Below is an infographic with some disturbing facts about the cost and numbers of prescriptions Americans are taking. This article, Pill Nation: Are Americans Over Medicated? is provided by The Nursing Bible blog.
We continue to receive reports of new phone scams. Yet while the “title” of the scam may change, the fundamental tactics are the same. Below is a warning of two recent scams reported to us this month, followed by a list of common tactics. This list provides a helpful reminder of what to watch out for to protect yourself from fraud and to report it when encountered.
Two Recent Scams:
New Medicare benefits phone scam: In this scam, a caller claims to be a Medicare representative and wants you to know all about Medicare’s new and improved benefits. The caller than asks you to verify your Medicare number, primary physician information and current health conditions. Remember, Medicare will never call you to report on new benefits, AND will not ask you for your personal information. Medicare already has it. Hang up and report this number to our Senior Medicare Patrol (SMP) helpline at 855-613-7080.)
Medical device alert robocall phone scam: In this scam, a beneficiary receives a call from recording (also referred to as a “robocall”) which says, “You have been recommended to receive this device by a physician … dial 1 to continue …” You will know if a medical device is recommended by your doctor through a direct one-on-one conversation with him or her, not through a phone call. This is a scam. Hang up and report the number to SMP.
Common Phone Scam Tactics:
- Fraudsters often call consumers early in the a.m.
- The sales pitch is done rapidly, usually with a foreign accent
- Callers deliberately confuse people into believing they represent Social Security or Medicare
- Caller promises a new Medicare card or medical card
- Caller offers free medical alert equipment (or other free equipment or supplies) to get their checking account information, credit card and/or Medicare number
Again, if you come across any of these scenarios, see if you can get some information on the caller and their number, hang up and report the scam to our Senior Medicare Patrol at 855-613-7080.
See our Medicare Fraud section for more info on fraud.
Where can people turn to get unbiased information about the quality of care provided by the thousands of doctors, hospitals, and long-term care providers in California? A new website, CalQualityCare.org, is one good place to go. It was recently created as a one-stop resource to compare hospitals, medical groups, and long term care facilities. CalQualityCare.org is the result of a partnership between the California Healthcare Foundation (CHCF) a non-profit philanthropy, and Consumer Reports and their commitment to ensure all Californians have access to better healthcare.
Free and easy-to-use, the website features rating information on California hospitals, medical groups, nursing homes, and other long-term care facilities, and reviews a range of measures—such as patient experience, nursing home staffing levels, and hospital quality (including ER wait times). In addition, CalQualityCare.org provides tips and checklists about how to choose a health care provider, questions to ask, how to pay for care, and what to do if something goes wrong.
Because CalQualityCare.org is not commercial, users can be assured:
- The site is always be free and offer fully open access
- The information is objective and unbiased
- Users are not required to register or provide any contact information
- Users will not be hounded by aggressive emails and phone calls
- Users won’t see advertising or promotion of one provider over others
The California Healthcare Foundation is a non-profit philanthropy working to fulfill the promise of better health care for all Californians.
Without legal intervention, women could end up paying 40% more for long-term care insurance coverage than men. And this could happen as early as January 2015. To stop such gender-based pricing products from being sold in California, Assembly member Mariko Yamada has introduced AB 1553.
Gender discrimination on health insurance premiums is illegal under the Affordable Care Act, but long-term care insurance in California is not classified as health insurance, but rather as disability insurance, so this prohibition does not apply.
While California is currently 1 of 6 states that does not yet offer such gender-based priced products, this could quickly change if the California Department of Insurance approves the sale of several new long-term care insurance products that are currently under review. Colorado and Montana have already passed legislation to prohibit the sale of such policies.
“Gender discrimination has broad public policy implications,” Yamada said. “Women earn less than men in their lifetime and accumulate less wealth, so charging women more for the same policies is neither a fair nor effective solution to covering the industry’s costs. Pricing based on life expectancy sets an extremely dangerous precedent.”
