Helping keep the promise.

Transcription

1 FraudAlert! Helping keep the promise. April 2014 Volume 17, No. 9 Coalition of Wisconsin Aging Groups Elder Law Center From the Project Director Elizabeth Conrad Check out our website at Let s Get Acquainted By Judy Steinke, Wisconsin SMP Volunteer Coordinator Wisconsin SMP (Senior Medicare Patrol) is pleased to introduce Janet Meyer of Greenville as this month s featured volunteer. Janet retired from the Social Security Administration (SSA) in 2009 after a 36-year career. She served in the Appleton, Oshkosh, Fond du Lac, and Rice Lake offices and was very involved with educating beneficiaries during the roll-out of Medicare Part D. After retiring from the SSA, she was employed part-time as a Medicare Assistant for the Outagamie County Aging and Disability Resource Center, where she assisted beneficiaries during open enrollment. While training for this job, she was introduced to the Coalition of Wisconsin Aging Groups and Wisconsin SMP. When Janet read in her local paper that Wisconsin SMP was holding a new volunteer training near her home, she decided to join the group. Wisconsin SMP is fortunate that someone with her expertise has joined the team. In addition to SMP, Janet also volunteers for the National Alliance for Mental Illness (NAMI) and her church. Her hobbies include golf and stamping. Wisconsin SMP In this issue: Let s Get Acquainted with Janet Meyer, SMP Volunteer Report Healthcare Fraud to WI SMP Older Americans Month 2014 Monroe Man to Pay $375,000 for Defrauding Medicaid WI DOJ News Release DATCP: Beware of Powerball Scam WI BBB News Release FTC Stops Mass Telemarketing Scam That Defrauded Seniors Out of Millions New Strategies in Fight against Medicare and Medicaid Fraud Proving Successful CMS News Release SMP Activities Published and distributed by the Coalition of Wisconsin Aging Groups Elder Law Center funded in part by grant #90MP0187 from the Administration on Aging/Administration for Community Living, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging Policy. EDITOR AND PROJECT DIRECTOR Elizabeth Conrad ASSOCIATE EDITOR Kevin Brown This publication may be reproduced ONLY in its entirety. Permission to excerpt portions must be obtained prior to use CWAG. All rights reserved. Janet and her husband, Bill, will celebrate their 11 th wedding anniversary in May. Happy Anniversary, Janet, and thank you for your service to Wisconsin SMP and seniors in Outagamie County! FRAUD ALERT! Coalition of Wisconsin Aging Groups Elder Law 1 Center 2850 Dairy Drive Madison, WI econrad@cwag.org

2 Report Healthcare Fraud to Wisconsin SMP By Kevin Brown, Wisconsin SMP Capacity Building Grant Manager/Trainer Earlier this month, a spine doctor in the Milwaukee area was sentenced to six months in prison and six months on house arrest after pleading guilty to healthcare fraud. Cully White, who had surrendered his medical license last year after complaints about substandard surgeries going back to 2004, also was fined $60,000. Fortunately, the incidence of healthcare fraud in Wisconsin is relatively low compared to other states. However, even though Wisconsin is considered a low fraud state that doesn t mean healthcare and other types of consumer scams are not big problems in our state. Every issue of this publication contains stories about healthcare and consumer fraud that has been committed in Wisconsin. Elsewhere in this issue, we report on a Monroe man who recently settled a Medicaid fraud case for $375,000 and a Milwaukee man who has been sentenced to prison for Medicaid fraud. Other fraud cases in the state that have been in the news in the past month include the following: The Wisconsin Department of Agriculture, Trade and Consumer Protection warned residents to be on the lookout for calls from scammers that request their bank account information while claiming to represent the BadgerCare Plus health care program. BadgerCare Plus members in the Fox Valley were told that they were eligible for a $200 stipend from the state and were asked for their bank account information in order to make the deposit. When the call recipients refused to turn over that information, the calls were disconnected. A 79-year-old Madison woman was swindled out of $2,000 when she victimized by the grandparent scam. She received a phone call from someone who identified himself as her grandson. He said he needed money to get out of jail, so she wired $2,000 to an address in Beirut, Lebanon. She later learned from her son that she was a victim of fraud. The Wisconsin Department of Revenue (DOR) warned residents about a scam in which crooks posing as Internal Revenue Service agents have called taxpayers demanding immediate tax payments via debit cards or wire transfers and threatening arrest or other penalties. DOR officials reminded Wisconsin taxpayers that the agency does not initiate telephone communications through or request detailed personal information by phone or . The mission of Wisconsin SMP (Senior Medicare Patrol) is to empower seniors to prevent healthcare fraud. If you suspect healthcare fraud is being committed in your area of the state, please report it by calling us at (800) , ext Low fraud is good, but no fraud is even better. Older Americans Month 2014 When Older Americans Month was established in 1963, only 17 million of the Americans alive at that time had reached their 65 th birthdays. About a third of older Americans lived in poverty, and there were few programs to meet their needs. However, interest in older Americans and their concerns was growing. In April 1963, President John F. Kennedy s meeting with the National Council of Senior Citizens served as a prelude to designating May as Senior Citizens Month. Thanks to President Jimmy Carter s 1980 designation, what was once called Senior Citizens Month, is now known as Older Americans Month, and it has become an annual tradition. 2

