Illinois SMP Program Fraud Alerts

 

The Illinois SMP Program sends email Fraud Alerts every Friday. These alerts contain fraud-related news articles, information about current scams in Illinois or other parts of the United States, and useful healthcare or fraud-related resources. If you would like to be added to the Illinois SMP Fraud Alert email list, please contact:

Erin Weir, Healthcare Consumer Protection Coordinator

Phone: (800)699-9043, (708)383-0258

TTY: (708)524-1653

Fax: (708)524-0870

erin.weir@ageoptions.org

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Illinois SMP Fraud Alert - May 21, 2010

Dear SMP readers,

Today’s Fraud Alert contains a warning about Medigap plan sales scams, a salesman who markets “free government money” advice, a CBS news special on the identity theft dangers involved in disposing of a photocopier, information on a Medicare sanction issued against a Medicare Advantage plan insurance company, and of course, Fraud in the News.

Have a great weekend!

Sincerely,

Erin Weir, MSW, LSW, Healthcare Consumer Protection Coordinator

AgeOptions

1048 Lake Street, Suite 300

Oak Park, IL 60301

phone (708)383-0258 fax (708)524-0870

erin.weir@ageoptions.org

ageoptions.org

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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 Erin Weir, Healthcare Consumer Protection Coordinator at AgeOptions.

What you will find in this week’s Fraud Alert

• Be Aware of Medigap Sales Scams
• “Free Government Money” is Too Good To Be True
• CBS Warns About Dangers in Disposing of Photocopiers
• CMS Sanctions Medicare Advantage Insurance Company
• Fraud in the News

Be Aware of Medigap Sales Scams

The Make Medicare Work (MMW) Coalition released a warning in yesterday’s Bulletin about marketing scams that seem to be resulting from the new Medigap (Medicare Supplement Policy) plan changes that take effect June 1, 2010. These changes affect what types of Medigap plans will be sold, and what benefits those plans will include. However, the changes do NOT affect beneficiaries who are already enrolled in a Medigap plan – they only affect the choices available to people who will purchase Medigap plans in the future. Unfortunately, it seems that some unscrupulous agents have taken advantage of these changes to try to convince Medicare beneficiaries to change their plan. See the MMW warning below:

“Some Medicare beneficiaries have been approached by agents selling Medigap plans about switching to a new plan. They are being told they need to make a change.  Individuals who are enrolled in Medigap plans should be advised that if they are happy with their current policy there is no need to make a change or switch to a new policy. An individual who has a Medigap plan today is guaranteed renewable for that policy unless he/she stops paying the premium or is no longer eligible for Medicare.

Please report any suspicious marketing activities to the Illinois Senior Health Insurance Program (SHIP) at 1-800-548-9034 or AgeOptions SMP Program at 1-800-699-9043. Please make sure to obtain as much information about the contact, agent and company as possible including the full name of the agent, the company they work for, where it is located, a phone number to reach them,  and when the call or visit was made.”

 

“Free Government Money” is Too Good To Be True

The Texas SMP program recently spoke with an individual who received a phone call from someone who told her that she could get help – for a fee -  by visiting the website www.leskomentor.com. This website is run by a man named Matthew Lesko, who has several websites and does infomercials how to access “free” government benefits. Marketing schemes like this are often scams, and it appears that Mr. Lesko’s work has been reported as such: http://consumerfraudreporting.org/leskoscam.php.

Please note that information about a “free” program or benefit should also be free – consumers should never pay for information about free services, especially if the pitch is regarding government grants. “Free government money” is a popular topic for scam artists.

CBS Warns About Dangers in Disposing of Photocopiers

Many people are not aware of the fact that photocopiers and fax machines generally store the information they process on a hard drive. If that hard drive is not specifically set to delete that information after it is used, it will generally stay on the hard drive forever, until the hard drive is destroyed. This poses a great identity theft risk, given that many businesses dispose of their photocopiers without destroying the hard drive inside. CBS News recently aired a 2 part news story on this problem. Below are the links to both videos, as well as the follow up article.

Video 1: http://www.cbsnews.com/video/watch/ ?id=6412572n&tag=mg;mostpopvideo

Video 2 (follow up): http://www.cbsnews.com/video/watch/ ?id=6493270n&tag=related;photovideo

article (follow up): http://www.cbsnews.com/stories/2010/05/17/eveningnews/ main6492698.shtml?tag=contentBody;featuredPost-PE%22%3EFederal

CMS Sanctions Medicare Advantage Insurance Company

Earlier this week, the Centers for Medicare and Medicaid Services (CMS) issued a sanction and civil monetary penalties against Quality Health Plans (QHP), a Medicare Advantage Plan provider. The statement by CMS states that QHP exhibited such problems as “deficiencies in billing procedures and practices, denying and/or delaying Part D medications to beneficiaries, developing and implementing an adequate compliance plan for both its operations and pharmacy benefit manager, and non-compliance in beneficiary appeals and grievance procedures.” For more information about the sanction, please see the following article:

http://www.mcknights.com/cms-issues-notice-of-sanctions-to-medicare -advantage-insurer/article/170484/

Note: QHP does not have any Medicare Advantage plans in Illinois, so Illinois beneficiaries should not be affected by this sanction.

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Fraud In The News

The following are current news articles about health care and fraud issues.

1. “Pharmacist Will Be Confined to Home” (article about the sentencing of a pharmacist from The Medicine Shoppe in Edwardsville, IL): http://www.theintelligencer.com/articles/2010/05/18/ local_news/doc4bf2b9087216f055751156.txt

2. “Nine Hospitals Pay $9.4 Million in Medicare Fraud Settlements” (settlement by hospitals in 7 states regarding kyphoplasty procedures): http://www.fiercehealthcare.com/story/nine-hospitals-pay-9-4-million-medicare-fraud-settlements/2010-05-18

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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 erin.weir@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.

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