Healthcare

Scams and Frauds

Among the best sources of health information is someone you can meet face-to-face. Talk about all of your health-related decisions with your doctors and other trusted health care providers. Below you will find imformation on common health related fraud.

 

 

Affordable Care Act Imposters

If you are shopping in the Health Insurance Marketplace, only shop at HealthCare.gov.  People who try to sign you up elsewhere may be scammers. If you’re overwhelmed, you can find free official helpers at HealthCare.gov. Official helpers will never ask for money or try to sell you a particular plan.

Another important tip: the government will not call to sell your health insurance. And no one from the government will ask you to verify your Social Security number or bank information over the phone.

Discount Drug & Medical Plans

Looking for health insurance? Make sure that's what you're buying, or you could find yourself on the hook for big medical bills with no way to pay them. That's because what sounds like affordable health insurance may be a medical discount plan instead. Medical Discount Plans are a way for some to save money but it is NOT insurance.

The plans generally consist of, but are not limited to programs offering discounts on physician, prescription drugs, vision, dental, chiropractic, or massage therapy services. If you are offered a discount on your health care expenses by a company, you should make sure that the company has Nebraska medical providers in your area who are willing to honor those discounts.

Here are some tips to remember when considering discount drug & medical plans:

  • You could give be giving up your current health coverage, mistakenly by believing you found a better insurance deal.
  • Some plans offer discounts of up to 70% - but how often will you save that much? Savings with discount plans typically are a lot less. When you consider a discount plan's monthly premiums and enrollment fees, there may be no "discount" at all. What's more, if you have major health problems or an emergency, you will have to cover most, or all, of the bills if you don't have health insurance.
  • You'll have to pay medical bills yourself if you're scammed into believing you have real insurance.
  • Identity thieves also use pitches for medical discount plans and insurance to get your personal information. Don't give out your financial information to someone who calls you out of the blue, or whose reputation you haven't checked out.

Healthcare Open Enrollment

As you select your health insurance plan, watch out for scams. Whether you are on Medicare, selecting a plan through the Affordable Care Act (ACA), or have private insurance, here are tips to help you more safely navigate the open enrollment season.

Medical Discount Plans

If you’re looking for health insurance, make sure that’s what you’re buying. Be on the lookout for medical discount plans. They’re not the same as health insurance, even though they sometimes pretend to be. Many of these plans are scams that don’t deliver on the services promised. Others are just a way for identity thieves to get your personal information. The Nebraska Department of Insurance can tell you whether a plan is actually an insurance product. You may contact them by visiting them online at www.doi.nebraska.gov or calling 402-471-2201.

Medicare Fraud

A variety of scams take advantage of Medicare recipients. Here are a few:

  • An “official Medicare agent” knocks on your door selling Medicare insurance that can save you money. Stop. It’s a scam. There are no Medicare sales representatives. It’s probably someone who wants to use your information to commit fraud or identity theft.
  • Someone calls and says you must join the prescription plan or else you’ll lose your Medicare coverage. Don’t believe it. The Medicare prescription drug plan (also known as Part D) is voluntary.
  • Someone calls claiming that you need to give your Medicare number in order for you to keep your Medicare coverage under the ACA. It’s a scam. Don’t give your personal information over the phone. If you need help with Medicare, call: 1-800-MEDICARE or go to: www.medicare.gov.

Medical ID Theft

Medical identity theft happens when someone steals your personal information and uses it to commit health care fraud. Medical ID thieves may use your identity to get treatment or even surgery by making fake claims.

Signs of Medical Identity Theft

  • A medical bill arrives for medical services you didn’t receive.
  • A call from a debt collector about a medical debt you don’t know about or that you do not have.
  • Medical collection notices on your credit report that you don’t recognize.
  • A notice from your health plan saying you reached your benefit limit.
  • A denial of insurance because your medical records show a condition you don’t have.

You can catch medical identity theft early on. First, read every “Explanation of Benefits” statement you get from your health insurer. Follow up on any item you don’t recognize. At least once a year, ask the health insurers you’ve been involved with for a list of the benefits they paid in your name. Finally, make it a regular practice to check your credit reports. You’re entitled to a free credit report from each of the three nationwide companies every 12 months. You can order your free credit report at AnnualCreditReport.com.

Correcting Mistakes in Your Medical Records

If you know a thief used your medical information, get copies of your records. Federal law gives you the right to know what’s in your medical files. Check them for errors. Contact each doctor, clinic, hospital, pharmacy, laboratory, health plan, and location where a thief may have used your information. A provider might refuse to give you copies of your medical or billing records because it thinks that would violate the identity thief’s privacy rights. The fact is, you have the right to know what’s in your file. If a provider denies your request for your records, you have a right to appeal.

