Discretionary Grant Product Disclaimer Notice

1. Discretionary Grant Product Disclaimer Notice This project was supported, in part by grant 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.

2. Medicare Fraud & Scams This project was supported, in part by grant number 90MPPG0019-02-00  from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201.   California Health Advocates (c) 2019

3. Agenda • Who is Senior Medicare Patrol (SMP) • SMP Message: Protect, Detect & Report • CA-SMP Current Trends • Common Fraud Trends • Other Types of Health Care Scams • Non- Health Care Related Scams • How to Stay Connected with SMP

4. California Health Advocates (CHA)Our Focus Providing quality Medicare and related healthcare coverage information, education and policy advocacy • Advocacy – Bring the experiences of Medicare beneficiaries to the public, and especially legislators and their staff at federal and state levels, through media and educational campaigns. • Policy – Conduct public policy research to support recommendations for improving rights and protections for Medicare beneficiaries and their families. • Education – Provide timely and high-quality information on Medicare through our website, fact sheets, policy briefs and educational workshops.

5. Senior Medicare Patrol (SMP) • SMP is a federally funded project • Established in 1997 • SMPs empower and assist Medicare beneficiaries, their families and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling and education • 54 SMPs across the country

6. Three Roles of SMPS • 1. Provide Medicare fraud prevention education via health fairs, presentations, etc. • Address complaints reported via our SMP State-wide fraud hotline 1-855-613-7080. • 3. Refer potential Medicare fraud cases to appropriate investigative entity.

7. SMP Message: • Protect Medical Identity • by guarding the Medicare card • Detect Fraudulent Billing • by reviewing Medicare Summary Notices and Explanation of Benefits • Report Medicare Fraud • by calling SMP at 1-855-613-7080

9. Medicare fraud: It’s fraud associated with these two cards below:

10. Not a victimless crime! 2015: Michigan doctor sentenced to 45 years -Dr. FaridFata misdiagnosed patients as having cancer, when in fact, they did not. -Gave patients medically unnecessary infusions or injections. Some patients died. -Collected $17.6 million from Medicare.

12. Program Accountability ACL = U.S. Administration for Community Living OIG = Office of Inspector General

13. Why Should We Care? • Theft of Medicare/Medi-Cal numbers leads to false claims • Higher premiums • Billions of tax dollars wasted • When it comes to Medicare fraud, everyone loses! It should be in everyone’s best interest to save the integrity of the program for future generations.

14. PROTECT- Guard Your Card = • Treat you Medicare card like a credit card number. • Don’t carry your Medicare card unless you need it. • Only take it to medical appointments, visits to your hospital or clinic, or trips to the pharmacy. • Never give your Medicare number to a stranger.

15. Beware of New Medicare Cards Scams • Unsolicited calls where scammers offer to: • Verify your new Medicare #. • Activate the new Medicare card. • Send the new Medicare card along with a free back brace. • Send a plastic Medicare card.

16. DETECT-Review MSNs & EOBs • Keep track of medical appointments • -Use journal or calendar • Look for three things on your statements: • -Charges for something you didn’t get • -Billing for the same services or supplies twice • -Services that weren’t ordered by your doctor • Medicare Summary Notice (MSN) • -List of charges by providers & suppliers • that billed Medicare in a 3-month period • -Accessible 24/7 via mymedicare.gov • Explanation of Benefits (EOB)

17. Situations That May Not Be Fraud Beneficiary does not understand 20% patient responsibility. Beneficiary forgot about medical appointment. Beneficiary does not recognize name of provider on Medicare statement, but turns out to the provider who read/interpreted results. Billing mistakes. Example: Patient mix-up led to wrong Medicare# billed.

18. Current Trends: • Fraudulent Genetic Tests • Deceptive Hospice Enrollments • MA Plan and Agent Complaints • DME Brace Scams

19. Fraudulent Genetic Tests • Scammers call saying: “Medicare is conducting a 10 year study on cancer.” “Free DNA testing kit will be sent in the mail.” “Genetic testing is a new Medicare benefit.” • Health fair events & presentations by vendors promoting • Cancer genetic testing (cgx) • Pharmacogenomic testing (pgx) • Say Medicare covers it at 100%. Not true! • Senior centers and apartment complex targeted • Facebook Ads and Postcards • Setting up at your local grocery store!

