Uncaring “Obamacare” scams alive

Pitchmen try to steal consumer identities

nullLast week’s forward-reaching FraudBlog opened visitors’ eyes to the myriad challenges that exchanges will have in protecting consumers and businesses from scammers once enrollment under health reform begins in October.

Actually, identity-theft scams already are alive and well right now. A wave of identity-theft scams are trying to exploit confusion over health reform to rob people’s bank accounts and credit cards.

People are receiving cold calls or knocks on their door from strangers. The thieves typically peddle a load of baloney much like this:

“Hi, I’m from the federal government. You’re among the first lucky people to receive your Obamacare health reform card early. Federal law requires you to sign up. All we need are your bank routing and account numbers, and your Social Security and credit card numbers.”

Swindlers have told some consumers they’ll go to jail unless they sign up now. One brazen cheater even tried to sell insurance against “death panels.”

Pretty cynical ploys. And some thieves target seniors, who tend to be home more often, and frequently have tidy nest eggs to loot.

Consumers in states around the U.S. are receiving these illicit pitches. The cons are pretty transparent, but trusting people have given out their financials. This left the con artists free steal from their bank accounts and abuse their credit cards — all in the name of nonexistent “Obamacare” health insurance.

Folks, take heed: The feds aren’t sending agents door to door or cold calling at present. Nor is there a federal law called “Obamacare.”

Nobody will legally contact you for signup until the October open enrollment. Health reform takes effect in January.

Take convenient and firm steps to thwart cheaters: Just hang up the phone or close the door. Don’t engage these strangers. Many are trained pitchmen who will try to sweet talk you into letting down your guard. Also contact the Federal Trade Commission, the federal agency that investigates swindles like these.

Navigating the brave new world of health reform will be challenging enough. Let’s make it one step easier by stiff-arming these identity thieves out of business.

About the author: Jim Quiggle is director of communications for the Coalition Against Insurance Fraud.

“Obamacare” scams: Who’s alerting consumers?

Exchanges can be focal points for informing public

Whether you call it the Affordable Care Act or Obamacare, healthcare reform is fast approaching. Open enrollment for the exchanges starts just a mere four months away in October, and coverage takes effect in January 2014.

These exchanges will bear the brunt of insuring many small businesses, families and individuals — some of whom aren’t now insured. States are creating their own exchanges, but the feds will create and run some exchanges if the host state begs off. We can also expect state-federal partnership exchanges, and regional ones.

The Coalition has noted several developments that raise concerns for anti-fraud efforts with the exchanges. Our main concern: How will anti-fraud efforts be managed amid this mishmash of diverse exchanges?

In discussions with state insurance regulators and health insurers, we expect that health insurers now supplying coverage in states also will be included in the exchanges. Yet it’s unclear if their anti-fraud efforts will remain the same once inside an exchange. We also need to determine what anti-fraud plans and other requirements exchanges will expect from insurers.

But more than anything, the Coalition will closely monitor how the states and exchanges protect consumers and small businesses from being solicited by shady operators who mask their scams under the aegis of a health exchange.

One possible scheme: Fake exchange recruiters with forged credentials go door to door, trying to steal consumers’ sensitive financial data under the guise of signing them up for an exchange.

Concern about schemes is widespread enough that they’ve caught the attention of key federal watchdog agencies.

CMS, the Senate Aging Committee and Federal Trade Commission already have sought the Coalition’s expertise. The Coalition has met with these agencies to share field intelligence and strategic insights about current and potential “Obamacare” schemes.

Suspicious websites lying that they’re exchanges already have sprung up. How many others are waiting to lure consumers and small businesses into thinking they’re buying real insurance from a legitimate exchange?

Exchanges can be focal points for educating consumers and small businesses about scams that may strike in the coming months. Public-interest groups such as the Coalition are interviewing reporters and sending consumer alerts around the U.S.

Equally important, Washington and state capitals should use their outreach resources and influence to help develop an alert consumer population that will simply close the door or hang up the phone when shysters come calling.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Gains in curbing healthcare fraud in jeopardy

DOJ says budget cuts will curtail anti-fraud efforts

blogEighty-nine accused fraud defendants in eight cities were on the receiving end of a national sweep by the U.S. Department of Justice this week. It’s the sixth large-scale crackdown on healthcare fraud conducted since the feds created fraud strike forces a few years ago. This one involved suspected false Medicare claims totaling more than $223 million.

