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Reports of Fraud Relating to the Affordable Care Act

The Affordable Care Act brings provides opportunities and benefits for America’s seniors. Unfortunately, new opportunities for beneficiaries also bring new opportunities for scam artists to try and defraud seniors. That’s precisely why HHS is working with the Department of Justice to crack down on criminals who are trying to obtain personal information from seniors by promising them rebate checks and other benefits under the law. Seniors should never give their Medicare ID number to anyone promising benefits or discounts under the new law.

The Obama Administration is returning more stolen money to taxpayers and is also preventing health care fraud at higher rates than before, according to the 2009 Health Care Fraud and Abuse Control (HCFAC) Program Report prepared by the HHS Office of the Inspector General (OIG). The results include $2.51 billion deposited to the Medicare Trust Fund in fiscal year 2009 –a $569 million, or 29 percent, increase over FY 2008.

The Affordable Care Act strengthens government-wide efforts to fight fraud through tough new rules and sentences for criminals, enhanced screening and other enrollment requirements, and other new resources to fight fraud.

Below are some recent examples of scams reported to HHS through the Senior Medicare Patrol Program:

SCAM:	In Utah, we heard reports of phone calls to seniors regarding "new Medicare cards,” and seniors are told that they need the new card as a result of the new Affordable Care Act.
FACT:	Seniors are NOT required to do anything to receive any of the benefits of the Affordable Care Act. Seniors won’t be issued new Medicare cards and do not need to register with anyone to receive the $250 rebate check. The check will be mailed directly to each senior at their home after they hit the prescription drug coverage gap known as the “donut hole.”
SCAM:	In Wyoming, we have a report of a fraudulent caller claiming to be from Medicare and wanted to confirm a senior’s Medicare number.
FACT:	No senior should ever give their Medicare number to any caller. All seniors should treat their Medicare, Medicaid and Social Security numbers like a credit card number, and should never give these out to a stranger. If someone claims to be with Medicare and asks for your information, ask for their name and report it to 1-800-MEDICARE.
SCAM:	In Kansas, a creative insurance salesman has mailed a release form to his policy holders that authorized him to make medical decisions for them.
FACT:	Seniors should never sign a form without understanding its contents or knowing its source. Always read and keep a copy of any document or agreement that asks for a signature. Contact a trusted source or your local State Health Insurance Program (SHIP) representative to help you verify the validity of these type of offers. A directory of your local SHIP number can be found in your Medicare & You Handbook.
SCAM:	In Michigan, we have reports of seniors being approached by insurance agents claiming that the recent legislation requires seniors to make changes to their health care benefits, including Part D plans.
FACT:	The Affordable Care Act gives seniors more control over their health care choices. No senior is required to make any changes to their Medicare plans. Seniors can make changes to their plans during the Open Enrollment period which takes place every year from November to the end of December. The Centers for Medicare and Medicaid Services (CMS) offers seniors various tools through its www.Medicare.gov website to compare health plans and drug costs under those and other plans. Seniors should be leery of anyone approaching them and encouraging them to switch plans.