JustCare

Tag: Scams

  • When will the Medicare Advantage scam end?

    When will the Medicare Advantage scam end?

    Matthew Cunningham-Cook writes for The Lever on why Medicare Advantage is a scam, focusing on the $20 billion in overpayments the insurers offering Medicare Advantage now receive each year. Health insurers are making a killing off of the Medicare Trust Fund, as are their top executives and shareholders. The only question is whether this raiding of Medicare will end in time to save Medicare or whether Congress will sit back and continue to let these excess payments happen.

    Humana profits totaled $2.8 billion last year.  The chief reason: Overpayments from Medicare, which resulted in Humana receiving 80 percent of its total revenue from Medicare. Cunningham-Cook pegs the overpyaments at $20.5 billion, a ton. He relies on the calculations of the Medicare Payment Advisory Commission, MedPac. But, other moderate analysts believe they are closer to $60 billion a year.

    Cunningham-Cook also fails to mention that the government is responsible in large part for these overpayments. It adjusts payments to Medicare Advantage plans based on the diagnosis codes insurers ascribe to their enrollees–a measure of how sick the enrollees are. And, it pays Medicare Advantage plans more for each diagnosis code, even when those codes have no bearing on the number or cost of services the Medicare Advantage plans are delivering to their enrollees.

    The insurers offering Medicare Advantage take advantage of this defective payment system. Why not? They are allowed to, for the most part. And, it earns them greater revenues.

    Cunningham-Cook rightly charges the Medicare Advantage plans with overbilling–they are hunting for diagnosis codes, even when the diagnoses have no bearing on the services their enrollees need. But, in many cases, the insurers are acting within the framework the government gives them to charge for their enrollees.

    The underlying issue is that the government seems to want to privatize Medicare, turn it over to the profiteer corporate health insurers and let older Americans and people with disabilities fend for themselves. It’s a good gig for the enrollees, so long as they’re relatively healthy. Their out-of-pocket costs are lower than they would be if they were in traditional Medicare where they would need to buy supplemental coverage to protect themselves financially. They also almost always get Part D prescription drug coverage at no additional cost, as part of the Medicare Advantage benefit package.

    But, people in Medicare Advantage are playing with fire. They get sick and all bets are off. They are likely to face large administrative and financial barriers to care, inappropriate delays and denials of care, and restricted access to specialty care. In 2o22, the Office of the Inspector General reported that Medicare Advantage plans wrongly denied about 1.5 million claims.

    While people are told they can go back to traditional Medicare, most are locked into their Medicare Advantage plans once they sign up. The supplemental coverage they need to protect themselves financially is often not available or, when it is, it is not affordable.

    The Biden administration proposed to slow down the overpayments with a one-percent rate increase this year. But, somehow the insurance lobbyists won the day, and the insurers ended up getting a three percent increase.

    The biggest insurers in the Medicare Advantage game are UnitedHealth, Centene and CVS Health, all of which are realizing enormous profits because of this line of business.

    Medicare’s financial well-being is at tremendous risk. So, is the health and well-being of people with Medicare. Even with the massive overpayments to the Medicare Advantage plans, the Medicare Advantage plans are delaying and denying critical care persistently. When the overpayments end, you can only imagine the consequences for their enrollees. Meanwhile, traditional Medicare gets weaker and weaker each year as more enrollees move to Medicare Advantage because of its lower upfront costs, not appreciating the great risks they are taking with their health and well-being or not able to afford the cost of the supplemental coverage they need in traditional Medicare.

    The Biden administration did finalize a rule that prevents the insurers from using certain diagnosis codes to earn higher payments. It’s not clear what the effect of those changes will be.

    Most people do not appreciate the risks they are taking with their health when they enroll in Medicare Advantage. They see the Joe Namath ads and assume Medicare Advantage is a good deal. The Centers for Medicare and Medicaid Services does little to help educate them about barriers to care and coverage that people in traditional Medicare do not face.

    There is no one in Congress currently advocating to end Medicare Advantage, even though it is a failed experiment. The data is in and the corporate insurers not only cost Medicare more per person, they engage in practices that too often lead to people not getting the care they need. And the larger Medicare Advantage becomes, the more politically difficult it is to control them.