The latest action piles on more arrests to the nearly 1,500 DOJ has logged in recent years. It’s an impressive campaign, especially considering the lackluster effort by the government in prior years. The arrest and conviction totals mirror the success DOJ has achieved in recovering billions of dollars through civil actions.

Together, the two initiatives are saving taxpayers great sums of money, and are taking some of the worst crooks out of circulation.These fraudsters also steal from private insurers. So health plans, property/casualty carriers and their policyholders are benefiting as well.

But the real benefit of a proactive, high-profile anti-fraud campaign is its deterrence value. Yes, 1,500 arrests have been made, but how many more medical providers also are thinking twice about committing fraud? How many organized criminals decide to go elsewhere to ply their trade? No one knows, but it’s likely substantial. Never underestimate the value of having an effective cop on the beat.

Unfortunately, some of these gains may be jeopardized by the inane sequester. DOJ has to cut $1.6 billion from its 2014 budget, and the axe could fall heavily on anti-fraud efforts. The biggest asset of the strike force initiatives is the strong momentum that has taken years to create. Once lost, it could take years to build that momentum again.

I don’t have faith that Congress will fix the federal budget problems anytime soon, but I do hope DOJ find ways to minimize the damage to a program that’s greatly benefiting taxpayers and the fraud-fighting community.

About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.

Arson continues to devastate communities

Awareness Weeks highlights strategies to deter this insurance crime

blogIntent of burning his entire family to death for an insurance payout, Armin Wand III tried to shove his daughter back into his burning house after her pregnant mother had rescued her from the fire.

The Madison, Wis. man enlisted his brother to help for $300 of the expected insurance score. They shoved crumpled pieces of paper under Armin’s sleeping wife Sharon. Lighter fluid burned three-year old Joseph to death while he slept on a couch. Two older boys were locked in their rooms before the blaze began. Their bodies later were found charred together on the bedroom floor.

Wand was convicted of three counts of first-degree intentional homicide, one count of attempted first-degree intentional homicide, and felony murder and arson, which carries a mandatory life sentence. He also testified against his brother. He was given three life sentences.

When arson fires spread out of control, entire communities can be devastated. The consequences, far-reaching.

When arsons are committed for financial gain, the human losses can be staggering. The fires endanger innocent neighbors, family members and brave firefighters.

Part of the reason arson scams are even attempted may be that fraudsters think they can get away with their crimes and make money from bogus claims.

This week is National Arson Awareness week, spreading awareness about the dangers of home arson, and providing communities with tools to help thwart this crime. The Coalition is an official partner of this outreach effort, part of a small and select group of fraud-fighters.

Arson cases often end brutally. Family members have died inside their homes. Fraudsters get caught, find themselves without a home — or just ashes of it —  and with long jail sentences, risking innocent lives and putting their own lives in danger… a bad bargain.

Talk to your friends and neighbors about arson, how to protect their homes, and why fraud is not worth it.

About the author: Jennifer Tchinnosian is communications specialist for the Coalition Against Insurance Fraud.

Anti-fraud bills remain in neutral in Albany

N.Y. governor key to no-fault fraud reforms

blogI am a native New Yorker and started my career in public policy as a legislative intern in Albany. So it’s a homecoming of sorts whenever I return to the Capitol, walking the same halls I did several decades ago as a college student.

Last week I spent the day meeting with key legislators or staff, discussing auto-fraud issues. Several important insights about the future of much-needed reforms emerged.

There’s general agreement with senior legislators that a long-stalled anti-fraud bill can pass only if the governor takes the lead. They voiced frustration that they couldn’t get the legislature to move, and believe the governor must be the catalyst. This sentiment came from legislators from both parties.

One Democrat said that given the governor’s falling approval ratings because he pushed gun control, championing auto-fraud reforms gives him a good rebound issue to show he’s helping state insurance consumers.

A senior legislative counsel to a high-ranking Republican also weighed in on efforts to weaken the penalties in an anti-runner, anti-solicitation bill. For years the Senate has passed a bill that made the penalty a felony, only to see the bill die in the state Assembly. Last year, the Assembly passed the bill, but weakened the penalty to a misdemeanor. Runners would be charged with a felony only if they had multiple charges in a calendar year.

The problem, according to the counsel: No prosecutor in a large urbanized county would waste his or her time bringing a misdemeanor case to trial, and the charge likely would be plea-bargained even lower.

