The Adult and Aging Services division of the Merced County Human Services Agency (“HSA”) coordinated a summit consisting of a keynote speaker and a panel on the morning of June 26 at the Merced Senior Center to create awareness about elder financial abuse and fraud.
Elder financial abuse is illegal or improper use of an elder’s funds or property by someone for their own profit. The summit’s goal was for members of the community to learn about the different agencies and resources available to help protect seniors. Attendees were encouraged to ask questions at the conclusion of the summit.
The keynote speaker was Sandy Morales with California Health Advocates Senior Medicare Patrol (“SMP”).
The panel included Morales, as well as Paul Mullen, an attorney with Central California Legal Services, Stefanie Hiser, Merced County’s Long Term Care Ombudsman, Derrick Oliveira, the Supervisor at the Merced County Veterans Services office, Nicole Silveira, a supervising Deputy District Attorney in Merced County, Cristian Lopez, the branch manager of Merced’s BBVA Compass Bank, and Nora Kisling, a Supervising Social Worker with HSA’s Adult and Aging Services branch.
The panel members brought to light some interesting facts — up to 2 million elders are mistreated per year by someone they trusted; 90 percent of the abuse is committed by a trusted person like a relative or caregiver. The reason elders often do not report abuse is shame; embarrassment; their feeling that the person mistreating them is kind to them in some other way; inability to acknowledge the abuse; or lack of awareness of the abuse or what to do about it.
One resource the victim can use is the United States Administration for Community Living, and the number to call is 1-800-677-1116.
During Morales’ presentation, she explained, “The Senior Medicare Patrol is a Federally funded program within the Administration for Community Living, which is part of the U. S. Department of Health and Human Services. Their mission is to empower seniors and their family members regarding Medicare fraud and where to report it.”
According to Morales, there is one SMP in every State and in the United States territories.
California’s SMP office is in Irvine.
Highlighting the seriousness of the problem, Morales said, “We lose $60 to $90 billion a year to Medicare fraud and abuse, and that’s only what is reported.”
One of SMP’s key roles is outreach. Attendees at SMP conferences are taught to protect (guard one’s Medicare card), detect (detect fraud by evaluating services charged to their Medicare account to determine if the service was actually provided), and report (report possible fraud to a statewide fraud hotline number, 855-613-7080).
When the SMP evaluates the subject matter of calls it receives and notices a fraud trend, a fraud alert is created on its website.
Some new fraud trends seniors and their family members need to be aware of are free braces to relieve pain, the genetic testing scam, and fraudulent hospice enrollment.
Morales’ caseload recently increased from the 20s to 63 per month due to the new fraud trends.
She said, “Our role is to research and solve these cases.”
If fraud is found, the SMP makes a referral.
Morales said, proudly, “85 percent to 95 percent of SMP referrals end up being investigated.”
In June, 288 cases were opened in 20 days and most were due to the back brace and genetic testing scams.
The brace scam is perpetrated through telephone calls, occasionally through visits to the home, and through television commercials.
An example is a lady who saw a tv commercial and called the number to receive a free back brace. After it arrived, she began receiving additional braces for various parts of her body from six companies that she hadn’t ordered and didn’t want.
Morales said, “The Medicare brace claims end up costing thousands of dollars. The way it works is they collect personal information on the phone such as the caller’s Medicare number. Then the person calling is transferred to a ‘tele-doctor,’ who receives a kickback for every prescription. The doctor tells the caller they might have pain in a different area in the future and writes in ‘medical necessity’.”
Morales emphasized the importance of reporting fraud in that perpetrators of a back brace scam based in the Philippines were recently apprehended.
She said, “In March, a $1.2 million scheme was the subject of a take down. A call center in the Philippines was calling people in the United States about free back braces.”
In the fraudulent genetic testing scam, someone calls an elderly person claiming to be from Medicare and offers free genetic testing which will allow them to find out if they are a candidate to suffer a certain type of cancer. The caller gets the elder’s Medicare number. The testing kit never arrives, and scam labs bill Medicare for testing that never took place.
The deceptive hospice enrollment scam is perpetrated on both the elderly and their family members. A caller contacts an elderly person who may be ill, claiming to be from an additional benefits company. The caller tells the elder they don’t have to be on hospice, and can still receive free cooking and cleaning services, and free in-home nursing and medical equipment.
Morales said, “Then the senior finds they can’t get their medications at their pharmacy, and the reason is they were enrolled in hospice without their knowledge.”
The scam caller tells a senior’s family member they need to enroll the senior in hospice because of their age, omitting to mention hospice enrollment requires them to be certified terminally ill evidenced by a doctor stating the individual has six months or less to live.
Morales said, “The scam company ripped off Medicare for $4,000 worth of cooking and cleaning services for one person for one month.”
She also cautioned elders and their family members to be on the look out for New Medicare Card scams.
She said, “With change comes an opportunity for scammers. The new cards do not contain social security numbers but if the card is compromised, it still opens the way for abuse.”
She explained, “The scammers are saying your new card needs to be activated, and then they ask for your card number. Another scam is they say the cards are going to be changed to plastic and get your number.”
Her best advice is “When a caller says ‘free’ and asks for your Medicare number, hang up.”