    Here’s more from Just Care:

  • Financial scams: Beware of strangers offering help

    Financial scams: Beware of strangers offering help

    Financial scams abound. Scammers prey on people, particularly older people, in all kinds of ways — first building trust, then offering “help” and then asking for money.  Here are a few things you should never do.

    1.  Do not give strangers your Social Security number, credit card information or bank account information under any circumstances. A scammer might call or e-mail you to say you have a problem that he can fix for you if you provide him with some financial information. If you don’t know the caller, you should not disclose this information.  If in doubt, ask the caller for his name and phone number, discuss the issue with someone you trust, or call your local police department for advice.

    2.  Don’t wire money to anyone without first checking with someone you trust. A scammer might call or e-mail, impersonate a family member, often a grandchild, and claim she is in an emergency situation and needs an immediate wire transfer of money. With new technology, scammers can sound exactly like one of your family members or friends. If you are inclined to help, before doing anything, ask the caller for her name and phone number. Then, call the person you believe you just spoke with using the number you have in your contacts. You will likely find that the person who called you is an impostor. Note: If you wire money, you cannot get it back, even if it is to a fraudster.

    4. Do not buy gift cards to help someone claiming to be a friend or family member in need. A scammer might call, impersonate a family member and claim that she has been arrested and needs money for bail.  The scammer will then put someone else on the phone who claims to be a police officer. The alleged police officer asks the victim for thousands of dollars of gift cards. The alleged police officer gives a phone number to the victim and asks for a call back with the gift card numbers. Again, you can verify that you are being scammed if you call your family member directly using the contact information in your personal records.

    5.. Do not give strangers access to your computer. A scammer might call or e-mail you, claim he is from a computer company, and offer to clean up your computer files or remove a computer virus. The scammer is trying to gain remote access to the personal information stored on your computer files, which he can do if you give him your computer passwords.

    6. Do not pay money to a caller, claiming to be an IRS agent or police officer from the IRS.  The scammer will say you have a past due tax balance, which must be paid immediately. If it is not paid, the scammer says, a team of officers will come to your home to arrest you.

    These are classic scams. And unsuspecting people lose millions of dollars a year to these scams. The Federal Trade Commission shut down two computer scam operations that allegedly tricked people out of $120 million.

    If you are wondering whether an email you receive is for real or the person on the other end of the phone is telling you the truth, go to www.snopes.com.  Type in the nature of the email or phone call you received and see if it pops up. Snopes should tell you if it is a common scam. WISER, the Women’s Institute for a Secure Retirement, offers a checklist of common scams.

    [Editor’s note: This post was originally published on June 3, 2019]

    Here’s more from Just Care:

     

  • How a software engineer goes after scammers

    How a software engineer goes after scammers

    AARP reports on how one unassuming older computer software engineer set about to go after the scammers who prey on older adults. He broke into the scammers’ computer systems to stop them from attacking people’s computers in order to get money from them. According to the Federal Trade Commission, in 2020 these impostor scams were the number one consumer fraud.

    Older Americans, like all of us, sometimes get scary popups about a security breach on their computers. Sometimes they’re told that their phones and iPads are also compromised. Every time, they are asked to pay for a fix. Too often, older adults are easy prey and hand over their savings to scammers to the tune of hundreds of thousands of dollars each year.

    The software engineer, “Jim,” fabricated an alias and called a phone number a scammer left on his voicemail. The person on the other end of the call asked for access to Jim’s computer to “fix” the alleged computer problem, but the scammer really wanted to steal money from Jim. Jim was prepared; he had set up a “virtual computer” in his computer that protected his computer from being hacked. Jim recorded the conversation and decided to spend his time reaching out to scammers like the first one he spoke to, recording those conversations and exposing the scams on YouTube.

    Then, Jim had the good luck to get inside a scammer’s computer. I won’t explain how. Suffice it to say that the scammer believed he was taking control of Jim’s computer. In the process, the scammer opened up his own computer, and Jim was able to seize control of  the scammer’s computer. Jim could see all the scammer’s files and software. From there on in, every time a scammer reached out to Jim, Jim knew how to trick the scammer into giving Jim control of the scammer’s computer.

    Jim could literally see how scammers were reaching out to loads of older people in the US and the UK and getting them to pay to fix a nonexistent computer problem or something else. Jim exposed these scams on YouTube. He was able to stop them for a limited period by using software that sent junk calls to their phones, jamming them.