3 Older Americans Month is focusing on injury prevention this year, and the theme is Safe Today. Healthy Tomorrow. Older adults are at a much higher risk of unintentional injury than the rest of the population. Unintentional injuries to this population group result in at least 6 million medically treated injuries and more than 30,000 deaths every year. With its focus on safety during Older Americans Month, the Administration for Community Living plans to use this opportunity to raise awareness about this critical issue. By taking control of their safety, older Americans can live longer, healthier lives. Sources: Administration for Community Living Newsroom Releases (March 27, 2014 and April 3, 2014) Monroe Man to Pay $375,000 for Defrauding Medicaid A Monroe man who allegedly received more than $1.5 million in overpayments for transporting Medicaid patients has agreed to pay $375, 000 to settle the False Claims Act lawsuit filed by the U.S. government to recover the funds. The civil suit alleged that Anglin Transport Services, Inc., which is owned by Anthony R. Anglin, submitted 55,778 reimbursement claims for specialized transportation of Medicaid patients between February 2006 and May The company allegedly submitted claims for patients it did not transport on the date specified or did not have the cot and stretcher equipment that is required to bill Medicaid at a higher rate. In January 2012, Anglin was convicted of Medicaid fraud in Green County Circuit Court and placed on probation for five years, including a year in jail with Huber privileges. He was also ordered to reimburse the Medicaid program for the funds he received fraudulently and paid $7,619 of the $110,417 restitution that was ordered when he was sentenced. According to the civil suit, Anglin began to dispose of the real estate and construction equipment he purchased with the fraudulently obtained Medicaid funds while the Green County case was proceeding through the court system. In October 2011, he sold three properties in Monroe for at least $197,927. He deposited some of this money into his concrete and excavating business accounts. U.S. District Judge Barbara Crabb approved the judgment on February 28 in which Anglin admitted to violating the False Claims Act, but said he did not have the ability to repay Medicaid for its entire loss. The judgment allowed the government to immediately take $12,950 that Anglin made from a real estate sale and $6,319 from two of his bank accounts. He also agreed to make monthly payments of $600 until the judgment is satisfied. In addition, Anglin is required to provide the government with financial statements twice a year, which would demonstrate his ability to increase his monthly payments. According to Assistant U.S. Anthony Trillo, Anglin does have some business assets, but they are exempt from the judgment because the court considers them necessary to maintain his business and continue to make ordered payments. Trillo said the amount of the judgment indicates what we can get from him. Anglin s attorney, Richard Coad said his client has taken his lumps but intends to pay back every penny of this. Source: Monroe Times (March 14, 2014) 3

