Fraud Target: Senior Citizens: File a complaint if suspicious
Raymond
Write to President Obama. He wants to stop medical fraud. Give names
of quilty persons so FBI can follow up. Aided by surveillance and
undercover sources, authorities can determine who charged for services
never performed. .
Be suspicious of anyone in the health care profession. Every family
with elderly members has its horror story.. Billing Medicare or
another insurer for services or items you never received is common. It
amounts to billions with a "B". And few are punished.
Our Common Fraud Schemes webpage provides tips on how you can protect
you and your family from fraud. Senior Citizens especially should be
aware of fraud schemes.
Why should Senior Citizens be concerned? Because the health care
industry is rampant with crooked doctors, hpspitals and other
providers
It has been the experience of the FBI that the elderly are targeted
for fraud for several reasons:
1) Older American citizens are most likely to have a "nest egg," own
their home and/or have excellent credit all of which the con-man will
try to tap into. The fraudster will focus his/her efforts on the
segment of the population most likely to be in a financial position to
buy something.
2) Individuals who grew up in the 1930s, 1940s, and 1950s were
generally raised to be polite and trusting. Two very important and
positive personality traits, except when it comes to dealing with a
con-man. The con-man will exploit these traits knowing that it is
difficult or impossible for these individuals to say "no" or just hang
up the phone.
3) Older Americans are less likely to report a fraud because they
don't know who to report it to, are too ashamed at having been
scammed, or do not know they have been scammed. In some cases, an
elderly victim may not report the crime because he or she is concerned
that relatives may come to the conclusion that the victim no longer
has the mental capacity to take care of his or her own financial
affairs.
4) When an elderly victim does report the crime, they often make poor
witnesses. The con-man knows the effects of age on memory and he/she
is counting on the fact that the elderly victim will not be able to
supply enough detailed information to investigators such as: How many
times did the fraudster call? What time of day did he/she call? Did he
provide a call back number or address? Was it always the same person?
Did you meet in person? What did the fraudster look like? Did he/she
have any recognizable accent? Where did you send the money? What did
you receive if anything and how was it delivered? What promises were
made and when? Did you keep any notes of your conversations?
The victims' realization that they have been victimized may take weeks
or, more likely, months after contact with the con-man. This extended
time frame will test the memory of almost anyone.
5) Lastly, when it comes to products that promise increased cognitive
function, virility, physical conditioning, anti-cancer properties and
so on, older Americans make up the segment of the population most
concerned about these issues. In a country where new cures and
vaccinations for old diseases have given every American hope for a
long and fruitful life, it is not so unbelievable that the products
offered by these con-men can do what they say they can do.
What to Look For and How to Protect Yourself and Your Family--
Health Insurance Frauds:
Medical Equipment Fraud:
Equipment manufacturers offer "free" products to individuals. Insurers
are then charged for products that were not needed and/or may not have
been delivered.
"Rolling Lab" Schemes:
Unnecessary and sometimes fake tests are given to individuals at
health clubs, retirement homes, or shopping malls and billed to
insurance companies or Medicare.
Services Not Performed:
Customers or providers bill insurers for services never rendered by
changing bills or submitting fake ones.
Medicare Fraud:
Medicare fraud can take the form of any of the health insurance frauds
described above. Senior citizens are frequent targets of Medicare
schemes, especially by medical equipment manufacturers who offer
seniors free medical products in exchange for their Medicare numbers.
Because a physician has to sign a form certifying that equipment or
testing is needed before Medicare pays for it, con-artists fake
signatures or bribe corrupt doctors to sign the forms. Once a
signature is in place, the manufacturers bill Medicare for merchandise
or service that was not needed or was not ordered.
Some Tips to Avoiding Health Insurance Frauds
Never sign blank insurance claim forms.
Never give blanket authorization to a medical provider to bill for
services rendered.
Ask your medical providers what they will charge and what you will be
expected to pay out-of-pocket.
Carefully review your insurer's explanation of the benefits statement.
Call your insurer and provider if you have questions.
