Category Archives: insurance

Oklahoma Disaster Officials Are Now Fighting Off Fraud

It might seem hard to believe, but even areas that are suffering are not immune to fraudsters and scam artists. In fact, these areas seem to draw them in like crazy. In Oklahoma, where the tornadoes and disasters touched down with regularity over the past few months, the scam artists are already trying to take advantage of insurance and government programs. The tornado outbreak started around May 19 and the anti-fraud units in Oklahoma have been on high alert. In fact, officials from North Carolina have come in to aid in the fight as well.

The fraud is multifaceted and includes fraud of the victims, fraud of the system and insurance fraud to name a few.  Tornado victims are being counseled to teach them what to look out for, but it seems inevitable that there will be victims that were victims to start with. How someone can victimize people that have been through so much is hard to understand.

The other part of policing the situation includes Continue reading Oklahoma Disaster Officials Are Now Fighting Off Fraud

Why We Need To Pay Attention To Medicare Fraud

It is hard to imagine, but our seniors are being unwittingly used in a Medicare scam that is costing taxpayers billions. In fact, the numbers are staggering. Medicare fraud has numbered 27 billion over the last four years. The latest method, however, stoops to lows that most people never think about. Home medical supplies, scooters, wheel chairs, diabetic supplies and countless other materials are being billed under senior citizen’s names but they are never ordered or asked for.

These medical supply houses will hound a Medicare recipient sometimes up to three times a day to try to get their information or help. There are a ton of warning signals that jump out where these fraudulent companies are operating. Keep an eye out for:

  • Companies offering low or no deductible even though you know you generally owe one.
  • Companies offering a free scooter or wheelchair
  • Equipment being billed for you that you never receive
  • Companies that will not leave you alone even after you have asked them to do so
  • Something sounding too good to be true.

These are some good general guidelines but the key is to go with your gut. If you think something feels fishy, then check it out with your doctor or call the Medicare office at 1-800-MEDICARE and find out.

Many of these companies are being investigated and will soon be answering for some of these crimes. The fact is that there are some good companies that offer good services to our seniors. The key is that they need to be transparent. If a product is billed to Medicare and to the American people, then they need to make absolutely certain that it is legitimate. The government and the taxpayers deserve to know that is being followed.

If we continue to let these types of thing go, we will not even have Medicare when our kids are older. That is a risk we are already undertaking, but allowing things such as this to slide without stiff punishments are what forced us into this position in the first place.

Medicare fraud is a very serious issue and it needs to be addressed not only by Congress, but by the American people through information and our votes. If our representatives are not going to take this seriously, then perhaps we should change who we are voting for.

State Farm Charged in Hurricane Katrina Claim Fraud Case

When you think of fraud, you generally think about some scum hiding behind a keyboard somewhere in a dark basement. The last thing that would come to mind would be your insurance company. State Farm Insurance has been charged with fraud in a case out of Mississippi. In the wake of horrible Hurricane Katrina, State Farm is accused of burying, modifying and hiding damage reports to keep from having to pay.

The whole idea of insurance in a hurricane becomes difficult to sort through. The general idea is that an insurance company is often on the hook for wind damage whereas the water damage is paid out federally. In this case, the National Flood Insurance Program was to be reimbursed a quarter of a million dollars due to the accused fraud.

How tough must that be? How in the world do you separate wind and water damage in a storm the size of Katrina? Some houses were blown away while others were ripped from their foundations by rising tide waters. The insurance companies had plenty of motives to aim the destruction towards the waters. They knew they were facing huge debts regardless so a culture of deception is not really all that surprising. In a world where looters take advantage of people whose homes are devastated, nothing really surprises us anymore.

It was first brought to light in 06 when ABC News spoke with two sisters that accused the company of an entire culture of fraud around the locations in Biloxi and Gulfport. They accused Continue reading State Farm Charged in Hurricane Katrina Claim Fraud Case

How The Cloud Saves Your Data from Total Destruction

save your data in the cloud If you’ve needed to access work-related information from anywhere other than the office, you understand the inherent value of cloud computing. Cloud computing stores everything from graphs to policy briefings online, making them available to authorized users via the Internet. Not long ago, only large companies with a vast amount of expensive information networks could afford to give their employees this level of convenience and efficiency. Cloud storage gives small businesses a secure method of online backup while providing fluid access to information without the drawbacks of hard drives, flash drives and disks.

Have a Safety Net

While operating your small business on a cloud system of computing undoubtedly saves time and money, like any method of information storage, backup is essential. While a cloud system stores information on the Internet, a cloud backup system duplicates all online material before storing it with an online-storage service provider. Should your cloud system become compromised or damaged, the only method of protection is using an online backup service, which can be a life saver.