Because women generally live longer than men, they depend on long-term care benefits more and often reduce men’s dependence on these services by serving as their caregivers. According to the American Association of Long-term Care Insurance, almost 70% of women 75 or older are widowed, divorced, or never married. This makes them less likely to have spouses to provide care for them and more likely to reside in assisted living and nursing facilities. Indeed, in California 2 out of 3 nursing home residents are women.
Many advocates agree that gender-based pricing would make it nearly impossible, especially for women with lower fixed incomes, to afford long-term care insurance. This means many women would have to do without care, and the risk of elderly women falling into isolation and poverty would most likely increase.
“Women have always had a hard time figuring out how to pay for long-term care insurance from their lower incomes and resources,” said Bonnie Burns, our Training and Policy Specialist. “Gender discrimination will force even more women out of the market, shifting the cost of their care to their families and the state’s Medicaid program.”
This blog is edited from the article, California bill seeks to stop insurers from implementing gender-based pricing.
One of the biggest “avenues” of Medicare fraud is with suppliers of durable medical equipment (DME). Last February the Centers for Medicare and Medicaid Services (CMS) reported that two-thirds of the roughly $10 billion Medicare spent on the program were “improper” payments. While some of this is fraud and some is just errors in documentation, this number shows that fraud accounts for a huge percentage of the money Medicare is paying out for DME.
Why DME? Until recently:
- There were no professional licensing requirements;
- Suppliers could set up shop with very little investment; and
- There was huge potential for quick profit.
By knowing of common scam tactics, you can help us detect and report fraud. Some things to look out for include DME suppliers who:
- Send unauthorized, unsolicited supplies to beneficiaries
- Send authorizations to doctors to obtain fraudulent equipment orders
- Deliver supplies to beneficiaries without a prescription or authorization
- Obtain medical records illegally
- Deliver more supplies than required (i.e. diabetes test strips)
- Deliver lower cost equipment than what is prescribed (i.e. a manual wheel chair versus a power wheel chair) and submit a claim for higher cost equipment (this will show up on a beneficiary’s Medicare Summary Notice)
- Pay beneficiaries for illegal use of their Medicare numbers
If you or someone you know detects any of the above situations, please gather any documentation materials and call our Senior Medicare Patrol (SMP) at 855-613-7080. These are honestly earned tax dollars being swindled away to fraudsters. By each of us being aware of common tactics, reviewing our Medicare Summary Notices to make sure the items and treatments charged for are indeed items and treatment received, and reporting any suspicious activity, we can significantly reduce Medicare fraud and abuse. See our section on Medicare Fraud for more info.
Scams come in all sorts of shapes and sizes, and more and more of them are targeting our elders. The National Commission on Aging put together a list of the top 10 scams affecting seniors in 2013. These are good to review and be aware of as a way to detect and report them, and prevent them from spreading. See below for the full article…
Top 10 Scams Targeting Seniors
Financial scams targeting seniors have become so prevalent that they’re now considered “the crime of the 21st century.”
Why? Because seniors are thought to have a significant amount of money sitting in their accounts.
Financial scams also often go unreported or can be difficult to prosecute, so they’re considered a “low-risk” crime. However, they’re devastating to many older adults and can leave them in a very vulnerable position with little time to recoup their losses.
It’s not just wealthy seniors who are targeted. Low-income older adults are also at risk of financial abuse.
And it’s not always strangers who perpetrate these crimes. Over 90% of all reported elder abuse is committed by an older person’s own family members, most often their adult children, followed by grandchildren, nieces and nephews, and others.
Review our list below, so you can identify a potential scam.
1. Health Care/Medicare/Health Insurance Fraud
Every U.S. citizen or permanent resident over age 65 qualifies for Medicare, so there is rarely any need for a scam artist to research what private health insurance company older people have in order to scam them out of some money.
In these types of scams, perpetrators may pose as a Medicare representative to get older people to give them their personal information, or they will provide bogus services for elderly people at makeshift mobile clinics, then use the personal information they provide to bill Medicare and pocket the money.