    But, to eliminate the scammers, Jim persuaded the BBC to do a show using his videos. He also sent the videos to police in India, where there is at least one big scammer center. And, a big scammer boiler room was shut down.

    Then, Jim partnered with AARP to reach the older people who tend to be the targets of these scams. Jim had a large audience for his videos, but they were mostly younger people, tech people, law enforcement people. Together with an AARP reporter, they were able to call older people as they were being scammed and tell them not to send the money being asked of them.

    As helpful as Jim has been to breaking up some scammers’ enterprises and keeping older adults from wiring money needlessly, the scams continue. Don’t believe anyone who says he or she can help fix your computer. Don’t wire money to strangers. To protect yourself, read these tips.

    Here’s more from Just Care:

  • Who’s protecting older adults from financial exploitation

    Who’s protecting older adults from financial exploitation

    Every state has an agency that provides protective services to adults. These adult protective services agencies collect and report data on abuses, including financial exploitation. But, the GAO reports that the data collection and reporting is not what it needs to be to understand the scope of the problem nationally and help older adults, their families and society at large.

    As you might imagine, older adults can be easy targets for financial exploitation by family, friends and unknown predators. There are so many types of scams. And, older adults might lose the mental acuity needed to manage their money without being scammed. Their judgment might be impaired because of dementia. But, with a good understanding of the biggest issues, interventions can be developed to help them.

    Right now, state reporting of data to the US Department of Health and Human Services (HHS) is voluntary. According to the GAO, 11 states and territories out of 56 do not report any financial exploitation data at all. Fewer than half of all states, 24, provide HHS with detailed financial exploitation case data. And, only 27 provide detailed HHS with case data on the the type of perpetrator.

    Without this data, the federal government does not have the needed information to devise strategies to minimize financial exploitation and develop interventions to improve the lives of abused and neglected older adults.

    To be sure, states cannot collect complete information on financial exploitation of older adults. Many instances are not reported. Often older adult victims do not want to implicate family members. But, to the extent states have this data it is generally not easily shareable with the federal government and it should be.

    Because complete and accurate national financial exploitation data is not available, we do not know the extent to which property and funds of older adults are illegally or wrongfully used. According to the Consumer Financial Protection Bureau, banks reported actual losses and attempts at elder financial exploitation totaling $1.7 billion in 2017. As high as that might seem, it appears it could be closer to $50 billion if complete data were collected everywhere in the country.

    Recent studies in New York, Pennsylvania, and Virginia, however, suggest the cost is likely to be more than $1 billion in each state. The GAO recommends that HHS do more to ensure states report the information they collet. States tend not to submit data on the cost of financial exploitation of older adults to HHS because they do not feel the need to do so.

    Here’s more from Just Care:

  • Coronavirus: Beware of scams

    Coronavirus: Beware of scams

    Julie Appleby reports for Kaiser Health News on the latest phone, text and email coronavirus scams. Beware of people who reach out to you claiming they are doing COVID-19 contact tracing. You should not give them any personal information, particularly your bank account information, credit card number or Social Security number.

    The scammers might say they are from a local health department. And, they might tell you that you have been near someone who has COVID-19. At that point, they will typically ask you for your credit card or bank account information or for your Social Security number.

    It’s possible that you will get a legitimate call from staff at a local health department about COVID-19. But, if the call is legitimate, the caller will not ask you for any personal information. Rather, the caller will know your address and birthdate and will confirm them with you to verify your identity. And, the caller will try to figure out who you have been around.

    A legitimate person from a health department usually will call or text if you have tested positive for COVID-19 or if you have been near others who have tested positive. The goal is to isolate anyone who has been in contact with someone with COVID-19 so as not to spread the virus further. It is how local health departments try to contain the spread of the novel coronavirus.

    If you receive a text or email with a link from someone who claims to be from your local health department, do not click on the link. And, if you have any concerns about the legitimacy of a caller, ask for the person’s name and phone number. Then, call your local health department directly to ensure the caller is legitimate.

    Here’s more from Just Care:

  • Medicare telemedicine scams around medical equipment on the rise

    Medicare telemedicine scams around medical equipment on the rise

    Victoria Knight reports for Kaiser Health News that family caregivers of institutionalized older adults are getting calls from scammers about the health care needs of their relatives. Medicare telemedicine scams around medical equipment are on the rise.