Do not do business with door-to-door or telephone salespeople who tell
you that services of medical equipment are free.
Give your insurance/Medicare identification only to those who have
provided you with medical services.
Keep accurate records of all health care appointments.
Know if your physician ordered equipment for you.
Top of Page
Counterfeit Prescription Drugs
Some Tips to Avoiding Counterfeit Prescription Drugs
Be mindful of appearance. Closely examine the packaging and lot
numbers of prescription drugs and be alert of any changes from one
prescription to the next.
Consult your pharmacist or physician if your prescription drug looks
suspicious.
Alert your pharmacist and physician immediately if your medication
causes adverse side effects or if your condition does not improve.
Use caution when purchasing drugs on the Internet. Do not purchase
medications from unlicensed online distributors or those who sell
medications without a prescription. Reputable online pharmacies will
have a seal of approval called the Verified Internet Pharmacy Practice
Site (VIPPS), provided by the Association of Boards of Pharmacy in the
United States.
Product promotions or cost reductions and other "special deals" may be
associated with counterfeit product promotion.
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Funeral and Cemetery Fraud
Some Tips to Avoiding Funeral and Cemetery Fraud
Be an informed consumer. Take time to call and shop around before
making a purchase. Take a friend with you who may offer some
perspective to help make difficult decisions. Funeral homes are
required to provide detailed general price lists over the phone or in
writing.
Educate yourself fully about caskets before you buy one and understand
that caskets are not required for direct cremations.
Understand the difference between funeral home basic fees for
professional services and any fees for additional services.
You should know that embalming rules are governed by state law and
that embalming is not legally required for direct cremations.
Carefully read all contracts and purchasing agreements before signing
and make certain that all of your requirements have been put in
writing.
Make sure you understand all contract cancellation and refund terms,
as well as your portability options for transferring your contract to
other funeral homes.
Before you consider prepaying, make sure you are well informed. When
you do make a plan for yourself, share your specific wishes with those
close to you.
And, as a general rule governing all of your interactions as a
consumer, do not allow yourself to be pressured by vendors into making
purchases, signing contracts, or committing funds. These decisions are
yours and yours alone.
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Fraudulent "Anti-Aging" Products
Some Tips to Avoiding Fraudulent "Anti-Aging" Products
If it sounds to good to be true, it probably is. Watch out for "Secret
Formulas" or "Breakthroughs."
Don't be afraid to ask questions about the product. Find out exactly
what it should do for you and what it should not.
Research a product thoroughly before buying it. Call the Better
Business Bureau to find out if other people have complained about the
product.
Be wary of products that purport to cure a wide variety of illnesses
(particularly serious ones) that don't appear to be related.
Testimonials and/or celebrity endorsements are often misleading.
Be very careful of products that are marketed as having no side
effects.
Products that are advertised as making visits to a physician
unnecessary should be questioned.
Always consult your doctor before taking any dietary or nutritional
supplement.
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Telemarketing Fraud
If you're age 60 or older, you may be a special target for people who
sell bogus products and services by phone. Older women living alone
are special targets of these scam artists. Telemarketing scams often
involve offers of prizes, low-cost vitamins and health care products,
and travel offers.
There are warning signs to these scams, including promises of "free"
or "low cost" vacations and get rich quick schemes. If you hear these--
or similar--"lines" from a telephone salesperson, just say "no thank
you," and hang up the phone:
- "You must act 'now' or the offer won't be good."
- "You've won a 'free' gift, vacation, or prize." But you have to pay
for "postage and handling" or other charges.
- "You must send money, give a credit card or bank account number, or
have a check picked up by courier." You may hear this before you have
had a chance to consider the offer carefully.
- "You don't need to check out the company with anyone." The callers
say you do not need to speak to anyone including your family, lawyer,
accountant, local Better Business Bureau, or consumer protection
agency.
- "You don't need any written information about their company or
their references."
- "You can't afford to miss this 'high-profit, no-risk' offer."
