Friday, June 24, 2016

In This Issue

Federal Government Charges 301 Individuals with Health Care Fraud in Largest National Sweep

Study Finds that Chicago is Still Hot Spot for Home Health Fraud

Fraud in the News

The following are current news articles about health care and fraud issues.

Health Care Fraud:

1. "Eye on Oversight: Home Health Fraud (Video)" (HHS OIG)

2. "'Doctor Trusted' Couldn't Be Trusted" (FTC)

Consumer Fraud:

3. "3 Things You Should Consider Before Co-Signing for an Auto Loan" (CFPB)

4. "Reduce Fraud Fallout Before and After a Wallet Goes Missing" (AARP)

5. "Password Breaches - What to Do" (FTC)

6. "Students the Latest Target of IRS Scammers" (AARP)

7. "Stolen Identity Refund Fraud" (IC3)

Please share this Fraud Alert with colleagues, consumers, or other professionals in your area. If you have any questions about the Illinois SMP program, or to receive these Fraud Alerts directly, please contact Jason Echols, Healthcare Consumer Protection Coordinator at AgeOptions.

This project was supported, in part by grant number 90MP0216, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

Dear SMP Readers,

This week's Fraud Alert highlights the federal government's largest health care fraud takedown and a report that shows Chicago is still a hot spot for home health fraud.

Have a great weekend!

Federal Government Charges 301 Individuals with Health Care Fraud in Largest National Sweep

On June 22, the federal government announced the nation's largest single health care fraud sweep in which 36 federal districts brought charges against 301 individuals accused of falsely billing the federal government $900 million.

According to the U.S. Department of Justice (DOJ) press release: "In the Northern District of Illinois, six individuals were charged in cases related to three different schemes involving bribery and false and fraudulent claims for home health services and disability benefits.... In total, these schemes resulted in over $12 million being paid to the defendants and their companies." To learn more about the fraud sweep and the cases from other federal districts, read the DOJ press release.

The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) released a fact sheet explaining the scope of this takedown and how data analytics played a role in identifying fraudulent providers. It also details a settlement in Illinois where a former home health owner agreed to pay the government $50,000 to resolve a kickback allegation. Read more in the HHS OIG fact sheet.

Back of an HHS OIG Agent during the June 22 federal health care fraud takedown

A federal agent during the national June 22 health care fraud takedown (Source: HHS OIG)

Study Finds that Chicago is Still Hot Spot for Home Health Fraud

On the same day as the national fraud takedown, the HHS OIG released a new report that looked at Medicare claims for home health from the past two years to find statistical outliers, meaning that the claims were very different from the national average and showed signs of potential fraud. The study found 27 geographic hotspots, including Chicago, in 12 states where there was a high concentration of these outliers. Read a summary of this report with a link to the full HHS OIG report.

Home health fraud is a major problem in Illinois. The Illinois SMP encourages Medicare beneficiaries to always work with their doctor for any medical need they want to address. Medicare should only pay for medically necessary services and only your doctor can prescribe these services. Never accept "free" services from strangers. Learn more about home health fraud in this SMP home health infographic.

Map of home health fraud hot spots, including Chicago (Source: HHS OIG)

AgeOptions Ideogram

Jason B. Echols, MSW,
Health Care Consumer Protection Coordinator
AgeOptions
1048 Lake Street, Suite 300
Oak Park, IL 60301
phone (708)383-0258 fax (708)524-0870
jason.echols@ageoptions.org

ageoptions.org

AgeOptions, the Area Agency on Aging of Suburban Cook County, is committed to improving the quality of life and maintaining the dignity of older adults and those who care about them - through leadership and support, community partnerships, comprehensive services, accurate information and powerful advocacy.

Fraud Alerts contain information about current scams taking place in Illinois, announcements and updates about programs or services related to health care and/or fraud protection, and links to news articles about health care and fraud topics. Please forward any recommendations or announcements that you would like to be included in a future Fraud Alert to jason.echols@ageoptions.org.