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Efforts Help Combat Local Hospice Enrollment Scams | #socialmedia | #hacking | #aihp

CALEXICO — A concerted effort to help prevent local Medicare beneficiaries from being fraudulently enrolled in a hospice appears to have helped stem the troubling trend.

The scam typically involved seniors who were approached outside discount stores and supermarkets and misled into believing they were signing up for additional Medicare benefits but were instead enrolled in a hospice.

A woman reportedly had approached customers outside the 99 Cent Store on East Second Street in Calexico attempting such fraud.

Advocates said that reports of those instances came more often from Calexico than any other Valley locale.

After being unknowingly enrolled in a hospice, Medicare beneficiaries would then encounter trouble either trying to access their primary doctor, specialists or obtain medication because the Medicare system would report that the individual was enrolled in a hospice and therefor solely eligible for palliative care for terminal illnesses and not preventative treatment.

Complaints about hospice enrollment scams began trickling into the California Rural Legal Assistance office in El Centro starting in September before increasing in number about a month later, said Carla Diaz, a community worker with the local CRLA office.

In response, CRLA partnered with the nonprofit California Health Advocates’ Senior Medicare Patrol program to help raise awareness of the issue and help resolve instances where Medicare beneficiaries were fraudulently enrolled in a hospice.

Some of those outreach efforts included going door to door at senior citizen apartment complexes, as well as alerting healthcare providers and partner agencies of the increased allegations of fraud.

After being advised of the issue, local pharmacies such as Hope Pharmacy and CVS in Calexico at times notified advocates of a beneficiary who appeared to have been scammed.

Hope Pharmacy on Heffernan Avenue in Calexico was one business that helped protect beneficiaries of Medicare and Medi-Cal by informing advocates when they heard of instances in which it appeared a scam had occurred. | CAMILO GARCIA JR. PHOTO

“We did our best to make people aware that there was a new trend in the Valley,” Diaz said. “It paid off because in January 2022 we haven’t see as many cases as 2021.”

No Valley-based hospice was reported to have taken part in the scams, advocates said.

But scammers appear to have temporarily used an unknowing healthcare provider to recruit Medicare beneficiaries by misleading the caregiver into thinking they were helping the seniors sign up for “additional Medicare benefits,” CRLA reported.

Those so-called “additional Medicare benefits” may include housekeeping, home health, nurse visits and/or “free” medications.  

“But eventually the provider realized it looked fishy so they don’t do it anymore,” Diaz said, noting that the caregiver was provided with $50 referrals from the hospice agency.

Fraudulently enrolling Medicare beneficiaries into a hospice can bring in at least $154 to $1,432 a day per patient in Medicare payments, the California Health Advocates’ website stated.

“This has spurred a burgeoning growth of illegal and fraudulent hospice providers along with a wide ring of complicit doctors receiving kickbacks and bold recruiters going after Medicare beneficiaries from all walks of life,” the CHA website stated.

The deceptive marketing of Medicare benefits can include television and social media ads, leaflets and flyers, and unannounced home visits or phone calls by insurance agents and brokers. Aside from using the tactics to fraudulently enrolling beneficiaries into a hospice program, such practices are used to fraudulently enroll beneficiaries into different Medicare plans, as well.

Locally, CRLA has received complaints about insurance brokers who will deceptively switch beneficiaries’ Medicare and Medi-Cal plans with promises of vision and dental benefits or free gym membership or transportation if they enroll, said Beatriz Garcia, CRLA managing attorney for the El Centro office’s health unit.

“They don’t realize that they’re actually join a new network, or Medicare plan,” Garcia said.

Last year, of the 399 statewide complaints the Senior Medicare Patrol (SMP) received, 92 of those were reports of suspicious advertisements, said Sandy Morales, SMP case manager and outreach specialist.

“That was the No. 1 potential trend that we saw,” Morales said, noting that SMP received four complaints of fraudulent hospice enrollment in February from across the state.

In 2021, hospice-related complaints were the second largest reported to SMP’s fraud hotline, she said.

Locally, CRLA received about seven complaints of fraudulent hospice enrollment during the last three months of 2021. So far this year, it has received just two, managing attorney Garcia stated.

When CRLA receives a complaint from a Medicare beneficiary, the organization will contact SMP, which will reach out to the federal Centers for Medicare & Medicaid Services on behalf of the impacted beneficiary to help resolve the issue.

Senior Medicare Patrol will also contact the U.S. Health and Human Services’ Office of Inspector General to request the agency investigate the allegation of enrollment fraud or deceptive marketing.

Investigations can take months or years, and SMP is not made aware of their outcomes.

Because fraudulent hospice enrollment and switching of Medicare plans typically results in the disruption of medical services, both SMP and CRLA will advocate to have the reinstatement of the beneficiaries’ original benefits restored.

“We do our best to be the squeaky wheel,” Morales said, noting that benefits aren’t typically restored overnight.

In spite of the troubling trends, the majority of hospice agencies and insurance agents and brokers are operating in legitimate fashion and provide essential services to Medicare beneficiaries and the public, advocates said.

“It’s just those few bad apples that decide to take advantage of the system,” Morales said.

In the past, unscrupulous actors would steer Medicare beneficiaries into different medical plans with promises of free back braces if they signed up for “additional Medicare benefits,” advocates said. The current practice of enrolling beneficiaries into hospice programs appears to be the latest in a long and evolving line of fraudulent practices.

Seniors on a fixed income are particularly vulnerable to such instances of deceptive marketing, and are often swayed by the promises of free and/or expanded medical services and resources that they otherwise may not be able to afford, advocates said.

“People sign up for plans that are really not suitable for them,” Morales said. “They are losing access to their doctors and specialists and that’s a huge concern.”

Efforts to combat fraudulent hospice enrollment have been aided by recent statewide legislation, Senate Bill 1280, that went into effect on Jan. 1 and which prohibits hospice providers (and their employees and agents) from paying caregivers for the referral of patients, advocates said.

To report possible fraudulent hospice enrollment and deceptive Medicare marketing, the public is encouraged to contact CRLA at 760-353-0220, the Senior Medicare Patrol hotline at 855-613-7080, or the Health Insurance Counseling and Advocacy Program (HICAP), which provides free, unbiased Medicare information, at 800-434-0222.

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