2. Counterfeit Prescription Drugs
Most commonly, counterfeit drug scams operate on the Internet, where seniors increasingly go to find better prices on specialized medications.
This scam is growing in popularity—since 2000, the FDA has investigated an average of 20 such cases per year, up from five a year in the 1990s.
The danger is that besides paying money for something that will not help a person’s medical condition, victims may purchase unsafe substances that can inflict even more harm. This scam can be as hard on the body as it is on the wallet.
3. Funeral & Cemetery Scams
The FBI warns about two types of funeral and cemetery fraud perpetrated on seniors.
In one approach, scammers read obituaries and call or attend the funeral service of a complete stranger to take advantage of the grieving widow or widower. Claiming the deceased had an outstanding debt with them, scammers will try to extort money from relatives to settle the fake debts.
Another tactic of disreputable funeral homes is to capitalize on family members’ unfamiliarity with the considerable cost of funeral services to add unnecessary charges to the bill.
In one common scam of this type, funeral directors will insist that a casket, usually one of the most expensive parts of funeral services, is necessary even when performing a direct cremation, which can be accomplished with a cardboard casket rather than an expensive display or burial casket.
4. Fraudulent Anti-Aging Products
In a society bombarded with images of the young and beautiful, it’s not surprising that some older people feel the need to conceal their age in order to participate more fully in social circles and the workplace. After all, 60 is the new 40, right?
It is in this spirit that many older Americans seek out new treatments and medications to maintain a youthful appearance, putting them at risk of scammers.
Whether it’s fake Botox like the one in Arizona that netted its distributors (who were convicted and jailed in 2006) $1.5 million in barely a year, or completely bogus homeopathic remedies that do absolutely nothing, there is money in the anti-aging business.
Botox scams are particularly unsettling, as renegade labs creating versions of the real thing may still be working with the root ingredient, botulism neurotoxin, which is one of the most toxic substances known to science. A bad batch can have health consequences far beyond wrinkles or drooping neck muscles.
Perhaps the most common scheme is when scammers use fake telemarketing calls to prey on older people, who as a group make twice as many purchases over the phone than the national average.
While the image of the lonely senior citizen with nobody to talk to may have something to do with this, it is far more likely that older people are more familiar with shopping over the phone, and therefore might not be fully aware of the risk.
With no face-to-face interaction, and no paper trail, these scams are incredibly hard to trace. Also, once a successful deal has been made, the buyer’s name is then shared with similar schemers looking for easy targets, sometimes defrauding the same person repeatedly.
Examples of telemarketing fraud include:
“The Pigeon Drop”
The con artist tells the individual that he/she has found a large sum of money and is willing to split it if the person will make a “good faith” payment by withdrawing funds from his/her bank account. Often, a second con artist is involved, posing as a lawyer, banker, or some other trustworthy stranger.
“The Fake Accident Ploy”
The con artist gets the victim to wire or send money on the pretext that the person’s child or another relative is in the hospital and needs the money.
Money is solicited for fake charities. This often occurs after natural disasters.
6. Internet Fraud
While using the Internet is a great skill at any age, the slower speed of adoption among some older people makes them easier targets for automated Internet scams that are ubiquitous on the web and email programs.
Pop-up browser windows simulating virus-scanning software will fool victims into either downloading a fake anti-virus program (at a substantial cost) or an actual virus that will open up whatever information is on the user’s computer to scammers.
Their unfamiliarity with the less visible aspects of browsing the web (firewalls and built-in virus protection, for example) make seniors especially susceptible to such traps.
One example includes:
A senior receives email messages that appear to be from a legitimate company or institution, asking them to “update” or “verify” their personal information. A senior receives emails that appear to be from the IRS about a tax refund.
7. Investment Schemes
Because many seniors find themselves planning for retirement and managing their savings once they finish working, a number of investment schemes have been targeted at seniors looking to safeguard their cash for their later years.