    If you get a call from anyone claiming to be with Medicare about a health care product or service you or someone you love needs, hang up. Or, if you want to know more, ask for the person’s name and callback number. Then, before you do anything else, call Medicare at 1-800-633-4221.

    Sometimes, the scammer on the phone pretends to be providing a telemedicine consultation. The scammer may ask about pain. Sometimes you simply receive medical equipment you don’t need.

    Whether there’s a call or not, scammers enlist doctors to make orders from medical equipment companies and then bill Medicare for the equipment. The doctors never consult with the Medicare patients, let alone examine them.

    If you receive equipment that you did not discuss with your treating physician, report the fraud to Medicare or call your local State Health Insurance Assistance Program (SHIP).

    Keep in mind that there are many types of fraud committed, particularly targeting older adults. Never give your personal information to anyone who calls or emails you, including your Medicare number or Social Security number. Do not believe the person if he or she claims to be from Medicare or Social Security or any other agency. Government agencies will never ask you for this information.

    You can read more on Just Care about financial scams here, Social Security scams here, and health insurance scams here.

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  • What to do if someone you love struggles to use a computer

    What to do if someone you love struggles to use a computer

    Modern technology can be a godsend for handling affairs speedily. But, there often comes a time when older adults struggle to use their smart phones, computers and tablets, and caregivers need to step in. What should you do if someone you love starts having difficulty using a computer?

    Judy Graham reports for Kaiser Health News that millions of older adults (nearly three in four) depend on computers to pay their bills, access their bank statements, and connect with their families and friends. Blocking their use of a computer may disconnect them from things they care deeply about. More than four in ten (42 percent) of them own smartphones.

    We all know how easy it is to forget a password and not be able to access online accounts. It can be particularly difficult for older adults. Problems could be related to people’s vision, coordination or cognition. When struggling to use a computer stems from loss of mental function or dementia, it’s likely time for caregivers to act.

    Learn what’s confusing: Ask about what’s confusing on the computer and smart phone. And, if possible, sit down at the computer with the people you love to see what they can and cannot do.

    Share passwords: It’s wise to create shared passwords so that you too have access to the programs your loved ones use. If you want to check their accounts online, make sure you have power of attorney or, at the very least, their written agreement to do so. Otherwise, it’s a federal crime!

    Reduce confusion: One easy fix is to delete any apps that are confusing older adults. In fact, the fewer the apps, likely the better. Why should they struggle?

    Minimize scamming: Make sure that the older adults whom you care for know not to give anyone their Social Security, Medicare or credit card information. Scams abound. Scammers are pros at pretending to be a relative or a government agency staffer in order to obtain this information.

    Manage purchases: Get permission to unsubscribe your loved ones from marketing emails. If appropriate, ask to install a parental control app that can block use of online devices at certain times.

    Replace a credit card with a stored value care: A stored value card limits the amount of money that can be spent. Or, reduce the credit amount on the credit card.

    Notify credit bureaus not to open new accounts in the name of your loved ones.

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  • Beware: Social Security scams abound

    Beware: Social Security scams abound

    If you get a call or email from anyone claiming to need your Social Security number or other personal information, including anyone who says he or she works for Social Security, do not give out this information. Beware: Social Security scams abound.

    In one Social Security scam, scammers call and pretend that they work for Social Security. They tell people receiving Social Security benefits that they are due additional money from Social Security, and then ask them to verify their personal information.  With that information, scammers can alter people’s addresses and telephone information on file with the Social Security Administration and redirect people’s Social Security checks to their own bank accounts.

    Phone scams are common and come in many different forms. (See this Just Care post on financial scams and why you should beware of strangers offering help.) Back in March 2017, Social Security’s Office of the Inspector General reported that people were receiving recorded messages that Social Security had suspended their benefits. People receiving Social Security benefits were told that to avoid arrest they must call a phone number; when they did, the scammers demanded money from them.

    While Social Security agents may sometimes call people, they will never ask for your personal information. And, you should never give anyone this information over the phone or via email, even if you think you know the person. Keep in mind that with new technology, scammers can impersonate relatives, sounding exactly like a child or grandchild.

    If you get a call from someone you believe is a scammer, pressuring you for money or personal information, hang up. You can report the call to 1-800-269-0271, the Social Security Administration’s Office of the Inspector General or contact Social Security online at https://oig.ssa.gov/report.