4 Reprinted with permission of the Wisconsin Department of Justice April 22, 2014 Milwaukee Man Sentenced for Medicaid Fraud MADISON Attorney General J.B. Van Hollen announced today that Tyvex Benford has been sentenced in Milwaukee County on two convictions for Medicaid fraud. Milwaukee County Circuit Court Judge William Brash imposed and stayed sentences of imprisonment for three years, to be served concurrently to each other and consecutive to any other sentences, comprising 18 months initial confinement and 18 months extended supervision. He then placed Benford on probation for two years, with conditions of six months in jail, alcohol or other drug abuse (AODA) assessment, anger management treatment, participation in a criminal thinking program, preclusion as a payee for any government public assistance program, and payment of $3,546 restitution. Benford pleaded guilty on February 28 to two counts of Medicaid fraud. Four other counts of Medicaid fraud were dismissed and read-in for sentencing purposes. According to the criminal complaint, Benford completed fraudulent time reports requesting payment for work he did not perform caring for his grandmother, and submitted them to the Milwaukee Center for Independence (MCFI). Benford s grandmother is a participant of the Include, Respect, I Self Direct (IRIS) program, which provides Medicaid funds for the needy and people with disabilities to hire workers to provide them with care services. On one occasion, Benford s time reports indicate he had cared for his grandmother for five hours every day between December 22, 2012, and January 3, 2013, when in fact he was in the custody of the Milwaukee County Sheriff during that time. In total, Benford submitted six fraudulent time reports, requesting payment for performing 394 hours of work providing care services to his grandmother. The case was investigated and prosecuted by the Medicaid Fraud Control and Elder Abuse Unit of the Wisconsin Department of Justice. DATCP: Beware of Powerball Scam The Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP) issued an alert late last month about a unique Powerball scam that is soliciting personal information from Wisconsin consumers and setting them up for potential future scams. Lottery scams usually involve scammers telling their victims that they won a prize but have to pay taxes or fees to claim it. Sometimes, scam artists will also ask for personal information such as Social Security numbers. However, the current Wisconsin Powerball Lottery scam is different. Callers tell consumers they are eligible for unclaimed Powerball prizes and ask them to pick some numbers. The scammers then contact the consumers later and claim they won a third or fourth prize of a car and millions of dollars, said DATCP officials. They seem to be casing the consumers for future scams, asking them general financial questions about their investments and the values of their homes, the warning said. Officials say even if the caller doesn t ask for personal information during the first call, he or she is still gathering valuable data that allows them to build a profile on the consumer that they can use for future scams. The DATCP alert added: If a consumer freely and eagerly answers the scammer s 4

5 questions, that scammer now has two important pieces of information: the overall wealth of the consumer and a sense that the consumer will be an easy and receptive target for future scams. These profiles are valuable for scammers and may be sold and shared among the criminals. Consumers are confused about the Powerball scam calls and have been calling DATCP to find out whether the calls were legitimate. The warning stated, Because these Powerball calls have not included the usual scam red flags of requests for money, sensitive personal data or bank or credit account numbers, it has been a challenge for the hotline staff to persuade consumers that the calls are fraudulent. The Wisconsin Powerball lottery is run by the Wisconsin Department of Revenue (DOR), which is aware of the scam. The DOR said the agency only calls consumers if they entered and won the lottery mail in drawing. Wisconsin consumers who want to file a complaint with DATCP about a scam can do so by phone at (800) , on DATCP's website or by ing DATCPhotline@wisconsin.gov. Source: Milwaukee Journal Sentinel (March 26, 2014) Reprinted with permission of the Wisconsin Better Business Bureau April 29, 2014 BBB s Bi-Annual Free Shredding Event to Help Fight Identity Theft ID Theft is Nation s #1 Complaint to FTC, for Third Consecutive Year Milwaukee, Wis. On Saturday, May 10th, the Better Business Bureau Serving Wisconsin will host ShredFest a free document shredding event that helps people protect themselves from identity theft, the top consumer complaint to the Federal Trade Commission for the last three years. The event will be held at Layton State Bank, W. Lincoln Avenue, from 9 am to 11:30 am. There is a limit of three boxes per car. Layton State Bank, Strongbox Document Destruction, LLC., and ProShred Security are co-sponsoring the event. In 2013, there were 3,635 reported cases of identity theft in Wisconsin, with 1,444 of those complaints coming from the metropolitan Milwaukee area, according to the FTC s Consumer Sentinel Network (CSN) report. In Wisconsin, government documents/benefits fraud was the most common form of reported identity theft at 43 percent, followed by credit card fraud (13 percent), phone or utilities fraud (11 percent), bank fraud (6 percent), employment-related fraud (4 percent) loan fraud (3 percent), other (21 percent) and attempted identity theft (7 percent). Those aged remain the most heavily targeted group, making up 20 percent of the total number of victims reporting their age in CNS, directly followed by those aged (19 percent), those aged (18 percent), and those aged (17 percent). 5