From pyramid schemes like Bernie Madoff’s (which counted a number of senior citizens among its victims) to fables of a Nigerian prince looking for a partner to claim inheritance money to complex financial products that many economists don’t even understand, investment schemes have long been a successful way to take advantage of older people.
8. Homeowner/Reverse Mortgage Scams
Scammers like to take advantage of the fact that many people above a certain age own their homes, a valuable asset that increases the potential dollar value of a certain scam.
A particularly elaborate property tax scam in San Diego saw fraudsters sending personalized letters to different properties apparently on behalf of the County Assessor’s Office. The letter, made to look official but displaying only public information, would identify the property’s assessed value and offer the homeowner, for a fee of course, to arrange for a reassessment of the property’s value and therefore the tax burden associated with it.
Closely related, the reverse mortgage scam has mushroomed in recent years. With legitimate reverse mortgages increasing in frequency more than 1,300% between 1999 and 2008, scammers are taking advantage of this new popularity.
As opposed to official refinancing schemes, however, unsecured reverse mortgages can lead property owners to lose their homes when the perpetrators offer money or a free house somewhere else in exchange for the title to the property.
9. Sweepstakes & Lottery Scams
This simple scam is one that many are familiar with, and it capitalizes on the notion that “there’s no such thing as a free lunch.”
Here, scammers inform their mark that they have won a lottery or sweepstakes of some kind and need to make some sort of payment to unlock the supposed prize. Often, seniors will be sent a check that they can deposit in their bank account, knowing that while it shows up in their account immediately, it will take a few days before the (fake) check is rejected.
During that time, the criminals will quickly collect money for supposed fees or taxes on the prize, which they pocket while the victim has the “prize money” removed from his or her account as soon as the check bounces.
10. The Grandparent Scam
The Grandparent Scam is so simple and so devious because it uses one of older adults’ most reliable assets, their hearts.
Scammers will place a call to an older person and when the mark picks up, they will say something along the lines of: “Hi Grandma, do you know who this is?” When the unsuspecting grandparent guesses the name of the grandchild the scammer most sounds like, the scammer has established a fake identity without having done a lick of background research.
Once “in,” the fake grandchild will usually ask for money to solve some unexpected financial problem (overdue rent, payment for car repairs, etc.), to be paid via Western Union or MoneyGram, which don’t always require identification to collect.
At the same time, the scam artist will beg the grandparent “please don’t tell my parents, they would kill me.”
While the sums from such a scam are likely to be in the hundreds, the very fact that no research is needed makes this a scam that can be perpetrated over and over at very little cost to the scammer.
See our Medicare Fraud section for more information on Medicare fraud and abuse.
As of January 1 of this year, Medicare pays the same amount for outpatient mental health care treatment as it does for other covered medical services. Medicare pays 80% of the approved amount for care, and the beneficiary or his/her supplemental insurance pays the other 20%. This is a significant improvement from the 50% coverage Medicare provided in the past, and is great news for many elders seeking treatment for depression, anxiety and other mental health conditions.
Since the program’s inception, Medicare had paid a smaller portion of the bill for treatment from psychiatrists, psychologists or clinical social workers than it did for medical services. It has also imposed strict lifetime limits on psychiatric hospitals stays (no more than 190 days – and this restriction still stands), though it has no such limits to medical care received in inpatient facilities.
In 2008, however, Congress passed the Medicare Improvements for Patients and Providers Act. This law required Medicare to begin covering a larger share of the cost of outpatient mental health services in 2010 and to phase in additional increases over time. In 2008, Medicare covered only 50% of the bill, last year Medicare covered 65%, and as of January 1, 2014, Medicare now covers 80% of bill for covered treatment (after the annual deductible of $147 is met).
This Medicare change follows new regulations issued last month by the administration for the Mental Health Parity and Addiction Equity Act, which expanded the principle of equal treatment for psychological illnesses to all forms health insurance. But that law does not apply to Medicare.
