Posts Tagged ‘healthcare fraud’

Preventing Healthcare Fraud Schemes as HealthCare Reform Begins

The National HealthCare Anti-Fraud Association has made some great recommendations for making yourself aware of potential hazards with the onset of  health care reform. You must realize legitimate insurance companies must be licensed to sell insurance of any kind with the state Department of Insurance in each state where they sell insurance. Insurance brokers must be licensed as well. Before you consider buying insurance, you should determine if the company or individual selling the insurance policy is properly licensed.  Every state has  a Department of Insurance where you can check out the company and the independent brokers.

These are some simple steps to follow to help you avoid being the victim of a health insurance scam:

DON’T

  • Don’t buy insurance online or over the phone, based on mailers, fliers or ads without investigating first and clearly understanding what you are buying.
  • Don’t respond to high pressure or fear tactics from aggressive salespeople.
  • Don’t provide your Social Security number, bank account numbers or credit card numbers before confirming that you are dealing with a legitimate company, and don’t give out personal information over the phone.
  • Don’t sign blank insurance claims forms.
  • Don’t give blanket authorization to a medical provider to bill for services rendered.

DO

  • Do take the time to research any company before purchasing a health insurance policy from it-a few minutes invested in searching the Internet is worth your time.
  • Do check with your state’s Insurance Department to make sure the company is licensed to do business.
  • Do compare insurance coverage.
  • Do document your dealings with any company from which you are considering purchasing insurance.
  • Do get a list of doctors and other providers that participate with the insurance plan you are considering.
  • Do ask LOTS of questions.
  • Do report suspected fraud to your state insurance department.

Below are some resources to help you learn more about the Health Care Reform law, what it means to you and how to protect yourself from being the victim of fraudulent health insurance scams.

  • The U.S. Department of Health & Human Services manages a robust website intended to inform consumers about the new law: HealthReform.GOV
  • The Obama Administration has created a website which aims to explain the new health reform law: Health Reform: What It Means To You
  • To determine if a health insurer is licensed to do business in your state, check with your state’s department of insurance (DOI). Plus, most DOI websites provide information and resources on how to report suspected fraud.

For other information and further education connect with Linda at 310-831-4400 or Linda@theidentityadvocate.com

How to Prevent Medical Identity Theft As Healthcare Reform Rolls-Out

medical identity theftThe launch of healthcare reform begins in October 2013 and has many people worried. Unfortunately, this concern isn’t just about the Affordable Care Act itself. Identity theft experts warn that the already high instances of medical identity theft are set to explode, especially as millions of Americans start looking for insurance options.

They have reasons to worry. Medical identity theft affected 1.85 million Americans this year at a cost of $41.3 billion, according to the Ponemon Institute. As the opportunities for medical identity thieves increase, many more Americans can expect to become targets. The Federal Trade Commission received over 83,000 fraud complaints in 2012 regarding “imposter scams,” in which identity thieves pose as representatives of government agencies to collect personal information. Officials expect these numbers to grow exponentially once the Affordable Care Act begins to roll-out.

The Threat of Healthcare Fraud and Medical Identity Theft

There is a lot of confusion regarding the Affordable Care Act. Signed into law in 2010, enrollment through the healthcare “exchange” begins on October 1, 2013 for coverage starting January 1, 2014. Consumer confusion about the implementation of the law has allowed identity thieves to get a jumpstart on stealing medical identities using information such as Social Security numbers, addresses, Medicare account information, medical history, and other private information.

Gaining access to this information enables identity thieves to fraudulently receive medical care, purchase prescription medications, order medical supplies, and submit false insurance claims—among other forms of healthcare fraud. Although anyone can be a target of medical identity theft, people with the highest risk of fraud include senior citizens, individuals who don’t speak English, and those who have never had insurance coverage or have experienced a lapse in coverage.

medical identity theftOne of the latest healthcare reform scams and medical identity theft occurs when a scammer contacts someone and tells him he’s been selected for early enrollment. The scammer poses as a federal employee and tells him that he must supply his personal and financial information, including bank account data, to receive his insurance card. What most consumers are unaware of is that there are no insurance plans or cards directly associated with the Affordable Care Act. Insurance companies, not the federal government, provide these cards, so beware of anyone who asks for this information.

