Scammers taking advantage of new health-insurance system

Scammers are using the new health-insurance system "as an opportunity to try to collect consumers’ personal information or to make false claims," Gov. Steve Beshear and Attorney General Jack Conway warned Tuesday.

Conway's office sent civil investigative subpoenas and cease-and-desist orders Monday to the operators of two websites that had brought complaints from consumers to the Cabinet for Health and Family Services, which oversees Kynect, the state's health-insurance marketplace.

Scam sites try to mimic legitimate government sites, the officials said. People who register on the sites have reported getting telephone calls as a result. That is not the way the secure, state-operated website works. Its web address is Kynect.ky.gov; beware of sites ending in .com or .net, Conway advised.

“If something seems suspicious, do not share your personal information, and if you suspect fraud, report it immediately,” Conway said. He also warned Kentuckians to be on guard for attempts by identity thieves to collect personal or financial information by email, phone or mail.

Scammers may also try to sell bogus “discount medical plans” or mislead older consumers on Medicare by making false claims that Medicare coverage is affected by the new law, Conway said. It is not, but the annual Medicare re-enrollment period runs through Dec. 7, perhaps creating confusion.

“It’s appalling to think there are individuals out there who would prey on Kentuckians during this process,” Beshear said. “Everyone should be on guard and report any questionable websites or businesses. There is a lot of misinformation on the Affordable Care Act, which is why we have qualified staff who can answer questions and point consumers in the right direction.”

The attorney general's Office of Consumer Protection offered these tips:

• Make sure you’re working with a registered insurance agent or certified Kynector. Only legitimate insurance agents and government-contracted assisters, called “kynectors,” are authorized to assist Kentuckians with signing up for health care. A list of approved agents and kynectors maintained by the Cabinet for Health and Family Services can be found online or by calling 1-855-459-6328.
• Protect your personal information. Only a registered insurance agent, a certified Kynector, or customer-service representative at a contact center should ask for your personal information to help you apply. Keep personal and account numbers private to any others who offer assistance. Don’t give your Social Security number, credit card or banking information to companies or individuals you didn’t contact. Never give your information to someone whose identity you question.
  
• Do not pay for help. Insurance agents and Kynectors will not solicit money. There is no charge to use Kynect services with the help of an insurance agent or certified Kynector. If consumers get an offer to register for a fee, they should hang up the phone or walk away.
• Remember that you can only get tax credits through Kynect. Most Kentuckians who buy insurance through Kynect will qualify for tax credits to subsidize their premiums. No one but Kynect can offer these credits, and there is no charge to apply for them.
  
• Beware of phishing scams online. Consumers should be cautious of any email claiming to be connected to the Affordable Care Act, including any emails claiming to be affiliated with kynect and asking for personal information.
  
• Ask questions. Don’t sign anything you don’t fully understand, and verify the answers you get with trained kynect representatives.

If people think their personal information may have been compromised, they can visit www.ag.ky.gov, the attorney general’s website, which has an identity-theft toolkit.

Here are the seven factors driving health care cost increases

Escalating health care costs are everybody's problem and no one entity's fault. Julie Appleby at Kaiser Health News reports that the United States spends about18 percent of its gross domestic product -- or about $2.6 trillion a year -- on health care costs. So what's making that figure rise? A Bipartisan Policy Center study took on the task of finding out and came up with it believes are seven major factors:

1. Paying our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient. Even insurers like Medicare pay on a fee-for-service system. New efforts in the federal health law look to change that.
2. Growing older, sicker and fatter as a nation.Medicare is set to grow by an average of 1.6 million people annually. With two-thirds of adults are either overweight or obese, lots of additional medical spending looms.
3. Wanting the latest drugs, technologies, services and procedures. Prices for newer treatments are often higher than for the products they replace.
4. Employers and employees get tax breaks on health insurance, and it costs employees little to seek care. Appleby writes, "The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care."
5. Not having enough information to make decisions on which medical care is best for us.
6. Hospitals increasingly gain market share through consolidation and demand higher prices.
7. Legal issues complicate efforts to slow spending. Doctors sometimes prescribe tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing is another concern. The report notes that laws sometimes limit the ability of medical professionals to do work for which they are trained but that more highly paid doctors must do. (Read more)

To read the entire Bipartisan Policy Center report here.

Chiropractic clinic to pay $650K for Medicaid and Medicare fraud

A chiropractic clinic in Williamsburg will pay $650,000 to settle claims it improperly billed Medicare and Medicaid, reports Trent Knuckles for The News Journal of Corbin. (News Journal graphic)

Ho Medical Clinic, Kenneth Ho and Ana Moreno allegedly filed false claims when they billed for physician services, though they were performed by a chiropractor (chiropractors are not medical doctors); billed for unnecessary and unreasonable MRI and X-ray services; billed for work performed by unqualified personnel; and received funds for being a rural health clinic when it did not meet Medicare requirements.

Of the $650,000, $525,000 will go to the Medicare and Medicaid trust fund. The remaining sum will go to Danette Freeman, who sued the company under the False Claims Act. The investigation was conducted by the Kentucky attorney general's office, the Department of Health and Human Services' Office of Inspector General and the U.S. attorney's office. (Read more)

Two bills would encourage, protect whistleblowers

Two proposed bills would serve to crack down on fraudulent health care claims and make it easier for employees to blow the whistle on illegal activity.

State Sen. Tom Jensen, R-London, (photo, right) has sponsored Senate Bill 11, which would increase damages and penalties against wrongdoers and prohibits retaliation against employees who assist in prosecution. It would also allow an employee who "works for a Medicaid provider or contractor to turn over evidence to prosecutors and receive a portion of the money recovered," The Lexington Herald-Leader's Beth Musgrave reports.

House Bill 4, sponsored by House Speaker Greg Stumbo, D-Prestonsburg, (photo, left) proposes similar action, likewise protecting whistleblowers and paying "some of the proceeds of the action being distributed to the person successfully bringing the action." The consequences as proposed in Stumbo's bill would be more widespread, however. "I want to see this used not just in (Medicaid), as the Senate is proposing, but anywhere fraud with state dollars is taking place," Stumbo said.

Almost two dozen states have their own false claims acts, including Tennessee and Indiana. Attorney General Jack Conway has expressed some concerns about the proposals. (Read more)