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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
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Illinois SMP Fraud Alert - February 5, 2010
Dear SMP readers,
I hope this week’s edition of the Illinois SMP Program Fraud Alert finds you well. You’ll find information below about some of the scam reports we’ve been receiving lately, as well as a great video of the Ohio SMP from the NBC news in Cincinnati. Have a wonderful 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
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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
- Ohio SMP Featured on NBC News in Cincinnati
- Chicago Senior Receives Call “from Medicare”
- Agent/Broker Marketing
- Fraud in the News
Ohio SMP Featured on NBC News in Cincinnati
SMP has been receiving quite a bit of media coverage lately! Here is a link to a brief video (under 3 minutes) of a Cincinnati NBC News story about the SMP program, featuring the Ohio SMP:
http://www.wlwt.com/video/22468238/index.html
Chicago Senior Receives Call “from Medicare”
A Chicago woman recently reported a phone call from a man who asked her if she lived “at this phone number” and asked if she was on Medicare. The caller identified himself as a “Medicare Specialist” and said that he would come to her home the following day at 9 a.m. He offered her “help once or twice a week,” paid for by Medicare. The caller did not specify what kind of “help” this entailed. The woman questioned the caller as to who he was, and he would only refer to himself as a “Medicare Specialist.” The woman is not going to let the man into her home.
This call, of course, did NOT come from Medicare. Medicare does not make phone calls like this; in general, Medicare does not contact people at all. The only situations in which Medicare may contact someone via phone would be 1) to follow up on a contact that the person made initially, or 2) to conduct a survey. Currently, we are not aware of any Medicare surveys, and Medicare will NEVER call to offer services like this. This situation likely involves a home health company who is inappropriately using telemarketing to gain clients, and consumers should be warned that it is not a good idea to accept such services over the phone. If someone needs a Medicare-covered health care service, the person should speak to their doctor about obtaining that service – not to someone who calls on the phone or comes to the door.
Agent/Broker Marketing
In the last 2 weeks, we have received a number of complaints regarding inappropriate marketing by insurance plan agents. Here are a few examples:
- Several Mount Prospect residents have received phone calls from an organization called “Mature Health Services.” The caller asks if the person has received the 2010 Medicare and You book, then says that they will be visiting people in the neighborhood “to make sure that people are getting the services they deserve” and want to set up an appointment to meet with the person. This company’s website reveals that they sell a variety of insurance products, including Medicare Advantage plans, so they may be using telemarketing to establish appointments to discuss these products.
- Another complaint involved repeated calls from an organization called Senior Strategies Group, who also markets insurance products
- A dual eligible beneficiary (person who has both Medicare and Medicaid) in Evanston was inappropriately enrolled into a Medicare Advantage plan by a plan agent.
- A Rock Island woman received a phone call from an organization asking her about “living with diabetes,” and claiming that they got her information “from Medicare.” An online search of the phone number revealed several complaints about similar calls, as well as other calls from that number claiming to be an “Information Center” or “Rewards Center.” It is difficult to determine whether these calls are simply telemarketers trying to sell legitimate products, or perhaps a scam. Either way, these calls are NOT from Medicare.
We are currently in the middle of the Open Enrollment Period for Medicare Advantage plans, so it is important that consumers are aware of the rules involving insurance plan marketing. Plans and insurance agents are NOT allowed to “cold call” anyone. They must have permission to contact you by phone. (Note: “permission” includes putting your business card in a drawing, signing a list at a community event, etc. – Be aware of what you sign up for!) Agents are also NOT allowed to visit anyone’s home without an appointment. If an agent obtains an appointment to discuss plan options, the agent and the beneficiary must agree to the topics that will be discussed beforehand – this must either be recorded, if on the phone, or signed by the beneficiary on paper. Agents also may not lie or misrepresent their plans (i.e., by saying something is “free” when it is not). Finally, an agent cannot sign someone up for a plan without his/her permission. To give permission, the person must understand what type of plan he/she is enrolling in – an agent cannot tell you that you are signing up for a Medicare Supplement plan when you are being enrolled into an HMO.
For more information about Medicare’s marketing guidelines for Part D and Medicare Advantage plan agents, please see the attached handout from the Health Assistance Partnership (HAP):
HAP Marketing Regulations Fact Sheet
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Fraud In The News
The following are current news articles about health care and fraud issues.
Health Care & Health Care Fraud:
1. Illinois Health Care Fraud News (www.stopmedicarefraud.gov maintains a running list of health care fraud articles from each state. This is a link to the current updates for Illinois, including an article about a Perryville, MO clinic who pled guilty to fraud charges and a Decatur pediatrician charged with health care fraud):
Illinois Health Care Fraud News
2. AtriCure Pays $3.76M To Resolve Allegations of Medicare Fraud (2 articles):
Device Maker AtriCure to Pay $3.76M...
3. “Senator Chuck Grassley Introduces Bill on Medicare Payment Fraud” (Dotmed.com): Senator Chuck Grassley Introduces...
4. “Rating Doctors Online” (AARP Bulletin article about the pro’s and con’s of online doctor ratings): Rating Doctors Online
Consumer Fraud:
5. “AARP Scam Alert: No PIN At The Pump” (article about using debit cards at gas stations): AARP Scam Alert: No PIN At The Pump
6. “Ask Sid: Debit Card Safety” (another AARP article about how to safely use debit cards to make purchases): Ask Sid: Debit Card Safety
7. “Scam Alert: If Your Data Is Lost, Listen Up” (article about the steps people should take to minimize identity theft after being notified of a data breach): Scam Alert: If Your Data Is Lost...
8. " Facebook, Social Networks Increasing Source of Spam, Cyber Attacks" (article about internet safety):
Facebook, Social Networks Increasing Source of Spam...
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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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