums. When your out-of-pocket costs for drugs reach a certain level ($4,700 in 2012), you qualify for catastrophic coverage. After you qualify for catastrophic coverage, you are responsible for only 5% of your prescription drug costs for the rest of the year.] •Send automatically to those who were eligible •No one had to apply, request, give information, pay fee get help •Nothing anyone could do to get the check quicker • But, we saw reports that people were calling offering to “help you get your check” • It was a scam. 5
The other major way we are hearing about scams are sellers of what they may be calling “new” insurance who are building a sales pitch around a bit of the health care law programs . Yes, some new insurance programs are or will be available under the new law • One new program is the Temporary insurance for persons with pre-existing conditions that some refer to as “high risk pools”. This new coverage for this special group of people who have been without insurance for at least 6 months and have a pre-existing condition is now available. • But no government rep will come door-to-door or call you on the phone or send you an email to offer this temporary insurance • Another new program is the extension of coverage for young adults so families can add young adult children to existing health care plans. • But there are no separate young adult policies created by the new law • Some out there are trying to sell “young adult policies” as if they were what the law created but they are not • Another new program is the state-base health insurance exchanges—where you will be able to purchase private insurance at less costly group rates • But they do not come into operation until 2014 • No one can be selling this insurance at this early date • Medicare coverage—yes, there are improved benefits within Medicare • But watch out for insurance agents claiming “you have been pre-approved under the health care law for the new Medicare supplemental insurance”. • This scam has been tried across the country. These agents are fraudulently using uncertainty about the health care law to promote their insurance product that doesn’t 6
have anything to do with the law. 6
Other warning signs you should watch out for: We’ve also heard reports that people have tried to use the health care law to steal your identity. How is that supposed to work? I’ve got 3 examples: Some AARP members report that they got a call telling them that because of the changes to Medicare, they “need” a new Medicare card. They were asked for their Medicare number (which is also your Social Security number), name, address, so they could get a replacement card. There is absolutely no truth to this scam. You don’t need a new Medicare card no matter how convincing they may sound. They are just using the news headlines to sound a tiny bit legitimate as they try to convince someone to give away personal information. Another report is of a late night television ad with an 800 number to call. The pitch is for a “limited enrollment opportunity” to sign up for new insurance “now that the historic health care legislation has passed.” Whatever insurance they might be selling—it has nothing to do with the Affordable Care Act. You can expect to see some post cards coming in the mail to you offering “free information” about the changes brought about by the health care law. It might look like the card is sent from a federal agency with a DC post office box for a “Federal Processing Center.” They want you to give your name, age, Social Security Number, and address. While you just might get some free information, what you’ll surely get if you return the card is a sales call for annuities, investments, or other types of life insurance that has nothing to do with the heath care law. 7
Government officials aren’t going to be calling you on the phone or coming to your door or even sending you promotional emails And they aren’t going to be advertising on late night TV So how can you tell the bad from the good or the legitimate information about new programs versus the look-alikes? The fraudsters are going to try to make you think they are “official”—with seals, and DC addresses, or even by coming out and saying they are with “the government”. Slow down • Any time someone uses the “limited time only” short deadline to get you to act, they are trying to push you quickly into an ill advised decision. • Watch out for people who are trying to get you to sign before you can think things through and verify. • You will get plenty of time to think about any decisions you do have to make about • Medicare Open Enrollment • Medicare Advantage plans • Part D prescription drug plans • Temporary insurance for people with pre-existing conditions • Exchanges—what don’t come about until 2014. Which leads to the next point: Verify the information • if someone calls, ask for information in writing • if you get an email, don’t follow the link or open attachments until you independently verify that the sender is legitimate • if they ask for personal information (name, address, Social Security number or Medicare number, bank account, credit card), ask why they want it • go directly to a trusted source of information such as AARP or Medicare – we will give you lots of places to go in just a moment Any person selling any kind of insurance has to be licensed in your state. Check with the insurance department in your state to find out if any agent is licensed. If not, don’t do business with that person. 8
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