6 Shredding personal information is a great way to minimize your chance of becoming a victim of identity theft. In fact, most identity theft cases occur after personal information has been lost or stolen, which is why the BBB encourages consumers to dispose of unneeded documents responsibly. BBB is happy to give people the opportunity to protect their identities by shredding unwanted personal documents free of charge, said Ran Hoth, CEO and President of the Better Business Bureau Serving Wisconsin. Identity theft is a serious crime, and largely a crime of access. Our goal is to make the information less accessible to thieves and empower people to be their own first line of defense. Shredding personal documents is an important first step in identity theft protection. The BBB s shredding event is part of a larger, national shredding event hosted by BBB offices through the United States. This local, educational event is presented by the BBB Foundation of Wisconsin, Inc. In addition to the event in Milwaukee, the BBB will host a shredding event in Madison on May 3rd and in Appleton on May 17th. As the result of shredding events nationwide in 2013, BBBs helped individuals and businesses at sites across the country shred 3 million pounds of sensitive documents all for free. For more information including a list of items that should be shredded, go to For more information or further inquiries, contact the Wisconsin BBB at or (metro Milwaukee), (Appleton), (Madison) or (elsewhere in Wisconsin). Consumers also can find more information about how to protect themselves from scams by following the Wisconsin BBB on Twitter, Facebook and You Tube. FTC Stops Mass Telemarketing Scam That Defrauded Seniors Out of Millions The Federal Trade Commission (FTC) has moved to close down a multi-million dollar telemarketing fraud that targeted U.S. seniors across the nation, scamming tens of thousands of consumers. On March 18, U.S. District Judge J. Curtis Joyner issued a temporary order to halt the scam. After a hearing on March 27, three defendants agreed to court-issued preliminary injunctions, and the court imposed a preliminary injunction against the final defendant, Ari Tietolman and his companies. In shuttering the scheme, pending trial, the court found that the FTC was likely to prevail and that funds should be preserved so they can potentially be returned to the victims of the telemarketing fraud scheme. The defendants conduct in this case was simply outrageous. They targeted and called senior citizens and lied to them to get their bank account information. Then they used this information to withdraw money from their bank accounts, said Jessica Rich, Director of the FTC s Bureau of Consumer Protection. Consumers can count on the FTC to be aggressive in the fight against this type of fraud. Tietolman, the alleged leader of the telemarketing scheme, and his associates established a network of U.S. and Canadian entities to carry out their scam, according to the complaint filed by the FTC. The defendants used a telemarketing boiler room in Canada, where Tietolman lives, to cold-call seniors claiming to sell fraud protection, legal protection, and pharmaceutical benefit services. The cost for the defendants alleged services ranged from $187 and $397. In some instances, the telemarketers who carried out the fraud impersonated government and bank officials, and enticed consumers to disclose 6