For more info on the Mental Health Parity Act, see the article: Sebelius Releases Final Rules for 2008 Mental Health Parity Act. Also see the article: Medicare Requires Mental Health Parity.
The problem of beneficiaries being held in “under observation” while receiving hospital care is growing. It often leaves affected beneficiaries with unexpected, large and sometimes financially devastating bills. This is because when someone is in classified as “under observation,” the hospital bills Medicare for outpatient services instead of inpatient care, even though the care received is the same. Yet, the biggest difference with this labeling technicality is that Medicare will only cover skilled nursing care after at least 3 days of inpatient hospital care. Patients who receive 3 days of hospital care under the “observation status” label do NOT meet this criteria. This seemingly small technicality can have dire financial consequences on beneficiaries.
This scenario happened to Ms. Bricout, and is highlighted in the NBC Nightly News segment on observation status (see below). She was unknowingly classified under observation status for her 3 days of inpatient care before being transferred to a skilled nursing facility for rehab services. It wasn’t until after her 9 weeks of care that she found out of this technical label when she received a bill of $28,350 for her care.
Ms. Bricout’s case is one of over 600,000 such cases in just the last year, and the number of cases is rising. Since 2006, the number of beneficiaries being placed observation status has risen 63%.
Advocates nationwide are asking for a fix to this situation. And currently, there is a potential solution through Congressman Joe Courtney’s pending bill pending in Congress that would fix the observation status problem for good. It is the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179 and S. 569).
The Center for Medicare Advocacy has put together a campaign for people to take action. Click here to tell your legislators to support this bill. You can also watch the short NBC Nightly News clip on observation status. Act today; Medicare beneficiaries can’t keep waiting for this necessary financial relief.
People’s cost of living adjustments (COLAs) have arrived but you may have missed it…as it’s once again pretty small. This year’s 1.5% increase amounts to an average of an extra $19/month. This is the 4th year in the last 5 of little to no increase.
Some Washington lobbyists believe that this small increase is still too generous and are advocating to change the current COLA formula to tie to the Consumer Price Index (CPI). Yet, this would result in an immediate benefit cut for millions of people. Many advocates are urging Congress to instead adopt a fairer COLA formula called the Consumer Price Index for the Elderly (CPI-E). This formula would take elders’ higher health care costs into account when calculating the annual Social Security COLA.
For more info, see the National Committee to Preserve Social Security & Medicare’s article: The CPI-E: A Better Option for Calculating Social Security COLAs.
Bonnie Burns, our Training and Policy Specialist, and another advocate Amy Bach of United Policyholders have asked regulators to create new conversion rights for any long-term care insurance policyholder who has held a policy 10 years or more.
They both believe that if a person who has owned a long-term care insurance (LTCI) policy for 10 or more years is notified of a rate increase, s/he should be able to convert to a paid-up policy with benefits equal to the amount of premiums already paid. Burns and Bach sent this proposal in a letter to the Senior Issues Task Force at the National Association of Insurance Commissioners (NAIC). They were commenting on a draft of LTCI rate increase model revisions that the task force is reviewing.
If you know people who are experiencing high rate increases, please let us know how they are affected. We know these rate increases can cause much financial and emotional stress for consumers, yet there is little data on this affect, and it’s an important piece for our regulatory discussions. The main data looked at is lapse rates on these policies. But because the lapse rates are so low, less than 1%, it is challenging to argue that these increased rates are unaffordable since so few people appear to drop their policies. Therefore, if you know how the impact of these rate increases is affecting your clients or loved ones, please share their stories with us. Some people reduce their benefits or make financial cuts in other areas they can’t really afford to be cutting back on.
Some sample questions include:
- If you kept your LTC insurance policy after the rate increase and pay the higher premiums, are you cutting costs elsewhere?
- How is your life being affected to offset this higher cost?
Please share your stories with Bonnie Burns at bburns (at) cahealthadvocates.org.
For more information, see the article, “Groups call for tough LTCI rate rules.”