Remember, if you hear the lines above, or similar "lines" from a
telephone salesperson, just say "no thank you," and hang up the phone:
Some Tips to Avoiding Telemarketing Fraud:
It's very difficult to get your money back if you've been cheated over
the phone. Before you buy anything by telephone, remember:
Don't buy from an unfamiliar company. Legitimate businesses understand
that you want more information about their company and are happy to
comply.
Always ask for and wait until you receive written material about any
offer or charity. If you get brochures about costly investments, ask
someone whose financial advice you trust to review them. But,
unfortunately, beware -- not everything written down is true.
Always check out unfamiliar companies with your local consumer
protection agency, Better Business Bureau, state Attorney General, the
National Fraud Information Center, or other watchdog groups.
Unfortunately, not all bad businesses can be identified through these
organizations.
Obtain a salesperson's name, business identity, telephone number,
street address, mailing address, and business license number before
you transact business. Some con artists give out false names,
telephone numbers, addresses, and business license numbers. Verify the
accuracy of these items.
Before you give money to a charity or make an investment, find out
what percentage of the money is paid in commissions and what
percentage actually goes to the charity or investment.
Before you send money, ask yourself a simple question. "What guarantee
do I really have that this solicitor will use my money in the manner
we agreed upon?"
You must not be asked to pay in advance for services. Pay services
only after they are delivered.
Some con artists will send a messenger to your home to pick up money,
claiming it is part of their service to you. In reality, they are
taking your money without leaving any trace of who they are or where
they can be reached.
Always take your time making a decision. Legitimate companies won't
pressure you to make a snap decision.
Don't pay for a "free prize." If a caller tells you the payment is for
taxes, he or she is violating federal law.
Before you receive your next sales pitch, decide what your limits are
-- the kinds of financial information you will and won't give out on
the telephone.
It's never rude to wait and think about an offer. Be sure to talk over
big investments offered by telephone salespeople with a trusted
friend, family member, or financial advisor.
Never respond to an offer you don't understand thoroughly.
Never send money or give out personal information such as credit card
numbers and expiration dates, bank account numbers, dates of birth, or
social security numbers to unfamiliar companies or unknown persons.
Your personal information is often brokered to telemarketers through
third parties.
If you have been victimized once, be wary of persons who call offering
to help you recover your losses for a fee paid in advance.
If you have information about a fraud report it to state, local, or
federal law enforcement agencies.
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Internet Fraud
As Internet use among Senior Citizens increases, so does their chances
to fall victim to Internet Fraud. Internet Fraud includes non-delivery
of items ordered over the Internet and credit/debit card fraud. Please
visit the FBI's "Internet Fraud" webpage for details about these
crimes and tips to protect yourself.
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Investment Schemes
Senior Citizens, as they plan for retirement, may fall victim to
investment schemes. These may include Advance Fee Schemes, Prime Bank
Note Schemes, Pyramid Schemes, and Nigerian Letter Fraud schemes.
Please visit the "Common Fraud Schemes" webpage for more information
about these crimes and tips for protection.
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Reverse Mortgage Scams
The FBI and the U.S. Department of Housing and Urban Development
Office of Inspector General (HUD-OIG) urge consumers, especially
senior citizens, to be vigilant when seeking reverse mortgage
products. Reverse mortgages, also known as Home Equity Conversion
Mortgages (HECM), have increased more than 1,300 percent between 1999
and 2008, creating significant opportunities for fraud perpetrators.
Reverse mortgage scams are engineered by unscrupulous professionals in
a multitude of real estate, financial services, and related entities
to steal the equity from the property of unsuspecting senior citizens
aged 62 or older or to use these seniors to unwittingly aid the
fraudsters in stealing equity from a flipped property.
In many of the reported scams, victim seniors are offered free homes,
investment opportunities, and foreclosure or refinance assistance;
they are also used as straw buyers in property flipping scams.
Seniors are frequently targeted for this fraud through local churches,
investment seminars, and television, radio, billboard, and mailer
advertisements.
A legitimate HECM loan product is insured by the Federal Housing
Authority (FHA). It enables eligible homeowners to access the equity
in their homes by providing funds without incurring a monthly payment.
