Mission of HEAT

-To gather resources across government to help prevent waste, fraud and abuse in the Medicare and Medicaid programs, and crack down on the fraud perpetrators who are abusing the system and costing us all billions of dollars.

-To reduce skyrocketing health care costs and improve the quality of care by ridding the system of perpetrators who are preying on Medicare and Medicaid beneficiaries.

-To highlight best practices by providers and public sector employees who are dedicated to ending waste, fraud and abuse in Medicare.

-To build upon existing partnerships between the Department of Justice and the Department of Health and Human Services such as our Medicare Fraud Strike Forces to reduce fraud and recover taxpayer dollars.

Medicare Fraud Strike Force Expansion

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.

Actions taken

-Expansion of the Department of Justice, Centers for Medicare and Medicaid Services, and HHS Inspector General's Medicare Fraud Strike Forces to Baton Rouge, Brooklyn, Detroit, Houston, Los Angeles, Miami-Dade, Tampa Bay, Dallas and Chicago.

-Use of new state-of-the-art technology to fight fraud. Investigators in the HHS Office of the Inspector General are implementing state-of-the-art, cutting edge technology to identify and analyze potential fraud with unprecedented speed and efficiency.

-Commitment to expanded data sharing and improved information sharing procedures between HHS and DOJ in order to get critical data and information into the hands of law enforcement to track patterns of fraud and abuse.

-President's 2010 budget for HHS contains funding for anti-fraud efforts covering a five year period that is estimated to save $2.7 billion by improving overall oversight and stopping fraud and abuse within the Medicare Advantage and Medicare prescription drug programs. It also invests $311 million to strengthen Medicare and Medicaid program integrity.

-Outreach meetings with top anti-fraud leaders in congress, law enforcement, health care providers and the private sector

-New funding for and expanded use of Medicare Drug Integrity contractors to monitor Medicare Parts C & D compliance and enforcement.

-Expansion of the CMS Demonstration project on Durable Medical Equipment.

-Expansion of the CMS Medicaid provider audit program.

-Increased compliance training for providers.

http://www.stopmedicarefraud.gov/heattaskforce/index.html

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 May 2012

Door-to-Door Scammer in Oak Park Claims to Work for CEDA

We learned this week about a scam in which a man visited an Oak Park resident door-to-door and claimed to work for the Community and Economic Development Association (CEDA).  The man said that he was there to help the family pay their utility bills, mortgage, etc.  He made several phone calls (using speaker phone) to a “supervisor,” which further legitimized his story.  Ultimately, the man said that he had paid several bills for the family and gotten them into a mortgage forgiveness program that required a percentage payment from them.  The woman gave him $520.00 toward this payment.  She later realized that the man did not work at CEDA and had scammed her.

This case is a good reminder that scam artists are often VERY convincing, and may claim to be from legitimate organizations to gain our trust.  For this reason, we should never give out any information or payment to anyone who calls on the phone or comes to the door – it is impossible to tell if someone is telling the truth or not in these circumstances.  If anyone wishes to learn more about a legitimate program or seek assistance, we encourage people to contact organizations like CEDA by using their publicly available telephone numbers instead.

Use Caution When Purchasing Utility Insurance

SMP Programs in other states have been receiving complaints about an organization called “Home Serve” that offers water line insurance coverage to homeowners.  We encourage people to take caution when purchasing a new insurance product of any kind, as it is important to do thorough research before making a decision on products like this. Consumers should contact their local utility provider before purchasing utility insurance to determine what repairs would be covered by the provider and what repairs are the homeowner’s responsibility, then look critically at what benefits the insurance would offer to see if it would adequately cover the repairs that are the homeowner’s responsibility.

The Better Business Bureau has released an alert for Home Serve because they have had government actions taken against them.  To read about these actions and complaints against this company, see the Better Business Bureau’s website here: http://www.bbb.org/connecticut/business-reviews/home-warranty-plans/homeserve-usa-in-stamford-ct-87067998

Medicare Releases Home Health Compare Tool

The Centers for Medicare and Medicaid Services now have a tool that beneficiaries can use to search for and compare home health agencies in their area. (This tool is configured just like the CMS hospital compare and nursing home compare tools.) The home health compare tool can be accessed at the link below, or by clicking on “Facilities and Doctors” on medicare.gov.

Medicare Home Health Compare:

http://www.medicare.gov/homehealthcompare/search.aspx

If anyone believes they have been a victim of a scam, call the Illinois SMP program at AgeOptions: (800)699-9043. They can help consumers get in contact with the proper authorities to report it. 

For Previous Fraud and Scam Alerts visit the SMP website!