Proactive Damage Prevention

Imagine there’s a major technological catastrophe at your workplace. Someone hacks into the network and damages the cloud. That means every link, connection, contract and categorized folder inside the cloud is potentially damaged. Now think about this: How much money would your company lose if your entire bank of information was inaccessible for several days or more?

  • A major corporation with hundreds of IT specialists can perform damage control by attempting to recover as much intact information as possible.
  • As a small business, the recovery period is likely to take much longer, costing more time and money than necessary.

Total Recovery

Most small-business owners keep copies, either hard or virtual, of only their most important files, such as tax information or patent designs. Unfortunately, this information isn’t necessary for successful day-to-day operations, and the data that is critical to keep the business running smoothly is rarely backed up.

  • When it comes to preserving profitability, all documents, information and contact lists become vital.
  • Installing cloud backup is like adding a layer of carbon paper to your pad. Once installed, everything you have stored or will store in your cloud automatically transfers to an off-site virtual vault, where it remains until needed.

System & Program Storage

Accessing daily operational documents is only half the battle when it comes to running your small business. Another important feature of cloud backup is system and program storage.

  • Imagine that in addition to your documents, graphs and individual files, your business relies on three separate programs for estimating contractor fees, delivering paychecks and viewing potential worksites with detailed underground utility maps. Cloud backup not only stores these programs, it also preserves any information normally stored in each program.
  • A cloud system lets you control which employees have access to specific information. Having online backup means preserving the security settings for each individual program and file. When you implement cloud backup, the security settings are automatically installed.

Fast Access

Should your cloud system become inaccessible or damaged, the cloud backup lets you continue operating your business by immediately providing a duplicate version of your entire cloud. Exact procedures depend on the backup software, but you can be assured that implementing the cloud backup storage takes less time and costs less money than correcting a corrupted system.

Bad Medicine isn’t What I Need: Health Care Fraud’s Most Wanted List

Fast Facts and True Stories about Health Care Fraud

In 2008, Americans spent $2.34 trillion dollars on health care.  The Federal Bureau of Investigation (FBI) estimates that between 3 and 10 percent (between $70 billion and $234 billion) was lost to health care fraud.  $234 billion dollars is roughly the equivalent to the Gross Domestic Product of a nation the size of Columbia or Finland.

But the “costs” of these scams is not just measured in dollars and cents.  In June 2010, a doctor and his wife were convicted of running a “pill mill” that appeared to be a pain management practice in a Kansas.  The couple dispensed controlled prescription drugs; and collected more than $4 million from 93 different private health insurance and government health care programs.  The doctor was found to be responsible for more than 100 overdoses and at least 68 deaths over a six-year period.

Another organized health care fraud ring involved 5 states in pretend clinics and resulted in claims for approximately $110 million dollars in false claims.  In order for this “practice” to work the group also utilized identity theft techniques which allowed them to steal the identities of legitimate Medicare beneficiaries.  They were convicted in January 2010.

In Feb. 2011 FBI special agents broke up a health care fraud scheme in Puerto Rico and arrested approximately 200 of the 533 people named in the federal indictment. The scheme had been going on for years and involved false accidental injury claims made by policy holders and supported by certain doctors and medical professionals.

Feds Launch Most Wanted List for Health Care Fraud

Yes, it’s true the U.S. Department of Health and Human Services Office of Inspector General has launched a website with the 10 most wanted health care fraud criminals. These “fugitives” are accused of having cost tax payers over 124 million dollars in health care fraud.  However, they are actually seeking more than 170 fugitives on charges related to health care fraud and abuse.  The fugitive’s names, date of birth, descriptions and pictures are available on the website which is updated when they are apprehended.  You can even report a fugitive.

“We’re looking for new ways to press the issue of catching fugitives.  If someone walks into a bank and steals $3,000 or $4,000, it would be all over the newspaper. These people manage to do it from a less high profile position, but they still have a tremendous impact,” says,” said Gerald Roy, deputy inspector general for investigations at the Health and Human Services Department.

On the most wanted list:

Meet Leonard Nwafor; convicted of billing Medicare for more than $1million dollars for motorized wheelchairs that were not needed, one such “recipient” was blind.  Convicted of a federal crime and facing time in a penitentiary, he has disappeared.

Sisters Clara and Caridad Guilarte allegedly submitted $9 million to Medicare in false and fraudulent claims infusion drugs that were never administered, and offered rewards including cashing for those who agreed to visit their clinic in Michigan, and sign forms saying they received services which they didn’t.

Miami brothers Carlos, Luis and Jose Benitez were owners of a string of medical clinics.  They are accused of allegedly   “scamming” Medicaid out of out of $119 million by billing for costly HIV drugs that patients never received or did not need.

