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The Fast Guide to Fraud Prevention and Senior Healthcare Legislation

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Fraud has become of real concern in senior healthcare as criminals often take advantage of the confusion that surrounds changes in laws to present new con games and scams.

The passage and implementation of the Affordable Care Act (ACA), popularly known as Obamacare, has provided new opportunities for those who would commit healthcare fraud, and, unfortunately seniors tend to be a favorite target for these kinds of schemes.

To compound this problem, fraud is an under-reported crime as many victims feel embarrassed when they realize they have been duped. For many seniors, admitting victimization by a fraudster seems like admitting that they aren’t able to take care of themselves, their finances, or their own health. So they simply accept financial loss and move on, leaving the perpetrator free to commit the crime again.

If you’re worried that you or your parents may be taken advantage of, it’s important that you are able to recognize the numerous Affordable Care Act-associated scams now being conducted.

Know what the Affordable Care Act actually does.

In an article from September of this past year, the Better Business Bureau warned American consumers about a new telephone-based scam that was conducted in the run-up to the ACA's launch.

In this scam, a person is called and told that he or she will be among the first recipients of a new ACA insurance card, but that the caller (purporting to be a federal government employee) needs to verify the receiver's Social Security number, birth date, or other personal information before the card can be mailed out.

There are a few problems here.

To begin with, the Affordable Care Act is not in and of itself, a new government-run health plan. The legislation provides for the establishment of state-based healthcare exchanges, or marketplaces, where public and private health insurance companies offer coverage that can be evaluated side by side and chosen by individual consumers.

Additionally, the federal government does not call individuals to sign them up for coverage. You might receive in the mail informational mailings about what the ACA is, or what you need to do to enroll for coverage, but no representative of the United States government will never try to sell you a particular plan.

Be wary of individuals or organizations that ask for your personal information.

Scammers are smart. They can spin any number of believable stories in order to gain your trust, but if you don’t know the person or company you are dealing with, you probably don't want give out any details.

Before you share any confidential information over the phone or online:

  1. Ask for documentation to be sent to you by mail.
  2. Consult a state-certified ACA specialist to determine if a particular plan is legitimate before you sign anything.

An insurance provider will never need your bank account information to sign you up for coverage, but a scammer may try to convince you that your monthly premium must be auto-deducted from your bank account in order to qualify. This is false.

You can always be billed the good, old-fashioned way—by mail.

Understand how enrollment works.

It is each person's responsibility to enroll.

If you don't want to attempt to enroll on your own, a certified broker or specialist should be able to assist you. Check with your state's CMS (Centers for Medicare and Medicaid Services) for a list of certified ACA specialists and health coverage brokers.

People who are already covered under employers' health plans or who have already purchased health insurance on their own do not need to sign up for an ACA-compliant plan at this time.

Some Medicare Advantage (privatized Medicare HMO or PPO) participants may need to select a new, ACA-compliant plan, but only at the yearly renewal date. Traditional Medicare and Medicaid recipients don't need to do anything at all— they already have coverage!

Research the ACA and the new marketplace exchanges before you enroll. Older American on a Medicare Advantage or private insurance plan should consider contacting CMS, the AARP, or a senior healthcare advocacy group for more information on how your coverage may be affected by recent changes.

Knowledge is your best protection against healthcare fraud.

Worried about a loved one?  Download our tipsheet to decide if it's time to talk about senior care.
Bryan Reynolds
January 07, 2014
Bryan Reynolds is the Vice President of Marketing and Public Relations for Episcopal Retirement Services (ERS). Bryan is responsible for developing and implementing ERS' digital marketing strategy, and overseeing the website, social media outlets, audio and video content and online advertising. After originally attending The Ohio State University, he graduated from the College-Conservatory of Music at the University of Cincinnati, where he earned a Bachelor of fine arts focused on electronic media. Bryan loves to share his passion for technology by assisting older adults with their computer and mobile devices. He has taught several classes within ERS communities as well as at the Osher Lifelong Learning Institute run by the University of Cincinnati. He also participates on the Technology Team at ERS to help provide direction. Bryan and his wife Krista currently reside in Lebanon, Ohio with their 5 children.

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