21. MSNs showing genetic testing related claims:

22. Negative impacts: • Medicare may pay hundreds, even thousands of dollars worth of medically unnecessary tests. • Compromised Medicare # may lead to more fraud. • Tip: • Check with PCP first! Guard your DNA & Medicare Number!

23. New Jersey case 2019: Man Sentenced to 50 Months in Prison for Role in Medicare Fraud -Seth Rehfussheld “ICE CREAM SOCIAL EVENTs” at low-income senior housing complexes. -Used fear-based tactics to get seniors to participate. -Promised a “personalized medicine.” -DNA swabs taken by non-medical personnel. -Providers recruited via Craigslist advertisements to get tests authorized. -Providers were paid thousands of dollars per month to sign their names. -Billed Medicare more than $1 million!

24. Deceptive Hospice Enrollment • Negative impacts: • Medicare may stop paying claims. • PCP unaware of hospice referral. • Medications denied by pharmacy. • Denied referrals to specialists. • Outstanding Part D charges. • Health Declines. • Deaths. • Compromised Medicare # may lead to more fraud. “Free cooking and cleaning! Covered by Medicare! “Unlimited supply of shakes & diapers! You don’t have to be terminal! “ “Older seniors automatically qualify for hospice due to age.”

25. MSN showing hospice claim submitted to Medicare:

26. 2016:Pasadena Doctor Sentenced to 4 Years in Prison for Falsely Certifying Patients As Terminally Ill -Boyao Huang ordered to pay $1,344,204 in restitution. -Falsely certified that patients were terminally ill. -Sentenced to four years in federal prison.

27. 2019:Los Angeles Doctor and Patient Recruiter Found Guilty in $33 Million Medicare Fraud Scheme -Medicare beneficiaries targeted. -Dr. Robert Glazer billed Medicare for office services and tests that patients did not need or did not receive.  -Doctor made referrals to home health and hospice services, and ordered DME that patients did not need or did not receive.

28. Insurance Agent/Broker Marketing Misconduct • An agent enrolled a beneficiary into a plan without their permission. • Agent changed the scope of appt. • Agent offers free trips, meals in return for signing up. • Agent misrepresents the plans benefits. • Agent tells beneficiary they have to sign up or they will lose their Medicare.

29. “Betty and the Medicare Health Plan – Making the Right Choice” in English/Spanish • Negative impacts: • Medicare may stop paying claims. • No access to see PCP and/or specialists. • Medical bills.

30. DME Brace Scams DME Supply Company Tele-Doctor Telemarketer Pays telemarketer for leads. Ships equipment to beneficiary. Submits paperwork to Medicare. Medicare pay supplier. TV commercial, Ad, Cold Call, home visit, presentation offering free braces. Medicare # is obtained. Info sent to tele-doctor.  Doctor completes paperwork supporting medical necessity for the item. Gets $$ for prescribing. Info sent to DME Supply Company.

31. Urgently marked postcards notifying beneficiaries of pending eligibility for free Medicare-covered back and/or knee braces:

32. MSN showing brace claims submitted to Medicare: • Negative impacts: • False claims billed. • No access to needed DME. • Compromised Medicare number. • More scam calls.

33. Feds charge 2 dozen in billion dollar Medicare brace scam Photo provided by the Department of Health and Human Services, Office of Inspector General: HHS Office of Inspector General agents, and other law enforcement officers, take part in arrests Tuesday, April 9, 2019, in Queens, N.Y

34. SMP Fraud Alerts are available in different languages including: -English -Spanish -Chinese -Tagalog -Vietnamese -Korean -Russian -Farsi -Armenian You may access these fraud alerts by visiting our California Health Advocates website at: https://cahealthadvocates.org/fraud-abuse/medicare-fraud-alerts/

35. Common Healthcare Scams Insurance Bait & Switch or Cross-selling – licensed agents present information about a Medicare Advantage plan, describing benefits and services that the plan doesn’t actually offer, and then sign people up for a plan that isn’t right for them. Free Health Screenings – a vendor offers to provide “free” health care screenings, lab tests or other services but asks for a person’s Medicare number. Counterfeit Prescription Drugs – beneficiaries purchase medication over the Internet to save money, but the drugs they receive are not the right medication or the right dosage.