This would ensure that a fraud ring’s recruiters wouldn’t be charged with felonies for future arrests. Thus it would be a toothless law. It would do little to clamp down on the crash gangs and crooked clinics that are milking auto insurers and raising premiums for honest drivers.

There’s a sense in Albany that broader no-fault reform — with strong fraud provisions — may be rising in the governor’s pecking order. That’s encouraging. Earlier this year the Coalition encouraged Governor Andrew Cuomo to take the lead on this issue. We’re now watching for smoke signals that he’s serious about tackling auto insurance issues and auto fraud.

Without the governor’s leadership, no-fault fraud likely will continue to flourish and New Yorkers will continue to pay unfairly high rates of insurance premiums.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Snowing the patients; blinded by riches

Hospital owner accused of encouraging needless surgeries

blogA new phrase has entered the lexicon of insurance fraud — “snowing the patient.” It emerged from a case involving a Chicago hospital that’s accused of some of the most ghoulish fraud scams in memory. Federal prosecutors allege that doctors drugged patients until only the whites of their eyes were visible — thus the “snowing” reference. Then the doctors cut open their throats so they could breathe, prosecutors allege. The tracheotomies are highly priced medical procedures on Medicare’s fee schedule.

Five of 28 patients who underwent this treatment reportedly died within two weeks.

The CEO of Sacred Heart Hospital and five physicians have been charged in a wide-ranging kickback and fraud scheme. The 100-page federal indictment is filled with allegations of unnecessary surgeries that endangered patients and bought millions of the dollars to the hospital’s coffers.

If true, this case will undoubtedly go down as one of the cruelest fraud schemes ever. Maybe the patients were snowed, but hospital administrators and doctors under their direction are the ones blinded by the financial gain of fraud.

About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.

Beware of awry agents

Consumers should take precaution when buying insurance

blogYou discover that you have a serious illness, a circumstance beyond your control. Then, you learn that your nice, neighborly insurance agent had sold you a fake health policy. You urgently need treatment, but you don’t have coverage. Taking care to choose an honest agent was in your control, but now it’s too late.

Most agents are honest, but regrettably, we’ve seen a wave of agent fraud stories lately. Victims paid into all kinds of coverage they later discovered were fake.

Some examples:

In Missouri, an insurance agent sold homeowner and auto policies without a license, and pocketed clients’ premiums. She pleaded guilty this week to 20 counts of fraud.

In Oklahoma, an agent is charged with deliberately miscoding workers compensation policies to make roofing companies illegally eligible for coverage. Suspected victims were issued certificates of insurance that were not backed by actual policies. They discovered, as many do, that they’d allegedly had paid into a plan that didn’t cover them.

In New York, Norman Michaels was arrested for selling forged health policies to more than 400 individuals. Prosecutors say his victims were lured by the promise of cheap insurance. The insurance was cheap because the coverage allegedly didn’t exist.

The New York Alliance Against Insurance Fraud is arming consumers with important advice to empower themselves against crooked agents.

Among key tips:

  • Make sure the insurance agent is licensed in your state
  • Get a copy of every form you sign
  • Read your policy closely before you sign. Know the details of what your policy does and doesn’t cover.

In Spanish we say, “it’s better to prevent than to cure.” Let’s make sure that’s true when considering cheap insurance policies.

About the author: Jennifer Tchinnosian is communications specialist for the Coalition Against Insurance Fraud.

Towing & repair scams: Road to nowwhere

blogA workshop on towing fraud at this week’s annual conference of the Pennsylvania Insurance Fraud Prevention Authority serves as a reminder that we all need to be vigilant to potential schemes that can cause big headaches and empty our wallets.

First the disclaimer — most tow-truck operators are decent, hardworking folks trying to make an honest dollar. So are the body shops that received damaged vehicles.

But scams are a big-dollar business [something missing here] for bandit towing firms — and the body shops. Violence can flare up over lucrative territory in Philadelphia, the workshop presenters noted. Shouting matches, fist fights and evens shots fired come with territorial disputes.

Dishonest towing firms pounce on vehicles at the crash scenes. They quickly show up at crash scenes and try to reassuringly sweet-talk often traumatized drivers into having their car towed to ZWZ body shop. The towing firm may be operating in cahoots with the body shop to make outrageously inflated repair and towing claims against you and your policy.

Bandit towing firms also grab parked cars and lug them away to a commercial storage yard somewhere. Some vehicles were illegally parked, and others perfectly legal.