Eligible borrowers must be 62 years or older who occupy their property
as their primary residence and who own their property or have a small
mortgage balance. See the FBI/HUD Intelligence Bulletin for specific
details on HECMs as well as other foreclosure rescue and investment
schemes.
Seniors should consider the following:
Do not respond to unsolicited advertisements.
Be suspicious of anyone claiming that you can own a home with no down
payment.
Do not sign anything that you do not fully understand.
Do not accept payment from individuals for a home you did not
purchase.
Seek out your own reverse mortgage counselor.
If you are a victim of this type of fraud and want to file a
complaint, please submit information through our electronic tip line
or through your local FBI office. You may also file a complaint with
HUD-OIG at www.hud.gov/complaints/fraud_waste.cfm or by calling HUD’s
Hotline at 1-800-347-3735.
Resources :
- FBI/HUD Intelligence Bulletin
Related Links: USA.gov for Seniors | United States Special Committee
on Aging
Raymond
> Hotline at 1-800-347-3735.
>
> Resources :
>
> - FBI/HUD Intelligence Bulletin
> Related Links: USA.gov for Seniors | United States Special Committee
> on Aging
30 Arrested Around U.S. In Medicare Fraud Sweep
Associated Press
MIAMI, -- Federal authorities arrested more than 30 suspects,
including doctors, and were seeking others in a major Medicare fraud
sweep Wednesday in New York, Louisiana, Boston and Houston.
More than 200 agents worked on the $16 million bust, which included 12
search warrants at health-care businesses and homes across the Houston
area, where the bulk of the arrests were made.
Federal authorities say those businesses were giving patients
"arthritis kits," which were nothing more than expensive orthotics
that included knee and shoulder braces and heating pads. Patients told
authorities the kits were unnecessary, and many never even received
them, but clinic owners billed Medicare between $3,000 and $4,000 for
each kit.
Houston's other scam involved billing Medicare for thousands of
dollars worth of liquid food such as Ensure. Authorities said clinic
owners never distributed the food to patients. In some cases, clinic
owners billed patients who were dead when they allegedly received the
items.
It was the third major sweep since Attorney General Eric H. Holder Jr.
and Health and Human Services Secretary Kathleen Sebelius announced in
May that they were adding millions of dollars and dozens of agents to
combat Medicare fraud, which costs the United States billions each
year.
Using about a dozen agents in targeted cities, the Medicare Fraud
Strike Force has recovered $371 million in false Medicare claims and
charged 145 people across the country in two months, officials said.
Since 2007, strike forces in Miami, Detroit and Los Angeles have
indicted more than 293 suspects and organizations that collectively
have billed the Medicare program more than $674 million.
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/29/AR2009072903275.html
36 Arrested In Massive $251 Million Medicare Scam
KELLI KENNEDY and TOM HAYS | 07/16/10 09:38 PM |
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views Get Business Alerts
Email Comments 60 MIAMI — Elderly Russian immigrants lined up to take
kickbacks from the backroom of a Brooklyn clinic. Claims flooded in
from Miami for HIV treatments that never occurred. One professional
patient was named in nearly 4,000 false Medicare claims.
Authorities said busts carried out this week in Miami, New York City,
Detroit, Houston and Baton Rouge, La., were the largest Medicare fraud
takedown in history – part of a massive overhaul in the way federal
officials are preventing and prosecuting the crimes.
In all, 94 people – including several doctors and nurses – were
charged Friday in scams totaling $251 million. Federal authorities,
while touting the operation, cautioned the cases represent only a
fraction of the estimated $60 billion to $90 billion in Medicare fraud
absorbed by taxpayers each year.
For the first time federal officials have the power to overhaul the
system under Obama's Affordable Care Act, which gives them authority
to stop paying a provider they suspect is fraudulent. Critics have
complained the current process did nothing more than rubber-stamp
payments to fraudulent providers.