Preventing Medical Identity Theft

Although some medical identity theft is inevitable with the Affordable Care Act, there are ways you can protect yourself and limit the chances of becoming an identity theft victim:

  • Be proactive to prevent medical identity theft by signing up for an identity theft protection service such as ID Theft Solutions.
  • Never provide or verify personal information over the phone, even if the caller claims to be a federal employee. Federal agencies already have this information on file, so you will never be called to supply it.
  • Don’t automatically believe a caller ID screen indicating that a state or federal government agency is calling. Scammers have the latest technology and can display a government agency’s name on your caller ID.
  • The government does not send unsolicited emails to request personal information. It only sends correspondence through U.S. mail. You can check the authenticity of a letter by looking up the agency’s phone number yourself and calling it for verification.
  • Government employees do not make house calls, nor will they show up at your door requesting information or selling Affordable Care Act-related healthcare plans. Again, legitimate federal employees would already have your information on file.

The best way to prevent medical identity theft as healthcare reform goes into effect is to be aware of the warning signs, stay vigilant, ask plenty of questions, and never hand over your personal information. You can also take advantage of the tools, resources, and advice to avoid medical identity theft by visiting the experts at The Identity Advocate at www.TheIdentityAdvocate.com or by calling 310.831.4400.

Preventing Medical Identity Theft – Palm Scanning

See the quick video about Palm Scans at El Centro Hospital:

Palm Scanning started at facilities back east. Good to see its arrival here in California. This procedure can assist in the prevention of Medical Identity Theft and Identity Fraud!

FBI PRESS RELEASE. Jan 20.11. Medicare Fraud Scheme ~ Houston Home Health Agency $5.2 million

Department of Justice Press Release

For Immediate Release
January 20, 2011 U.S. Department of Justice
Office of Public Affairs
(202) 514-2007/TDD (202) 514-1888

Two Owners of Houston Health Care Company Plead Guilty to Alleged $5.2 Million Medicare Fraud Scheme

WASHINGTON—Two owners of a Houston health care company pled guilty today in connection with an alleged $5.2 million Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).

Clifford Ubani, 52, and Princewill Njoku, 51, each pled guilty before U.S. District Court Judge Nancy Atlas in Houston to one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks and 16 counts of payment of kickbacks to Medicare beneficiary recruiters.

According to court documents, Ubani and Njoku were owners and operators of Family Healthcare Group (Family Group), a home health care company. Family Group purported to provide skilled nursing to Medicare beneficiaries. According to court documents, Ubani and Njoku hired co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided. Ubani and Njoku admitted that they paid kickbacks to the recruiters for their referrals.

Ubani and Njoku previously pled guilty to conspiracy to commit health care fraud related to their ownership of another Houston health care company, Family Healthcare Services (Family Services). Family Services submitted approximately $1.1 million in fraudulent claims to Medicare for the costs of durable medical equipment.

At sentencing, scheduled for July 19, 2011, Ubani and Njoku each face a maximum sentence of 10 years in prison for each health care fraud conspiracy count, five years in prison for each kickback conspiracy count and five years in prison for each kickback count.

Today’s guilty pleas were announced by Assistant Attorney General of the Criminal Division Lanny A. Breuer; U.S. Attorney José Angel Moreno of the Southern District of Texas; Special Agent-in-Charge Richard C. Powers of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations; and Texas Attorney General Greg Abbott.

This case is being prosecuted by Trial Attorneys Charles D. Reed and Laura Cordova, and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.

Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov

Press Releases | Houston Home

LifeLock refunds nearly One Million Consumers as part of Nationwide Settlement

LifeLock will refund consumers in 34 states $10.87 as part of an FTC settlement for misleading advertising practices. Not being able to provide “guaranteed” protection from medical identity theft or employment information theft and no protection against misuse of current their existing account information, the FTC settlement was reached in March of this year. Read the Consumer Affairs.com article at: http://www.consumeraffairs.com/news04/2010/11/nearly-one-million-consumers-getting-refunds-from-lifelock.html

Medical Identity Theft from a Victims Perspective

See Fox News clip on You Tube: http://www.youtube.com/watch?v=Pz__DUISB6E&feature=player_embedded

Patient Recruiting schemes involving homeless resulted in $10 Million False Claims Settlement

All the makings of the great money making opportunity, first off, preying on the homeless, then kickbacks, violations of false Claims Act, performing medical unnecessary treatments and taking tax payer money to do so through Medicare and Medi-Cal. Read the article Fierce Healthcare: http://www.fiercehealthcare.com/press-releases/former-los-angeles-medical-center-owners-agree-10-million-consent-judgment-medicare-a?utm_medium=nl&utm_source=internal