Posts Tagged ‘bill’

Recent Developments in D.C. To Combat Financial Abuse of the Elderly

Thursday, March 15th, 2018

Recent Developments in D.C. To Combat Financial Abuse of the Elderly

by Robert M. Jaworski, Esq.

Financial abuse of the elderly is getting some attention in Washington these days, and, some say, it’s about time.  On February 22, 2018, Attorney General Jeff Sessions and law enforcement partners announced[1] the largest coordinated sweep of elder fraud cases in history.  In addition, it was reported[2] on March 13, 2018, that an elder fraud bill sponsored by Senate Aging Committee Chairwoman Susan Collins (R-Maine) was recently folded into the banking regulation bill (S. 2155) that is expected to be approved by the Senate in the near future.  Details concerning both of these developments are set forth below.

Nationwide Elder Fraud Sweep Coordinated by the Department of Justice

The cases, which include criminal, civil and forfeiture actions, involve more than 250 defendants from around the globe. They are charged with victimizing more than a million Americans, most of whom are elderly.  Of the defendants, more than 200 have been charged criminally.

The actions charged a variety of fraud schemes, including large scale mass mailing, telemarketing and investment frauds, as well as individual instances of identity theft and theft by guardians.  One case alone concerned a scheme that operated from 14 foreign countries and resulted in losses to American victims totaling more than $30 million.

Mass mailing schemes.  In each of the mass mailing schemes, fraudsters sent direct-mail letters to individuals falsely promising them that they had won cash or other valuable prizes.  All they had to do to claim their prizes was to send back a payment for what was represented as processing fees or taxes. The letters appeared to come from legitimate sources, typically on official-looking letterhead, and to have been personally addressed to each recipient. When an individual took the bait and sent the requested fee, the fraudsters simply kept the money.  No victim ever received a promised prize.  Worse yet, when people showed a susceptibility to these scams, the fraudsters repeatedly targeted and victimized them with other scams.

Other Schemes.  Other examples of elder financial exploitation schemes prosecuted by the Department of Justice include:

  • “Lottery phone scams,” in which callers convince seniors that a large fee or taxes must be paid before one can receive lottery winnings;
  • “Grandparent scams,” which convince seniors that their grandchildren have been arrested and need bail money;
  • “Romance scams,” which lull victims to believe that their online paramour needs funds for a U.S. visit or some other purpose;
  • “IRS imposter schemes,” which defraud victims by posing as IRS agents and claiming that victims owe back taxes; and
  • “Guardianship schemes,” which siphon seniors’ financial resources into the bank accounts of deceitful relatives or guardians;

The Department of Justice indicates that it has partnered with Senior Corps to educate seniors about these types of scams and prevent further victimization.  Senior Corps is a national service program administered by an independent federal agency, the Corporation for National and Community Service (CNCS).  You can access information on Senior Corps’ efforts to reduce elder fraud by clicking here.  If you suspect that you are a victim of a scam, you can file a report with the Federal Trade Commission by clicking here.  Finally, remember that the best way to avoid becoming a victim of a scam is to be skeptical of anything that sounds too good to be true.  It probably is too good to be true!  Check it out first.

Senator Collins Elder Fraud Bill

This bill, Senate Bill S-223[3], which is called the “Senior$afe Act of 2017,” strives to prevent elder financial abuse by encouraging financial institutions (including credit unions, insurance agencies, banks, investment advisers, and broker-dealers) and their employees to sound an alarm bell whenever they suspect that an elderly person is being financially exploited.  The bill seeks to accomplish this objective by immunizing these institutions and employees from potential liability in any civil or administrative proceeding for disclosing such suspicions.

This immunity, however, is subject to the following conditions:

  • The disclosure is made only to a State or Federal banking or securities regulator, a State insurance regulator, a law enforcement agency, and/or a State or local adult protective services agency.
  • The disclosing employee must be a supervisor or compliance officer employed by the financial institution at the time of the disclosure and have made the disclosure in good faith and with reasonable care.
  • The disclosing employee must have previously received training from the financial institution, appropriate to the employee’s job responsibilities, concerning (1) how to identify and report suspected exploitation of a senior citizen internally and, as appropriate, to government officials or law enforcement authorities, including common signs that indicate the financial exploitation of a senior citizen, and (2) the need to protect the privacy and respect the integrity of each individual customer of the financial institution.

Interestingly, New Jersey already has a similar law on the books, which dates back to 1998.  The New Jersey Foundation for Aging helped to educate concerned individuals and agencies about that law following its enactment.

 

Mr. Jaworski is a member of the NJFA Board of Trustees and an attorney with the law firm Reed Smith, LLP.  He specializes in providing banks and other financial institutions with advice and assistance concerning their responsibilities to comply with applicable federal and state laws and regulations, including, in particular, consumer protection laws and regulations.

 

 

 

Medicare Billing Issues- Be Informed

Thursday, October 25th, 2012

Medicare Billing Issues

 In the August/September issue of Renaissance magazine (http://www.njfoundationforaging.org/Ren_AugSep_WEBa.pdf), NJFA featured an article on observation status at the hospital versus being admitted. The article talked about how this can not only mean that seniors would see a bill for the time spent at the hospital, but that it also affected Medicare’s coverage of post hospital treatment at a rehab facility.

Medicare Part A is your hospital insurance and covers inpatient admissions to the hospital. There have been a few articles and news stories about these instances where a hospital changes a patient to observation status and therefore Medicare A does not cover the stay consequently, the patient is left with a bill. Furthermore, if that patient might benefit from a stay in a Skilled Nursing Facility for rehabilitation, then Medicare will not cover that either as a 3 day inpatient hospital admission is required in order for Medicare to cover an inpatient rehab stay.

Another issue recently cited in a New York Times article is that the Federal Government is concerned with inaccurate billing and coding by hospitals due to the new electronic record system. They feel there may be “upcoding”- increasing the severity of a patient’s condition or treatment as a means of profit. The Federal Government is also concerned about “cloning”- where information about one patient is repeated in other records.

Certainly there are many advantages to electronic medical records, both in cost and efficiency. However there needs to be tight guidelines and monitoring of these practices to make sure that fraud or abuse are not taking place in the system. The Federal Government issued a letter to several National hospital associations indicating that they are concerned about accurate billing in use of the electronic medical records system.

What does this mean for Medicare recipients? Make sure you talk to your doctor and anyone treating you in the hospital. Being an educated patient is your best defense; asking the hospital staff what you are being tested for; having open communication about your status and asking if they’ve communicated with your primary physician. It is also important to review your Medicare statements when they come and if you see anything that you feel  is incorrect to report it.

Know your resources. You can contact the following organizations with assistance understanding or navigating your Medicare coverage, as well as report possible fraud or abuse or other concerns, such as appeals.

Medicare- http://www.medicare.gov or 1-800-MEDICARE

Medicare Rights Center- http://www.medicarerights.org/ or 1-800-333-4114

SHIP (Statewide Health Insurance Assistance Program) 1-800-792-8820

Senior Medicare Patrol- 887-SMP-4359

County Office on Aging- 1-800-222-3737