The Main Stream

Jan 19, 2012 6:03 AM

Medicare fraud alert

TUCSON - Are you or is someone in your family on Medicare? The News 4 Investigators has an important fraud alert impacting nearly 1,000 people, most of them right here in Tucson.

Some of you contacted The Investigators after you noticed your insurance coverage was switched last year during open enrollment without your consent.

One of the victims wants to help get the word to the hundreds of elderly and vulnerable people about the problem.

"It was switched again after the 7th of December."

David White was diagnosed with leukemia 14 years ago.

"Now in my wife's case she suffers from a multitude of things."

When The Investigators were at the Whites' home, Anita had a migraine so severe she couldn't join us for the interview.

The Whites care for each other. David worries about proper medications. They're happy with the Medicare plan they have through Health Net.

Last month they started getting mail thanking them for changing to AARP Medicare Complete Plus with United Healthcare.

"First of all something we didn't elect," David explains. "And secondly it was somebody else playing games with our name."

The Whites never signed for a change. David started working the phone making several calls to Health Net, United Healthcare and the fraud unit with Medicare. He eventually he got it all back on track.

"The amount of paperwork that's entailed has to be astronomical."

David worries about others who did not catch the switch.

"And then all of sudden they have an emergency and they go to the emergency room and they have no idea who they are insured with," he says. "When you're talking senior citizens and people that are subject to easy prey, this is really an insult."

The investigators contacted Medicare and received this Press release:

The Centers for Medicare and Medicaid Services (CMS) is investigating an alleged fraudulent scheme to enroll about 900 Arizona Medicare beneficiaries in different Medicare health plans without their consent.

The affected beneficiaries are concentrated in the Tucson area. Medicare Advantage plans are managed-care health plans offered by private insurers under contract with Medicare.

Under the scheme, Medicare beneficiaries enrolled in Medicare Advantage health plans sponsored by Health Net and two other companies were switched without their consent to Medicare Advantage plans sponsored by United Healthcare. Most, if not all, of the switches are alleged to have been made by the same sales agent. Agents typically receive commissions of about $200 for every new member they enroll in a Medicare Advantage plan. Most of the affected beneficiaries were enrolled with Health Net during 2011, although some were members of Humana and CareMore plans.

The switches were initially detected by a compliance officer for Health Net, which reported them to CMS. Medicare beneficiaries are allowed to change health and prescription drug plans each year during the open enrollment period, which runs Oct. 15 through Dec. 7

CMS advises Medicare beneficiaries who suspect they may have been switched without their permission to call 1-800-MEDICARE (1-800-633-4227) and report their concerns. All affected beneficiaries will be re-enrolled in the plan of their choice with no interruption in medical coverage.

-Jack Cheevers, Public Information Officer, Region IX
U.S. CMS

United Healthcare provided this statement:

Immediately upon being alerted to this third party agent's conduct, we notified the appropriate authorities, investigated the matter and then terminated the agent. Such conduct is not acceptable. As importantly, all affected beneficiaries will be re-enrolled in the plan of their choice with no interruption in their medical coverage and we apologize for any inconvenience that may have occurred. Any Medicare beneficiary who suspects they may have been switched without their permission should call 1-800-MEDICARE (1-800-633-4227) and report their concerns.

-Matt Burns, Spokesman United Healthcare.

United Healthcare also adds that the problem was referred to the Arizona Department of Insurance-Fraud Unit.

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