    Note: A version of this post was published on July 27, 2017.

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  • New White House report recommends ways to help older people remain independent

    New White House report recommends ways to help older people remain independent

    A March 2016 report by the President’s Council of Advisors on Science and Technology, PCAST, recommends ways to help older adults remain independent, improving their ability to live in their homes and their communities longer. PCAST focuses on technologies and policies that foster independence, purpose, and engagement for older Americans. The report takes into account the need for social connectivity and physical and emotional well-being.

    The population is aging. In 2014, 46 million Americans were over 65, some 15 percent of the population. People are living longer. They are living with fewer functional limitations as they age. More than four in ten older adults report excellent or very good health status. And, one study found that almost nine in ten would like to remain in their homes as long as possible. While older adults are in better health than ever before, two out of three have multiple chronic conditions. Support services can be invaluable to them, yet many are unaffordable.

    PCAST looks at four changes many people experience as they age with the aim of recommending support services to make it easier for older adults to age in place: hearing loss, increasing social isolation, physical change and cognitive change. A report issued in March 2015 focuses on hearing loss. This report focuses on the other three changes and emphasizes their interrelationship. For example, if a person is unable to leave home, the person is more likely to be socially isolated, and the person’s social isolation can affect her mental health.

    PCAST offers 12 ways to promote independence and aging in place for older adults through technology. Here are five of the recommendations:

    1. Federal policy that promotes affordable internet access and training for older adults. Broadband access is key for social connectivity. It can help older adults be aware of local resources, volunteer opportunities and jobs. Broadband access also allows for telehealth and easy communication with caregivers.
    2. Sensors that monitor behaviors and activities of older adults also could add tremendous value, allowing caregivers to know whether an older person is safe at home. Of course, privacy and security issues need to be fully understood.
    3. The federal government should encourage banks and other financial institutions to improve ways to monitor and protect older adults from financial scams. PCAST states that “Financial exploitation of older adults is massively underreported.” The Consumer Financial Protection Bureau offers tips for people to protect themselves and the people they love.
    4. Federal agencies should promote the setting of minimum design standards for homes and products, which recognize people’s declining mobility as they age. Housing should have accommodations that make it easier for people to remain in their homes even if they have difficulty moving around. New technologies should be used to design and create lighter, more durable and more comfortable wheelchairs. And, packaging of foods and medical supplies should be designed so that older adults do not have to struggle to open them.
    5. Federal government needs to explore changes to its Medicare and Medicaid coverage policies that allow people to receive services at home, in particular telemedicine services.

    PCAST notes that there is no evidence that digital games of any sort promote memory or cognitive well-being. And, the federal government should be protecting older adults from spending money on these products.

    Here’s more from Just Care:

     

  • Three tips to avoid a health insurance scam

    Three tips to avoid a health insurance scam

    Health insurance scams abound. Marketing agents working for a health insurer may call you, appear at your door, or email you to get you to sign up for a health plan. That’s how they make money. So, beware. And keep these three tips in mind:

    1. Protect your personal information. Do not give anyone your Medicare number or Social Security number, credit card number or bank account details. Before speaking with anyone about your health plan choices, make sure the person is really representing a health insurance company. Some people pretend to be selling a health plan just to get your personal information. If you have Medicare, call Medicare, 1-800-333-4114, or call the health plan directly to confirm the agent trying to sell you health insurance is not scamming you.
    2. Don’t take the word of the person trying to sell you a health plan about the doctors you will be able to use. Before you sign up, call your doctors to make sure they are in the plan’s network and that they will continue to treat you. Or, if you’re willing to switch doctors, call to confirm that the doctors listed in the plan’s network are taking new patients and that you can use them. If you have Medicare, keep in mind that only traditional Medicare covers your care from most doctors and hospitals anywhere in the United States.
    3. Know your rights. Agents selling health plans to people with Medicare cannot call you, email you or appear at your door unless you give them permission to. They also cannot ask you for financial information or your Medicare number. Before you let them try to sell you a health plan, call your state health insurance program for free advice on your options. And, if you receive a letter that looks official–it looks like it comes from Medicare or a government agency–call your State Health Insurance Plan to confirm it’s legitimate before doing anything else.

    For more information on how to protect yourself against Medicare fraud, visit MedicareInteractive.org.