7 their confidential bank account information to facilitate the fraud. The defendants used that account information to create checks drawn on the consumers bank accounts. They deposited these remotely created checks into corporate accounts they established in the U. S. The defendants based in the U.S. then transferred the money to accounts controlled by the Canadian defendants, according to an analysis of bank records. The FTC alleges that the defendants conduct violated the FTC Act and the FTC s Telemarketing Sales Rule and that the telemarketing scheme drew in over $20 million dollars between May 2011 and December The defendants businesses include First Consumers, LLC; Standard American Marketing, Inc.; and PowerPlay Industries LLC. First Consumers, LLC is a Pennsylvania company formed in Consumer complaints and bank records indicate that from at least June 2009 until June 2013, the company scammed consumers using its own name and three other names: Patient Assistance Plus, Legal Eye, and Fraud Watch. The three other individual defendants who assisted in the scheme are U.S. citizens: Marc Ferry, Charles Borie, and Robert Barczai. Source: Federal Trade Commission Press Release (March 21, 2014) New Strategies in Fight against Medicare and Medicaid Fraud Proving Successful University of Cincinnati (UC) research shows advances in data analysis technology are proving to be very effective weapons for controlling the billions of dollars lost to Medicare and Medicaid fraud. The annual bill for Medicare and Medicaid fraud hit 11 digits in 2012, which is tens of billions. Estimates show that Medicare and Medicaid fraud cost somewhere in the range of $29.8 billion to $99.4 billion in 2012, says Michael T. Czarnecki, a doctoral student in UC s College of Education, Criminal Justice, and Human Services. This means that every day in 2012 Medicare and Medicaid fraud averaged between $81.5 million and $271.5 million, with every hour averaging between $3.4 million and $11.3 million lost to fraud. The numbers might be daunting, but UC research shows that recent strategies to combat this unique form of white-collar crime are increasingly effective. Czarnecki s research reviews what is known about Medicare and Medicaid fraud and how it is controlled, especially how control strategies have evolved during the past decade. Medicare loses billions of dollars to fraudulent claims every year, according to U.S. Department of Health and Human Services and the Department of Justice. Some examples of Medicare fraud provided by these departments include: a health care provider bills Medicare for services that were never received; a supplier bills Medicare for equipment a beneficiary never got; and a company uses false information to mislead people into joining a Medicare plan. Recent advances in data analysis technology have given federal controllers, such as the Health Care Fraud Prevention and Enforcement Action Team, new and effective weapons in the fight against fraud, Czarnecki says. Controllers are getting better at identifying irregular and suspicious patterns in claim submissions, he says. Collaboration and data sharing between agencies have improved. Teams are focusing their efforts in cities identified as hot spots. The results are encouraging. Czarnecki's research shows that for every dollar spent to control fraud from , $7 was returned. In fiscal year 2011, $2.5 billion of Medicare funds were recovered; in 2012, more than $3 billion was recovered. 7

8 "Every dollar that is saved from fraudsters can be reallocated to some useful purpose such as providing better health care or reducing overall health care costs," Czarnecki says. Source: University of Cincinnati Press Medical Press (February 8, 2014) Reprinted with permission of the Centers for Medicare and Medicaid Services April 9, 2014 Historic Release of Data Gives Consumers Unprecedented Transparency on the Medical Services Physicians Provide and How Much They Are Paid Today, as part of the Obama administration s work to make our health care system more transparent, affordable, and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the release of new, privacy-protected data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. The new data also show payment and submitted charges, or bills, for those services and procedures by provider. Currently, consumers have limited information about how physicians and other health care professionals practice medicine, said Secretary Sebelius. This data will help fill that gap by offering insight into the Medicare portion of a physician s practice. The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns. The new data set has information for over 880,000 distinct health care providers who collectively received $77 billion in Medicare payments in 2012, under the Medicare Part B Fee-For-Service program. With this data, it will be possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers. The information also allows comparisons by physician, specialty, location, the types of medical service and procedures delivered, Medicare payment, and submitted charges. Physicians and other health care professionals determine what they will charge for services and procedures provided to patients and these charges are the amount the physician or health care professional generally bills for the service or procedure. Data transparency is a key aspect of transformation of the health care delivery system, said CMS Administrator Marilyn Tavenner. While there s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program. Last May, CMS released hospital charge data allowing consumers to compare what hospitals charge for common inpatient and outpatient services across the country. To view the physician dataset, please visit: Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other- Supplier.html. 8

