1. Candice Twyman, LMSW-AP Better Business Bureau Education Foundation Houston, Texas

2. Crime Against the Elderly Older adults demonstrate a higher rate of fear of crime than any other group, despite having the lowest victimization rate. The media frequently portrays the elderly as victims.

3. A Growing Problem  Large, growing population.  Older adults cannot regain their loses.  Few resources are focused on prevention.  Fraudulent telemarketers direct anywhere from 56% to nearly 80% of their calls at older adults.

4. Why are older adults targeted? They have money, pensions and investments, plus they have something as valuable as money – a Medicare number. They are at home during the day. They still have landlines and they answer the phone. They believe that people are telling them the truth. Some are not savvy with new technology. Can no longer do their own home repairs.

5. Who are the Perpetrators?  Caregivers or family members use older adult’s retirement funds, social security and investments for their own personal gain.  Free lunch by financial advisors sells inappropriate products (annuities)or fraudulent products (Viaticals).  Strangers scams by phone, email, or mail contractors, workmen, home repairmen

6. Why do family members exploit loved ones?  Substance abuse, gambling or financial problems.  Stand to inherit and feel justified to take what is “rightfully” theirs.  Fear older adult will use up all their savings and take away their inheritance.  Have a poor relationship with the older person and have a sense of “entitlement.”  Want to keep other family members from acquiring or inheriting the older person’s assets.

7. How do Strangers Target Older Adults?  Younger person professes to love or care about the older person.  Seeks employment as caregivers, personal assistants.  Drive through neighborhoods or peruse obits.  Overcharge for products or use deceptive business practices.  Use their position of trust to gain compliance.

8. Signs of Financial or Material Exploitation  New person shows up at the bank with the older adult.  Includes new names on signature cards and gets an ATM card.  Abrupt changes in will and other documents.  Disappearance of stocks, funds or valuable possessions.  Unauthorized withdrawal of funds and forged signatures on checks.

9. Signs of Financial or Material Exploitation  Sudden appearance of previously uninvolved relatives claiming a right to the elder’s possessions.  Sudden transfer of assets to a family member or someone outside the family that no one knows.  Provision of services that are not necessary, but costly.  Unpaid bills despite ability to pay.

10. Examples of Scams Lotteries and sweepstakes Work-at-home/Secret Shopper jobs Grandparent scam Census scam Investment seminars Government officials calling Identity theft after a person has died Internet scams

11. What should we do? Encourage older adults not to give any personal information over the phone or Internet unless they instigate the action or call. Encourage older adults not to accept a free service if it requires giving a Medicare number or sweepstakes winnings if it requires money upfront. Call APS if you see an older adult being financially exploited – 1-800-252-5400. Call the Texas SMP program if you see Medicare fraud 1-888-341-6187.

12. A Program of the Better Business Bureau Education Foundation Houston, Texas Funded in part by a grant from the Administration on Aging Texas SMP Empowering Seniors to Prevent Healthcare Fraud

13. Federally funded One in every state Recruit and train volunteers and professionals about Medicare fraud and abuse. Report intentional fraud and abuse to Medicare fraud control units. What is SMP?

14.  Billing for services not furnished.  Misrepresenting the diagnosis to justify payment.  Billing for a service not furnished as billed.  Falsifying certificates of medical necessity, plans of treatment and medical records.  Offering or accepting kickbacks or referrals  Routine waiver of co-payment Forms of Fraud

15. Health care fraud is not just about the government or beneficiaries losing money. People can lose access to care, suffer inappropriate or untimely care, lose benefits, get stuck with bad equipment, the wrong drugs or other things they don’t need or want which affects their health and well-being. Why Should You Care About Health Care Fraud, Errors and Abuse?

16. Mafia /Organized Crime– turned to Medicare fraud because it offers a greater payoff and much shorter prison sentences. Common street criminals – used to recruit patients and doctors. Older adults – accept payments for referring their friends or getting their Medicare number. Who is committing Medicare Fraud

17.  Home Health Care Fraud  Scooter Scams  Arthritis Kit Scams  Ambulance Rides  Free tests and screenings  Diabetic supplies Examples of Fraud

18. New medical card to cover all your prescription drug costs for a small charge of $399. Review of Medicare records show they are not using benefits and are due a refund. Just need their bank account number to deposit money. Beneficiaries need a new card to take to the doctor along with their Medicare card. More Examples of Fraud - calls

19. A mental health center sends an ambulance each morning to a personal care home and takes residents to a psychiatric day center where they are shown a movie and fed lunch. They bill Medicare for group psychotherapy. And more……

20. Last year during the week of Christmas someone was standing outside a low income housing unit offering residents $200 for their Medicare number. And more……

21. And more….. A person hired by a medical provider to drum up business trolls through neighborhoods, often low- income areas, enticing people with money to come to a clinic for tests. Individuals were sent to an eye doctor who shined pen lights into their eyes and billed Medicare for cataract surgery.

22. Groups of doctors go into senior apartment complexes and nutrition sites offering “free” tests. Doctors offer their services to the management of an apartment complex to treat their residents onsite. Home healthcare agencies are the welcoming committee to new residents at an apartment complex. And more…

23. Help seniors find benefits and may qualify for a free trip to Las Vegas. Home healthcare agency providing bible study classes at apartment complexes yet billing Medicare for home healthcare to each person that attends the class. Podiatrist fitted a patient for diabetic shoes by drawing around their foot on a piece of paper on the floor. And more….

24. Older adults, only when they receive a bill or faulty equipment. Employees of a fraudulent company who aren’t paid. Physicians – when their Medicare Provider Number is compromised. Ex-spouses Who’s reporting Medicare Fraud?

25. Prompt Payment System No documentation required unless investigated. Claims are not reviewed or seen by a person. Easy money, less danger than selling drugs and less prison time. Why is Medicare an Easy Target?

26.  The test is free…but they need a Medicare number.  Medicare wants someone to have a item or service.  They know how to get Medicare to pay for it.  The equipment is free and won’t cost anything. Be Suspicious of If Someone says:

27.  Waive co-payments on any services without checking your ability to pay.  Advertise “free” consultations to people with Medicare.  Claim they represent Medicare.  Use pressure tactics.  Use telemarketing and door-to-door selling. (unlawful) Be Suspicious of Providers if:

28.  If a client says someone approached them or called on the phone to offer special Medicare benefits, refer them to the Texas SMP.  If a client calls and says they received a delivery of medical supplies or equipment they did not request, refer them to the Texas SMP.  If a Senior Center calls about people wanting to give a presentation about Medicare to their clients, have them first call the Texas SMP.  Call the Texas SMP at 1-888-341-6187. Report Suspicious Behavior