"That world is coming to an end," Health and Human Services Secretary
Kathleen Sebelius told The Associated Press after speaking at a health
care fraud prevention summit in Miami. "We've got new ways to go after
folks that we've never had before."
Officials said they chose Miami because it is ground zero for Medicare
fraud, generating roughly $3 billion a year. Authorities indicted 33
suspects in the Miami area, accused of charging Medicare for about
$140 million in various scams.
Suspects across the country were accused of billing Medicare for
unnecessary equipment, physical therapy and other treatments that
patients never received. In one $72 million scam at Bay Medical in
Brooklyn, clinic owners submitted bogus physical therapy claims for
elderly Russian immigrants.
Patients, including undercover agents, were paid $50 to $100 a visit
in exchange for using their Medicare numbers and got bonuses for
recruiting new patients. Wiretaps captured hundreds of kickback
payments doled out in a backroom by a man who did nothing but pay
patients all day, authorities said.
The so-called "kickback" room had a Soviet-era propaganda poster on
the wall, showing a woman with a finger to her lips and two warnings
in Russian: "Don't Gossip" and "Be on the lookout: In these days, the
walls talk."
With the surveillance, the walls "had ears and they had eyes," U.S.
Attorney Loretta Lynch said at a news conference in Brooklyn.
In a separate Brooklyn case, authorities charged six patients who
shopped their Medicare numbers to various clinics. More than 3,744
claims were submitted on behalf of one woman alone, 82-year-old
Valentina Mushinskaya, over the past six years.
At a brief appearance in federal court Friday, Mushinskaya was
released on $30,000 bond and ordered not to return to the Solstice
Wellness Center, scene of an alleged $2.8 million scam.
Authorities called Mushinskaya one of the clinic's "serial
beneficiaries," with phony bills totaling $141,161 paid by Medicare.
Her nephew, Vladimir Olshansky, told reporters his Ukrainian-born aunt
suffers from diabetes. "She doesn't know what this is about," he said.
"She's in the dark."
In Miami, Daniel R. Levinson, inspector general of HHS, which oversees
Medicare, said the arrests "illustrate how health care fraud schemes
can replicate virally and migrate rapidly across communities."
Cleaning up Medicare fraud will be key to paying for President Barack
Obama's proposed health care overhaul. Federal officials have
allocated more money and manpower to fight fraud, setting up strike
forces in seven cities with a plan to expand to a dozen more. So far,
the operations are responsible for more than 720 indictments that
collectively billed the Medicare program more than $1.6 billion.
Around the country, the schemes have morphed from the typical medical
equipment scam in which clinic owners billed Medicare dozens of times
for the same wheelchair. Now, officials say, Medicare fraud involves a
sophisticated network of doctors, clinic owners, patients and patient
recruiters.
Violent criminals and mobsters are also tapping into the scams, seeing
Medicare fraud as more lucrative than dealing drugs and having less
severe criminal penalties, officials said.
For decades, Medicare operated under a system that paid providers
first and investigated later. That pay and chase method was a boon for
crooks, giving them 90 days lag time to milk the system and flee with
millions before authorities were aware a crime had been committed.
Sebelius toured vacant storefronts in Miami on Friday where Medicare
fraudsters set up shop, including bogus clinics operated by Cuban
immigrants Carlos, Luis and Jose Benitez. The brothers are the
agency's most-wanted fugitives, charged with bilking $119 million for
costly HIV drugs that patients never received – and buying hotels,
helicopters, boats and even a water park with their spoils. They
allegedly fled to Cuba, where authorities believe they remain.
A new joint effort by HHS and the Department of Justice enables law
enforcement to view Medicare claims in real time and flag suspicious
patterns. More stringent screening methods, including more
comprehensive background checks, have also been put in place. The
agency gets roughly 18,000 applications daily to become a Medicare
provider. Now they can put a moratorium on new applications in certain
areas, like physical therapy, if they notice a spike in fraudulent
activities.
The changes are paying off.
CONT"D
http://www.huffingtonpost.com/2010/07/16/36-arrested-in-massive-25_n_649155.html