36. Other Types of Healthcare Scams

37. Part D Fraud • Opioid fraud & abuse occurs when: • Medicare beneficiaries are over-prescribed medications. • Pharmacies are involved in drug diversion which is a transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. • Medicare is billed for medications not prescribed or not received.

38. CMS Medicare Part D Prescribing Mapping Tool Opioid Prescribing Rate

39. Podiatry Fraud Tucson, Arizona 2019: Podiatrist sentenced to prison for Medicare fraud -Loren Wessel sentenced to 24 months in prison. -Provided routine care for patients at assisted living facilities, but billed Medicare for more expensive services he didn’t perform. -Falsified patients’ medical records with ailments they didn’t have. • Beware of: • Free foot massage, but Medicare number is requested. • Podiatry charges on Medicare statements that are different than services received.

40. Hearing Aid Fraud 2019: Father and Son Sentenced in Multi-Million Dollar Hearing Aid Healthcare Fraud -Terry Lynn Anderson and his son Rocky Freeland Anderson sentenced to eight and seven years in prison. -Billed insurance for hearing aids that were medically unnecessary or were never provided to patients. -Offered patients $100 gift cards in exchange for referring family members and coworkers for free hearing tests. • Beware of: • Free hearing test, but Medicare number is requested. • Offering of gift cards in exchange for signature or Medicare number. • Hearing aid charges on Medicare statements that are different than services/items received.

41. Ambulance Fraud 2018: Former Employee of Southern California Ambulance Company Sentenced to Prison for Role in Medicare Fraud Scheme -Aharon Aron Krkasharyansentenced today to 36 months in prison for his role in a scheme that resulted in more than $1.1 million in fraudulent claims to Medicare. -Provided non-emergency services to Medicare beneficiaries, many of whom were dialysis patients.

42. Home Health Care Services 2019: Owners of Los Angeles Home Health Agency Sentenced to Prison for Role in Health Care Fraud that Defrauded Medicare -Angela Avetisyanand AshotMinasyan, owners were sentenced 120 and 78 months in prison. -Recruited Medicare beneficiaries and paid kickbacks to doctors to enroll patients into home health care even though patients did not meet criteria. • From the Office of Inspector General (OIG), U.S. Department of Health & Human Services • For Medicare beneficiaries to be eligible for home health care services, they must be: • Under the care of a physician. The physician must certify that the beneficiary needs one or more of the following: physical therapy, occupational therapy, speech language therapy, or intermittent skilled nursing care. • “Home bound,” which means that due to their condition, leaving them home is not recommended and requires special transportation, or can only be done with a taxing effort.

43. Non-Healthcare Scams

44. IRS Phone Scam & Social Security Phone Scam Grandparent Phone Scam • IRS: “There is a warrant out for your arrest!” • Social Security: “Your SS# shows fraudulent activity and/or will be suspended.” • Masquerades as your grandchild • In trouble – please help! • “Don’t tell my parents!” • “Just send me $$” National Do Not Call Registry Managed by the FTC May register by phone at 1-888-382-1222 You can file a complaint using the FTC Complaint Assistant; choose “Other” and then “Imposter Scams.” If the complaint involves someone impersonating the IRS, include the words “IRS Telephone Scam” in the notes. SMP does not take reports about non-Medicare related scams, but we do mention them in our outreach to bring awareness

45. GET CONNECTED TODAY! 4TH Thursday of the month SMP Educational webinar at 10 a.m. Like & follow our CHA &SMP Facebook pages Subscribe to our e-newsletter www.cahealthadvocates.org Share SMP fraud alerts Order materials or schedule a presentation at no-charge Report fraud, call 855-613-7080

46. Welcome to CHA’s homepage:

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