Ask each of your health plans and medical providers for a copy of the "accounting of disclosures" for your medical records. The accounting is a record of who got copies of your records from the provider. The law allows you to order one free copy of the accounting from each of your medical providers every 12 months.

Write to your health plan and medical providers and explain which information is not accurate. Send copies of the documents that support your position. Send your letter by certified mail, and ask for a "return receipt," so you have a record of what the plan or provider received. Keep copies of the letters and documents you send.

Miracle Health Products

Whether you are seeking to shed a few pounds or treat a serious condition, beware of products that offer miracle cures. Every year, consumers spend billions of dollars on untested, fraudulently marketed, and utterly ineffective health products.

Be a skeptic in regard to miracle health products. Not only are they likely to be a waste of your money, without a doctor’s guidance, using them may put your health at serious risk.

Recognzie the Warning Signs:

  • Lose weight without diet or exercise! Getting to a healthy weight takes work. Take a pass on any product that promises miraculous results without the effort.
  • Lose weight no matter how much you eat of your favorite foods! Beware of any product that claims that you can eat all the high-calorie food you want and still lose weight. Losing weight requires sensible food choices.
  • Never diet again! Even if you’re successful in taking weight off, permanent weight loss requires permanent lifestyle changes. Don’t trust any product that promises once-and-for-all results.
  • Just take a pill! Doctors, dieticians, and other experts agree there’s no magic way to lose weight without diet or exercise.
  • Lose 30 pounds in 30 days! At best, products promising lightning-fast weight loss are a scam. At worst, they can ruin your health.
  • Lose weight with our miracle diet patch or cream! Ads for diet patches or creams claim to melt away the pounds. Don’t believe them. There’s nothing you can wear or apply to your skin that will cause you to lose weight.​

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Medicaid Fraud and Patient Abuse

The Nebraska Medicaid Fraud and Patient Abuse Unit (MFPAU) investigates and prosecutes Medicaid provider fraud and patient abuse and neglect.

About the Medicaid Fraud and Patient Abuse Unit

Medicaid is a program which provides health insurance for people who are unable to pay for such care, including disabled, elderly, and low-income patients. Medicaid is funded through both federal and State of Nebraska funds.

Medicaid providers are those doctors, dentists, hospitals, nursing homes, pharmacies, chiropractors, home health workers, medical equipment providers, and other persons and entities who are paid by the Medicaid program for the services they provide. Provider fraud occurs when a person or entity who is providing services to a Medicaid recipient misrepresents the services rendered to the State. The federal government requires that the State of Nebraska have a Medicaid Fraud and Patient Abuse Unit to recover money lost to fraud.

The MFPAU, as part of the Attorney General’s Office, is responsible for investigating and prosecuting Medicaid fraud and violations of all applicable state laws relating to the provision of Medicaid services and the activities of providers. The MFPAU has state-wide criminal jurisdiction over Medicaid provider fraud investigations and prosecutions. Additionally, the MFPAU has the authority to file civil actions under the False Medicaid Claims Act, Neb. Rev. Stat. § 68-934 et seq. 

Abuse, Neglect, and Financial Exploitation

The MFPAU also reviews and can act on complaints of abuse and neglect of patients at health care facilities that receive Medicaid payments. This includes both physical abuse or neglect and financial exploitation of a patient. Physical abuse includes anything from excessive force in the course of a prescribed treatment, to striking or even sexually assaulting a resident. Neglect can include withholding necessary and adequate food, physical care or medical attention, such as turning a patient who cannot move themselves. Financial abuse includes misuse or unauthorized use of a person’s trust funds, bank accounts, cash, or credit accounts.

Reporting Fraud Information

If you suspect that someone is being abused, neglected, or exploited, please report it immediately to your local law enforcement or the Adult Protective Services 24 hour hotline.
 
Adult Protective Services 24 Hour Hotline:  1-800-652-1999
 
Report Suspected Fraud or Abuse by a Provider
ago.medicaid.fraud@nebraska.gov
(402) 471-3549 or toll-free at 1-800-727-6432
 
Report Suspected Fraud by Medicaid Recipients to:
DHHS.InvestigationsSIU@nebraska.gov
Lincoln and greater Nebraska: (402) 471-9407 
Omaha: (402) 595-3789
 

To file a Medicaid fraud or patient abuse complaint: click here.

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