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THE COALITION AGAINST INSURANCE FRAUD

WHATEducating and increasing awareness among consumers, government organizations, insurers and others about insurance fraud and it's broad impact. The coalition also advocates for policies that help to detect, prevent, deter, and prosecute insurance fraud.
WHYThe Coalition Against Insurance Fraud aims to fight all forms of insurance fraud, reduce insurance costs for consumers and insurers and promote fairness and integrity of the insurance system. Through it's programs the coalition is fighting fraud against the elderly and elder financial abuse.
WHEREThe Coalition Against Insurance Fraud – An anti-fraud alliance speaking for consumers, insurance companies, government agencies and others.
Based in Washington, D.C., USA.


Program Description


"Fighting scams is like fighting any disease: Seniors should arm themselves with doses of caution and alertness as they weigh their choices of Medicare discount plans."

"Medicare doesn't permit phone payments. Approved plans can only do general marketing via telephone, and they can enroll you over the phone ONLY if you make the call. Marketers also can make appointments to visit your home to discuss their discount plans. Medicare-approved plans also must comply with federal and state 'Do Not Call' laws."

-insurancefraud.org

The coalition helps to fight Medicare Fraud and Scams.

Scammers often pretend that they are representatives of Medicare or private prescription plans and offer to ‘help’ seniors by requesting personal financial information, social security numbers, Medicare numbers, credit card and checking account numbers and steal a seniors’ identity.

The Coalition Against Insurance Fraud states that:

  • Medicare doesn’t permit online payment, plans must send a bill if seniors sign up online.
  • Drug plan marketing can’t begin until October 1.
  • Enrollment can’t begin until November 15.
  • Signup for drug coverage is strictly voluntary. Seniors can keep their Medicare benefits whether or not they sign up.
  • Medicare employees don’t personally market a drug plan, recommend specific drug plans, or offer government marketing literature. Only private companies market their own Medicare-approved drug plans. They also use their own material, Medicare doesn’t have any.
  • The official ‘Medicare & You’ handbook from Medicare provides general information about Medicare and the new drug coverage.

The Coalition Against Insurance Fraud suggests that seniors can help stop Medicare fraud by:

  • Never giving unknown people or strangers their Social Security, Medicare, health-insurance or bank-account numbers, or other personal financial information.
  • Verify a plan is Medicare-approved before signing up by contacting Medicare
  • Report suspected Medicare fraud and scams to Inspector General’s tollfree hotline: 1-800-447-8477.
  • Visit Medicare for general information about the discount program.

In addition to Medicare Fraud seniors should also be aware of Medical ID and Health Insurance Theft Scams which include:

Illegal and fake treatment -  Medical ID thieves bill a senior’s health plan for fake or inflated treatment claims. Scammers can be doctors and other medical personnel who know how the insurance billing system works. Organized theft rings can buy stolen patient information on the black market, and set up fake clinics to make fake claims.

Buy addictive drugs - Medical personnel with access to information may use a senior’s identity to obtain prescription drugs to sell. Dishonest pharmacists may bill a senior’s policy for narcotics, or nurses may call in prescriptions in a patient’s name but pick it up themselves.

Obtain free health care treatment - Medical ID thieves who don’t have health coverage will use a senior’s identity at a hospital or clinic for medical treatment and the senior’s policy will receive the bills.

The Coalition Against Insurance Fraud suggests that seniors can help stop Medical ID and Health Insurance Theft Scams by:

  • Reviewing the explanation of benefits (EOB) form sent by their health insurer to look for medical treatments they did not receive and notify their insurer and medical providers.
  • Monitor insurance benefits - Ask their insurer for a list of benefits paid out under their policy.
  • Check medical records - get a copy of their medical record from the doctor, hospital, pharmacy or laboratory. If anyone refuses to give access to medical files, seniors may appeal based on their medical provider’s ‘notice of privacy practices.’  Seniors are entitled to a statement of this policy upon request, and without cost.  A health-privacy complaint may be filed with the U.S. Department of Health & Human Service
  • Protect credit - Review credit reports with the credit agencies Equifax, Experian and TransUnion to see if anyone has rung up unpaid medical bills on a senior's name and place a fraud alert which asks the bank or other creditor to contact a senior to confirm their identity when anyone applies for credit in their name. Seniors can also have a credit freeze placed which means someone can access a credit report only with a personal identification number.
  • Correct inaccurate medical records - seniors should have errors in their medical record corrected immediately.
  • File a police report – seniors can notify law enforcement a crime may have been committed and send the report to their insurer, medical providers and all credit bureaus.
  • Notify the government –seniors can file a medical identify theft complaint with the Federal Trade Commission (FTC)

The Coalition Against Insurance Fraud has useful information on other scams and frauds including:

  • Contractors & Adjuster Fraud
  • Obamacare Scams
  • Fake Health Insurance Scams
  • Discount Cards Scams
  • Dental Scams
  • Long Term Insurance Scams
  • Scam alerts
  • Staged crashes
  • Workers compensation Scams
  • Agents & Insurer Scams

For those who would like to help stop insurance fraud, the Coalition Against Insurance Fraud website has  brochures, posters, DVD’s and other information to fight insurance fraud. Anyone interested can make presentations to community groups, organize outreach campaigns, participate in Fraud Awareness Day and organizations can train staff about fraud.
source: insurancefraud.org

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Elder Abuse Prevention Programs
Financial Elder Abuse Prevention Programs

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