“Scammers often utilize their ties to a particular community. They take advantage of ethnic communities based on language barriers or lack of knowledge about how the Medicare system works. These folks are exploiting low-income communities,” says Gerald Roy, deputy inspector general for investigations at the Health and Human Services Department.

“With our Most Wanted Fugitives List, OIG is asking the public’s help in tracking down fugitives,” said Daniel Levinson, the HHS’ inspector general. “(It) has a stake in the fight against fraud, waste and abuse.”

Resources and Sources

Report a health care fraud fugitive

Ten most wanted list US Dept. of Health and Human Services OIG

National Health Care Fraud Association White Paper

FBI

HIPAA: Did You Know Your Health Information Is Protected By Federal Law?

The Health Insurance Portability and Accountability Act (HIPAA) provides rights and protections for participants and beneficiaries in group health plans. The Privacy Rule, a federal law, grants consumers rights over health information and promulgates rules and limitations on who can look at and receive personal health information. The Privacy Rule applies to all forms of individuals’ protected health information, whether electronic, written, or oral.

The Security Rule, a Federal law that protects electronic health information, requires HIPAA-covered entities to ensure that electronic protected health information is secure.

Additionally, HIPAA includes protections limiting exclusions for preexisting conditions; prohibits discrimination against employees and dependents based on health status; and allows an opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also grant a right to purchase individual coverage if no group health plan coverage is available, and for those who may have exhausted COBRA or other continuation coverage.

You have the right to receive a copy of your health records

You can ask to see and get a copy of your medical records and other health information. In most cases, copies must be provided within 30 days of being requested, though there may be a fee associated with the cost of copying and mailing.

You can ask to have corrections added to your health information

You can ask that any misinformation in your file be corrected, or you may request to add information to an incomplete file. For example, if you and your hospital agree that your file has the wrong result for a test, the hospital must change it. Even if the hospital believes the test result is correct, you still have the right to note your disagreement in your file. In most cases the file should be changed within 60 days of the request to amend or change.

You can receive a notice that tells you how your health information is used and shared

You have the right to know how your health information is being used and shared. Your provider or insurer must give you a notice that tells you exactly how they may use and share your health information. In most cases, you should receive this notice on your first visit to a provider, or in the mail from your health insurer. Additionally, you may request a copy at any time.

You can decide whether to give your permission before your information can be used or shared

Generally speaking, your health information cannot be given to your employer, used or shared for things like sales calls or advertising, or used or shared for many other purposes unless you grant express permission by signing anauthorization form. This authorization form must tell you who will get your information and what the information will be used for.

Who must follow this law?

Most doctors, nurses, pharmacies, hospitals, clinics, nursing homes, and other health care providers. Also required to follow this law are health insurance companies, HMOs, most employer group health plans, and certain government programs such as Medicare and Medicaid.

Who receive and view your health information

To ensure your health information is protected in a way that does not interfere with treatment, your information can be used and shared:

  • For treatment and care coordination;
  • To compensate doctors and hospitals for your health care and help run their businesses;
  • With your family, relatives, friends, or others you identify who are involved with your health care or payment, unless you object;
  • To ensure doctors give good care and nursing homes are clean and safe;
  • To protect the public’s health, such as by reporting when there is a flu outbreak; and
  • For mandatory reports to the police, such as reporting gunshot wounds.

Your health information cannot be used or shared without your written permission unless this law allows it. For example, without your authorization, your provider generally cannot:

  • Give your information to your employer;
  • Use or share your information for marketing or advertising purposes; or
  • Share private notes about your health care.

You may request that your information not be shared

You can ask your provider or health insurer not to share your health information with certain people, groups, or companies, such as with other doctors or nurses in a particular hospital or clinic. However, they do not have to agree to do what you ask.

You have the right to file a complaint

You may file a complaint with your provider or health insurer if you suspect your information was used or shared in a way that is disallowed under the privacy law, or if you feel you were unable to exercise your rights.

Who Is Not Required to Follow These Laws

  • Life insurers;
  • Workers compensation carriers;
  • Most schools and school districts;
  • Many state agencies, for example child protective services;
  • Most law enforcement agencies; and
  • Many municipal offices.

When you make an original visit to a doctor’s office, hospital, or other health care provider, you should be given a copy of your HIPAA rights, which you will be asked to sign. Make sure you read the entire document, and request a copy for your own files.

Links:

How to file a complaint

HIPAA FAQs

Notice of privacy practices

Summary of HIPAA privacy rule (PDF)

U.S. Department of Labor HIPAA pages

AFLAC: The 411 on the “Quack”

The AFLAC duck has quacked through major league sports broadcasts and seems to be everywhere. It would be hard to find someone in America who hasn’t heard the name AFLAC and can associate it with the duck and the words “supplemental insurance.” But what does supplemental insurance mean and just what products does AFLAC offer?

Continue reading AFLAC: The 411 on the “Quack”