Either way, the towing firm piles on dubious fees— parking lot fees, security fees, winching and towing, and so forth. A simple tow down the street can add up to hundreds of suspicious dollars. The unfortunate drivers may have to pay out of pocket just to get their car back, or the fee may be tacked onto their auto policy if it was in an insured crash.

A banged up car may be hauled to a body shop that pays a kickback for the repair business. The body shop may enhance the damage to illicitly tack on thousands of dollars in repairs charged to your auto policy.

A whack with a hammer or baseball bat can add a nice-sized dent to your insurance bill, and so can ramming a forklift into the bumper. Body shops might even have intimidating “escorts” to tail insurer damage estimators around the shop or yard to try and distract them from spotting other fake damage to vehicles. A body shop might also try to bribe drivers into going along with inflated damage claims.

Drivers do have options, the Coalition is alerting the public.

It’s hard to prevent your vehicle from being illegally towed while you’re innocently shopping somewhere. But get a police report on record, and know your local laws about towing. Dispute any fees that seem unwarranted.

Avoid towing firms that miraculously show up at the crash scene. Especially, turn down operators that try to pressure you into hauling your vehicle away.

See if you have roadside service through your carmaker or other service.

Get a detailed invoice and damage assessment before your vehicle is taken, and know exactly where your car is going. Also, avoid giving out too much insurance-policy information. Scammers could use that to make more illicit damage claims.

Be sure to get the towing firm’s name address and phone number before it takes your vehicle away.

And use your cell camera to photograph the damage, position of the vehicles and other information. This can refute an inflated damage claim by a crooked body shop.

About the author: Jim Quiggle is director of communications for the Coalition Against Insurance Fraud.

With Friends Like This…

How law enforcement crashed bills limiting crash reports

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Florida enacted a law restricting access to police crash reports several years ago. The goal was to prevent fraud rings from using the info to identify and solicit crash victims for false injury claims, and often substandard medical treatment. The law was considered a harbinger for other states.
But the Florida success appears almost singular. Other state efforts to limit access to crash reports have faced stiff opposition — and not from the usual suspects.

Law enforcement and local governments throughout the nation sell crash reports to raise much-needed revenue in an unsteady economy. These unusual suspects often lead the charge against bills limiting access. And because they’re law enforcement, legislators listen.

Several examples:

A few years ago the Coalition worked with anti-fraud partners in Connecticut. Momentum to restrict access to crash reports was building, but law enforcement pushed back. Lo and behold, a promising idea was stopped cold. A bill was never drafted, let alone introduced.

The Coalition worked with Maryland legislators to enact a law in one session, only to see the law repealed in the next session after sudden resistance from law enforcement. Limiting crash reports didn’t even stay on the law books for a year.

Fraud fighters tried to move a similar bill in Indiana a couple of years ago. But the state police argued they had a contract to sell the reports to a company that marketed the info to outside parties. The state constitution made state contracts inviolate, the police contended. The bill failed.

An effort now in Arkansas also may be axed by local law enforcement, Coalition sources say.

See a pattern? The anti-fraud community should watch its back because we may not always know who our friends are. The best bet is to seek alternatives to limiting crash reports.

Texas forbids medical providers and others to solicit crash passengers by telephone or in-person for 30 days after a crash. The measure withstood two years of fierce constitutional challenge.

So the concept passes that test, and doesn’t run up against the pocketbooks of law enforcement. It might be the next model for keeping crash victims and their insurance info out of the clutches of crooked medical providers.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Is awareness reducing consumer tolerance?

New study suggests tolerance is falling, but still high among Americans

blogAre fraud awareness programs finally convincing some consumers that it’s not OK to scam insurers?

You might reach that conclusion from a 2012 study just released by the Insurance Research Council. The percentage of Americans who don’t see a problem with padding claims has fallen to its lowest level in more than 30 years, the study finds.

That’s encouraging news. Studies by the Coalition and several others had shown growing tolerance of  fraud, and sometimes dramatically, from 2000 to 2010. We hope more research this year will confirm the good news from the IRC study.

There’s still a large slice of Americans — perhaps as much as a quarter of the adult population — that tolerate fraud. So the fraud awareness efforts by the Coalition, NICB, Pennsylvania Insurance Fraud Prevention Authority, New York Alliance Against Insurance Fraud and many others should continue in a robust manner.

If these mostly meager efforts  are proven to help reduce tolerance, the fraud-fighting community should come together  and fund an all-out effort to reach consumers with a scaled-up campaign that would build on this momentum.

About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.