November 25. 2013 9:00AM

Elderly should be wary of health care fraud

By Steve Jagler

  
The Centers for Medicare & Medicaid Services in Baltimore, Md., recently posted the top five things elderly people who are enrolled in Medicare need to know as the Affordable Care Act (ACA) is rolled out. They are:
  • Your Medicare coverage is protected. Medicare isn't part of the Health Insurance Marketplace established by ACA, so you don't have to replace your Medicare coverage with Marketplace coverage. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you'll still have the same benefits and security you have now. You don't need to do anything with the Marketplace during open enrollment.
  • You get more preventive services, for less. Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly "wellness" visit.
  • You can save money on brand-name drugs. If you're in the donut hole, you'll also get a 50-percent discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy – you don't have to do anything to get it. The donut hole will be closed completely by 2020.
  • Your doctor gets more support. With new initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.
  • The ACA ensures the protection of Medicare for years to come. The life of the Medicare Trust fund will be extended to at least 2029 – a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.

State and federal officials say they've received a rising number of consumer complaints about unscrupulous sales practices from lower-echelon insurance companies to criminals leveraging the complexity of the new law and the confusion it causes among the general public.

The size and complexity of the Affordable Care Act, coupled with an elderly population that can become confused, creates a ripe landscape for fraud, experts say.

The Federal Bureau of Investigation (FBI) expects health care fraud to rise with implementation of the new law, coming from malfeasance and negligence alike. Aside from criminals exploiting opportunities for theft, otherwise law-abiding Americans may unwittingly use unlawful tax credits in enrolling in new plans, experts say.

Meanwhile, state and federal authorities are warning consumers – particularly elderly Americans traditionally susceptible to Medicare scams – to beware of telephone callers hawking health care plans under the guise of federal authority.

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