Medicare’s open enrollment is an open season for scammers

 Editorial Staff  November 24, 2021 By Susan Jaffe, Kaiser Health News

Finding the best private Medicare drug or medical insurance plan among dozens of options is difficult enough without throwing misleading sales strategies into the mix.

However federal officials say complaints are growing from seniors who have been deceived into buying policies – without their consent or the temptation to question suspicious information – which cannot cover their medications or involve their doctors. In response, Medicare and Medicaid service centers have threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or their agents mislead consumers.

The agency has also modified the rules to make it easier for beneficiaries to avoid plans where they have not signed up or admitted only to find out that the promised benefits do not exist or that they cannot see their providers.

The problems are particularly prevalent during Medicare’s open-enrollment period, which began on October 15 and runs through December 7. A simple trap begins with a phone call received in October by Iowa resident Linda Hammer. He will not answer the phone unless his caller ID shows the number he knows, but the call shows the number of the hospital where his doctor worked.

The person on the phone said he needed Hammer’s Medicare number to make sure it was valid for the new card he received. When Hymer hesitated, the woman said, “We’re not asking for Social Security numbers or bank numbers or anything like that. That’s fine.”

“I can’t believe it, but I gave him my card number,” Hammer said. The caller then asked questions about her medical history and offered to send her a “absolutely free” saliva test. At that moment, Hymer became suspicious and the phone rang. She contacted the 1-800-MEDICARE helpline to get a new Medicare number and the AARP Fraud Watch Network helpline and the Federal Trade Commission.

But then that morning the phone rang again and this time the caller ID showed a number that matched the toll-free Medicare helpline. When he answered, he recognized the woman’s voice.

“You’re not from Medicare,” Hammer told him.

“Yes, yes, yes, we are,” the woman insisted. Hammer hung up again.

It’s only been two weeks since Hammer revealed his Medicare number one to a stranger, and so far nothing has gone wrong. But armed with that number, scammers can bill Medicare for services and medical supplies that beneficiaries never receive, and scammers can sign seniors for Medicare Advantage or drug plans without their knowledge.

In California, reports of misleading sales practices for Medicare Advantage and drug plans have been a top complaint on state senior Medicare patrols for the past two years, said Sandy Morales, the group’s case manager. Patrol is a federally funded program that helps seniors solve insurance problems.

Nationwide, senior medical patrols sent 74% more cases to the CMS and the Inspector General of Health and Human Services for investigation in the first nine months of this year, the highest in 2020, said Rebecca Kinney, director of administration at the Office of Community Life. Healthcare information and counseling at HHS, which oversees patrols. She hopes to receive more complaints during Medicare’s open-enrollment period.

And last month, CMS officials warned private insurers selling Medicare Advantage and drug plans that federal requirements prohibit misleading sales practices.

Catherine Coleman, director of CMS Medicare’s Drug and Health Plan Contract Administration Group, told insurers in a memo that the agency was concerned about the wide-ranging advertising of benefits plan benefits, which are only available to a limited area or a limited number of beneficiaries. CMS has also received complaints about sales information coming from the government and pressure tactics can be used to recruit seniors, he noted.

Coleman reminded companies that they are “responsible and accountable for their marketing materials and activities, including marketing conducted by sales representatives on behalf of the MA plan.” Companies that violate federal marketing rules may face fines and / or nomination suspensions. But the CMS spokesperson could not give an example of the recent violators or their penalties.

If beneficiaries find a problem before March 31, the three-month enrollment period ends each year, they have the opportunity to switch to another plan or basic Medicare. (The latter may be unable to purchase supplement or Medigap insurance, with rare exceptions, In all but four states: Connecticut, Maine, Massachusetts and New York.) After March, unless they qualify for one of the rare exceptions to the rule, they are usually closed on their benefit or drug plans for a year.

CMS this year He explained another solution For the first time

Authorities may offer “special enrollment periods” to those who wish to abandon their plans due to misleading sales strategies. This includes “situations in which the beneficiary provides verbal or written allegations of his / her enrollment in the MA or Part D scheme. Based on misleading or misleading information.” [or] Where a beneficiary states that he or she was admitted to the plan without his or her knowledge, “according to the Medicare Managed Care Manual.

“This is a really important safety valve for beneficiaries who clearly go beyond the limited opportunity to switch plans when someone feels the buyer’s remorse,” said David Lipschutz, assistant director of the Center for Medicare Advocacy. To use the new option, beneficiaries should contact. In their state’s health insurance assistance program www.shiphelp.org/.

A significant number of plan members also have the option to leave if they are unable to access the doctors or hospitals that should be in the provider network.

In any case, scams continue across the country, experts say.

Misleading television commercials in the San Francisco area have enticed seniors with new features, including dental, vision, transportation benefits and even “money back to your social security account”. Morales said. The information was given to them “accidentally enrolled in a scheme that they were never allowed to enroll,” she said.

In August, a senior Ohio man received a phone call saying that Medicare was issuing new cards due to the Kovid-19 epidemic. When he did not provide his Medicare number, the caller became angry and the beneficiary felt threatened, said Chris Rigg, director of the Ohio Senior Health Insurance Information Program.

Reggie said another senior received a call from a vendor with bad news: she was not receiving all the benefits from Medicare. The beneficiary provided her Medicare number and other information but the caller did not feel she was enrolling in the Medicare Advantage plan. He found out when he saw his doctor, who did not accept his new insurance.

In western New York, the culprit is the official-looking postcard, said Beth Nelson, the state’s senior Medicare patrol director. “Our records indicate … you may be eligible for additional benefits,” it says in an attractive way. When Nelson’s client called the number on the card in September for further details, he provided his Medicare number and later ended up without a Medicare Advantage plan. His consent.

Hammer’s scammer was constant. When a stranger tried to reach her for the third time, Hymer said the caller ID showed the phone number of another local hospital. She told the woman she had reported calls to the CMS, the AARP Fraud Watch Network helpline and the FTC. It finally worked – the woman suddenly hung up.

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KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and voting, KHN is one of the three major operating programs. KFF (Kaiser Family Foundation). KFF is a non-profit organization providing information on health issues to the nation.

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