Seniors should beware of enrollment fraud
Seniors have been sold plenty of lies about health reform since the Affordable Care Act became law in 2010. They’ve been told that it will slash their benefits and create “death panels” to weed out those too old and sick to be worthy of medical care; that it will crush the popular Medicare Advantage program; and that government will get between them and their doctors.
Falsehoods, all. But with key provisions of Obamacare kicking off this month, seniors finally have something real to be concerned about: fraud. Consumer advocates and legal experts say they are seeing a rise in ACA-related identity theft and other scams targeting seniors on Medicare.
Medicare is a chronic focus of scam artists because of its huge size and many moving parts. The program identified $44 billion in improper payments last year, according to the Government Accountability Office, and the ACAincluded funds for beefed-up fraud prevention initiatives. But the ACAalso has added a layer of vulnerability, much of it playing off political attacks on the law.
“Many seniors already think the worst about the law, so they’re ready for some of these false pitches,” says Joe Baker, president of the Medicare Rights Center, a nonprofit consumer services group. “They’ll tell you Obamacare means you need to change your Medicare, or that you need to reapply for Medicare — or that if you don’t buy a new kind of insurance, you’re going to get fined or go to jail.”
Consumer protection advocates worry that scammers will falsely tell seniors that they need to renew their Medicare coverage or sign up in the new exchanges, and get them to divulge personal information on application forms.
They’ve also received reports of fake websites purporting to offer Obamacare insurance policies. The sites often will display an official-looking government seal.
“There hasn’t been a vehicle like this in a long time that can be used to steal Social Security numbers and bank account information,” says Dennis Jay, executive director of the Coalition Against Insurance Fraud, a national alliance of insurers, government agencies and consumer groups.
Seniors also are hearing a wave of marketing messages and publicity about the ACAinsurance exchanges in which open enrollment started Oct. 1 and runs through the end of March. Coincidentally, that ACAenrollment season overlaps with the annual fall Medicare enrollment period (Oct. 15-Dec. 7).
For consumers, the challenge is sorting out scams from the massive, legitimate outreach underway to promote the new law. That outreach includes state health care “navigators” who are supposed to help people sign up for legitimate coverage, as well as privately funded efforts to promote ACAenrollment. For example, Enroll America, a nonprofit funded by foundations, health insurance companies and others with an interest in making the ACAa success, is running a legitimate outreach campaign called “Get Covered America.”
Baker and other advocates have a simple message for seniors: You don’t have to make any changes in your Medicare coverage because of Obamacare.
Anyone who is on Medicare has no need to use the Obamacare health insurance exchanges; in fact, it is illegal for insurers to sell an exchange policy to anyone on Medicare.
“If anyone tells you that you have to do that, they’re lying,” Baker says.
Older Americans younger than 65 who don’t have group insurance coverage will be shopping for policies on the new ACAexchanges.
Here are some ways both groups can avoid falling prey to a health care scam:
Be suspicious of solicitations. “Medicare will never call or knock on doors to solicit you,” Jay says. Don’t give sensitive personal information to anyone who solicits you. Legitimate enrollment outreach personnel won’t ask you for it — they’ll simply point you to places where you can sign up for insurance, Jay says.
Look to a source you already know and respect. “If you already have a trusted financial adviser or an insurance agent who can help you, use that per- son,” says James Napoli, a Washington-based senior counsel at the law firm Proskauer Rose.
You can get additional counseling and assistance from the State Health Insurance Assistance Programs, which operate in every state ( bit.ly/14Y6ZNt).
Use official websites only. Seniors using the fall Medicare enrollment to shop for prescription drug or Medicare Advantage plans should sign up only through the official Medicare Plan Finder website ( 1.usa.gov/cK3At8) or by phone at 800-MEDICARE.
Report suspected fraud. The new federal health care marketplace call center can field questions about suspected fraud related to the ACA(800318-2596), and the Federal Trade Commission can field complaints online ( 1.usa.gov/19c8LxC). .