9 SMP Activities Date Activity County April 1 SMP Presentation-St. Nazianz Nutrition Site Manitowoc April 2 SMP Volunteer Foundations Training-Stevens Point Portage April 8 SMP Presentation-Racine County Elderly Services Network Racine April 9 SMP Presentation-Valders Nutrition Site Manitowoc April 9 SMP Presentation-First Lutheran Church-Beaver Dam Dodge April 12 SMP Booth-Caregiver Resource Fair-Appleton Outagamie April 16 SMP Presentation-Cleveland Nutrition Site Manitowoc April 21 SMP Presentation-Manitou Manor Nutrition Site Manitowoc April 24 SMP Presentation-Wausau Retired Educators Marathon April 24 SMP Booth-Senior Living Show-Neenah Winnebago April 24 SMP Booth-Honoring Our Seniors-Lac du Flambeau Vilas April 27 SMP Booth-Cedar Mall 50+ Fair-Rice Lake Barron May 1 SMP Booth-Independent Living Expo-Whitewater Walworth May 1 SMP Presentation-Eagle River Nutrition Site Vilas May 1 SMP Presentation- WI Assn. of LPNs Conf.-Lake Delton Sauk May 1-2 WVCA Conference-Rothschild Marathon May 4 SMP Presentation-English Lutheran Church-La Crosse La Crosse May 6 SMP Presentation-St. Nazianz Nutrition Site Manitowoc May 6 SMP Presentation-Land O Lakes Nutrition Site Vilas May 6 SMP Volunteer Foundations Training-Bristol Kenosha May 8 SMP Booth-Senior Living Show-Rothschild Marathon May 9 SMP Booth-Multi-Cultural Senior Health Fair-Madison Dane May 13 SMP Booth-Look Beyond Your Benefits-Milwaukee Milwaukee May 14 SMP Presentation-Valders Nutrition Site Manitowoc May 17 SMP Booth-Safety Fair-Plover Portage May 19 SMP Booth-Wisconsin Alzheimer s Conference-Wis. Dells Sauk May 19 SMP Presentation-Manitou Manor Nutrition Site Manitowoc May 22 SMP Booth-Manitowoc Senior Fair Manitowoc June 3 SMP Presentation-St. Nazianz Nutrition Site Manitowoc June 11 SMP Presentation-Valders Nutrition Site Manitowoc June 12 SMP Booth-Vital Aging Conference-La Crosse La Crosse June 13 SMP Presentation-Senior Council S.O.S. Mtg.-Madison Dane June 16 SMP Presentation-Manitou Manor Nutrition Site Manitowoc June 17 SMP Booth-Ozaukee County Senior Fair-Grafton Ozaukee We are always looking for opportunities to support our colleagues in the aging network. Please contact Wisconsin SMP and let us know about upcoming events in your area. 9

10 Wisconsin SMP Coalition of WI Aging Groups 2850 Dairy Drive Ste. 100 Madison WI ATTENTION: All of You with In an effort to save paper, postage and be volunteer friendly, we will issues of the Fraud Alert! to those who have . Please contact Kevin Brown at and give him your address to add to our list. Thank you! For more information, contact: Elizabeth Conrad, SMP Project Director Coalition of Wisconsin Aging Groups Elder Law Center 2850 Dairy Drive Suite 100 Madison, WI Phone: 800/ / You can also access our publication by visiting our web site Or you can visit the Coalition of Wisconsin Aging Groups web site Click on Publications then click on Wisconsin Senior Medicare Patrol (SMP) and scroll down and click on the edition you wish to view.