Health Medicare’s open registry is open to scammers

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Finding the best private Medicare drug or health insurance among dozens of options is difficult enough without adding misleading sales tactics to the mix.

Still, federal officials say complaints are increasing from seniors who are tricked into buying guidelines – without their consent or lured by questionable information – who may not include their medications or their doctors. In response to that Centers for Medicare & Medicaid Services has threatened to penalize private insurance companies that sell Medicare Advantage and drug plans if they or agents acting on their behalf mislead consumers.

The agency also revised the rules to make it easier for beneficiaries to escape plans they didn’t sign up or enroll in, only to find that promised benefits didn’t exist or they couldn’t see their providers.

The problems particularly arise during Medicare’s open enrollment phase that began Oct 15 and runs through December 7th. A common trap starts with a phone call like this Linda Heimer, a Iowa Residents, received in October. She doesn’t answer the phone unless her caller ID shows a number she knows, but that call showed the number of the hospital where her doctor works.

The person on the phone said she needed Heimer’s Medicare number to make sure it was correct for the new card she was going to receive. When Heimer hesitated, the woman said: “We don’t ask for anything social insurance Number or bank code or something similar. That’s fine.”

“I can’t believe it, but I gave her my card number,” said Heimer. Then the caller asked questions about her medical history and offered to send her a saliva test “absolutely free”. Heimer became suspicious and hung up. She contacted the 1-800-MEDICARE hotline to get a new Medicare number and called the AARP Fraud Watch Network Helpline and the Federal Trade Commission.

But later that morning the phone rang again and this time the caller ID showed a number that matched the Medicare toll-free helpline. When she answered, she recognized the voice of the same woman.

“You are not from Medicare,” Heimer told her.

“Yes, yes, yes, that’s us,” the woman insisted. Heimer hung up again.

It’s only been two weeks since Heimer gave her Medicare number to a stranger and nothing has gone wrong so far. But armed with that number, scammers could bill Medicare for services and medical care that beneficiaries never receive, and the scammers could enroll seniors for a Medicare benefit or drug plan without their knowledge.

In California, Reports of fraudulent sales practices for Medicare Advantage and drug plans have been the top complaint made to the state’s Senior Medicare Patrol over the past two years, said Sandy Morales, a case manager for the group. The patrol is a federally funded program that helps seniors solve insurance problems.

Nationwide, the Senior Medical Patrol sent 74% more cases to CMS and the Inspector General of Health and Human Services for investigation in the first nine months of this year than in all of 2020 Rebecca Kinney, Director of Administration for Community life Office for health information and advice at HHS, which oversees the patrols. She expects more complaints to come in during Medicare’s open enrollment period.

And last month, CMS officials warned the private insurance companies that sell Medicare Advantage and drug plans that federal regulations prohibit fraudulent sales practices.

Kathryn Coleman, Director of CMS group for contract management for Medicare drugs and health plans, in a memo to insurers, said the agency is concerned about advertisements widely promoting Advantage Plan benefits that are only available in a limited area or to a limited number of beneficiaries. CMS has also received complaints about sales information deemed to have come from the government and pressure tactics to get seniors to sign up, she noted.

Coleman reminded companies that they are “responsible and accountable for their marketing materials and activities, including marketing conducted on behalf of an MA plan” by salespeople. Companies that violate state marketing rules can face a fine and / or suspension of registration. However, a CMS spokesperson was unable to provide any examples of the recent violations or their penalties.

When beneficiaries discover a problem beforehand March 31, the date on which the three-month notice period ends each year, you have one opportunity to switch to another tariff or to the original Medicare. (Those who choose the latter cannot, with rare exceptions, take out supplementary or Medigap insurance in all but four countries: Connecticut, Maine, Massachusetts and new York.) After March, they are usually tied to their advantage or drug plans for the entire time

Year, unless you are eligible for one of the rare exceptions to the rule.

For the first time this year, CMS has created another remedy.

Officials can grant a “special registration period” to people who wish to abandon their plan because of fraudulent sales tactics. These include “situations where a beneficiary claims, verbally or in writing, that their inclusion in an MA or Part D plan was based on misleading or incorrect information … their knowledge,” according to the Medicare Managed Care Manual.

“This is a really important beneficiary safety valve that clearly goes beyond the limited ability to change plans when someone feels the buyer’s remorse,” said David Lipschutz, deputy director of Medicare Advocacy Center. To take advantage of the new option, beneficiaries should contact their state’s health insurance assistance program at www.shiphelp.org/.

The possibility of leaving also exists if a significant number of insured persons do not have access to the doctors or hospitals that should be part of the provider network.

Still, the scams continue across the country, experts say.

A misleading television commercial in the San Francisco The area has attracted seniors with a host of new benefits, including dental, eyesight, transportation benefits, and even “money back in your life”. social insurance Account, “Morales said. Beneficiaries have told their group that when they requested information, they” were mistakenly placed on a plan they never gave permission to enroll in, “she said.

In August, a Ohio senior received a call from someone stating that Medicare was issuing new cards because of the Covid-19 pandemic. When he did not provide his Medicare number, the caller got angry and the beneficiary felt threatened, said Chris Reeg, Director of the Ohio Senior Health Insurance Information Program.

Reeg said another senior received a call from a salesperson with bad news stating that she did not receive all of the Medicare benefits to which she was entitled. The beneficiary provided her Medicare number and other information, but did not know that the caller was enrolling her on a Medicare Advantage plan. She found out about this during her visit to the doctor, who did not accept her new insurance.

In western new York, said the culprit is an official looking postcard Beth Nelson, the state’s Senior Medicare Patrol Director. “Our records show … that you may be entitled to additional benefits,” it says enticingly. When Nelson’s client called the number on the card in September for more information, she gave her Medicare number and later ended up on a Medicare Advantage plan without her consent.

Heimer’s impostor was persistent. When the stranger tried to reach her a third time, Heimer said, the caller ID showed the phone number of another local hospital. She told the woman she had the calls to CMS, the AARP Fraud Watch Network Helpline and the FTC. That finally helped – the woman abruptly hung up.

Susan Jaffe: [email protected], @SusanJaffe


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