FraudAlert! Helping keep the promise. January 2015  Volume 18, No. 6

 Coalition of Wisconsin Aging Groups Elder Law Center

From the Project Director. . . . . . . Kevin Brown

Check out our website at www.wisconsinsmp.org Report Medicare fraud at the Stop Medicare Fraud website: www.stopmedicarefraud.gov

Let’s Get Acquainted By Judy Steinke, Wisconsin SMP Volunteer Coordinator Wisconsin SMP (Senior Medicare Patrol) introduces LaVerne (Buzz) Marshall of Livingston as this month’s featured volunteer. Buzz joined Wisconsin SMP in 2012 after being referred by Mariann Muzzi of Wisconsin AARP. He had previously been an AARP Fraud Fighter and that program was coming to an end. Ms. Muzzi was familiar with the work of Wisconsin SMP, and she encouraged the Fraud Fighter volunteers to share their expertise with our project. We are very thankful that Buzz and several other former Fraud Fighters have joined our team. Buzz volunteers because he wants to keep seniors safe and aware. He continues to serve as an AARP Advocate, AARP Smart Driver instructor, and AARP CarFit volunteer. AARP Advocates work on state and federal issues that affect seniors, such as strengthening and preserving Social Security and Medicare. Buzz is the chief trainer in Wisconsin for the Smart Driver program, which is a driving refresher course to help keep older drivers independent, safe, and confident while on the road. The CarFit program helps drivers fit safely in their vehicles. If you have an opportunity to meet Buzz, please ask him to share his stories about the CarFit program.

Wisconsin SMP In this issue: Let’s Get Acquainted with LaVerne “Buzz” Marshall, SMP Volunteer WI SMP to Hold Volunteer Trainings in Madison, Campbellsport, and Platteville Medical College of WI Pays $840,000 to Settle Medicare Fraud Claims U.S. Atty. Seeking Aurora Documents in Federal Fraud Investigation WI BBB News Release Senate Aging Committee Releases Report on Fraud Hotline CMS News Release FTC News Release FTC Hosts Tax Identity Theft Awareness Week Upcoming Wisconsin SMP Activities Published and distributed by the Coalition of Wisconsin Aging Groups Elder Law Center. This project was supported, in part by grant #90MP0187, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

EDITOR AND PROJECT DIRECTOR Kevin Brown This publication may be reproduced ONLY in its entirety. Permission to excerpt portions must be obtained prior to use. © 2015 CWAG. All rights reserved.

Buzz’s service to others began with four years in the U.S. Air Force where he taught electronics and served in the Airborne Early Warning program. He is a veteran of the Korean Conflict. Continued on page 2 FRAUD ALERT! ● Coalition of Wisconsin Aging Groups Elder Law1 Center

2850 Dairy Drive Madison, WI 53718-6742 608-224-0606 www.cwag.org  [email protected]

Let’s Get Acquainted continued Following his military service, Buzz attended the UW-Madison and UW-Platteville. He became a medical technologist with a lifetime appointment as a clinical laboratory scientist. After a 20-year career in various hospitals, Buzz decided to change career paths and became a rural mail carrier for the U.S. Postal Service. He delivered mail to over 500 homes in the Madison area for more than 20 years until he retired on April 1, 2000. When not volunteering, Buzz’s favorite hobby is reading. Wisconsin SMP salutes and thanks Buzz for his service to our country and to senior citizens in our state!

WI SMP to Hold Volunteer Trainings in Madison, Campbellsport, and Platteville By Kevin Brown, Wisconsin SMP Project Director Healthcare fraud is a big problem in the United States. According to estimates from the Office of Management and Budget (OMB), the Medicare and Medicaid programs made over $64 billion in improper payments in fiscal year 2013. The OMB has labeled Medicare Fee-for-Service (Part A and B), Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), and Medicaid as “high-error” federal programs because they are particularly vulnerable to fraud, waste, and abuse. Fortunately, the federal government has expanded its anti-fraud efforts for these programs over the past six years. Since January 2009, the U.S. Department of Justice has recovered $14.5 billion in federal health care funds. Wisconsin SMP (Senior Medicare Patrol) is an important part of these efforts. Wisconsin SMP has more than 50 dedicated volunteers who make presentations to groups and distribute materials at community events across the state to educate Medicare beneficiaries, caregivers, and professionals about how to prevent, detect, and report healthcare fraud, waste, and abuse. We have an excellent group of volunteers, but we are always looking for new ones so that we can spread our message of fraud prevention to more people around the state. I am pleased to announce that we will be hosting three workshops for new volunteers in the coming months. Wisconsin SMP Volunteer Trainings will be held from 9:30 a.m. until 3:30 p.m. at the following locations:   

Coalition of Wisconsin Aging Groups (in Madison) – February 27 Campbellsport Public Library – April 28 Platteville Public Library – May 14

The Wisconsin SMP Volunteer Training is an in-depth workshop that provides participants with a foundation of knowledge in four main areas: the SMP program; Medicare basics; Medicare fraud, errors, and abuse basics; and common scams and fraud within specific Medicare services. It is open to volunteers and professionals who are interested in learning how to protect seniors from healthcare fraud. If you would like to attend one of these sessions, please contact Will Armstrong at (608) 2216121 or [email protected]. 2

Medical College of Wisconsin Pays $840,000 to Settle Medicare Fraud Claims The U.S. Attorney’s Office announced on January 9 that the Medical College of Wisconsin (MCW) paid $840,000 to resolve allegations that it billed Medicare for false claims. MCW allegedly billed Medicare for neurosurgeries involving residents who did not receive the level of supervision from teaching physicians required by law. The payment settles a False Claims Act lawsuit claiming that MCW billed for surgeries between 2006 and 2013 as though teaching physicians were always present. The whistle-blower who filed the action, a surgeon in residency at the college, will receive a portion of the settlement. The False Claims Act enables individuals with knowledge of fraud to sue on behalf of the government. Federal prosecutors then decide if they would like to join the case. “The federal government’s focus on this matter was on compliance with Medicare regulations regarding requirements for surgical schedules and billing,” MCW spokeswoman Maureen Mack said. “Patient safety was not an issue. MCW cooperated fully with the government throughout this investigation.” According to the U.S. Attorney’s Office, MCW denies the allegations that it intentionally billed Medicare when resident physicians were not properly supervised by teaching physicians. Mack said that the college has already addressed the issue internally to ensure compliance with the Medicare regulations in the future. U.S. Attorney James Santelle said, “The settlement we are announcing today reflects the focused, sustained, and purposeful efforts of the Justice Department, together with our partnered federal agencies, to investigate and redress fraud in our health care system.” Source: Milwaukee Journal Sentinel (January 9, 2015)

U.S. Attorney Seeking Aurora Documents in Federal Fraud Investigation The U.S. Attorney’s Office has asked a federal judge to order Aurora Health Care to release over 600 documents that it is seeking in a civil investigation involving fraudulent payment claims made to the federal government. The petition requesting the records is heavily redacted and does not provide details about the probe. However, the petition does state that the U.S. Attorney is investigating possible violations of the False Claims Act. The U.S. Attorney first requested the documents on January 31, 2014. As of December 30, 2014, Aurora had turned over 1,260 records, including more than 300 medical records. According to the petition, Aurora Health Care argues that the remaining documents are protected under the state’s peer review statute under which peer-review committees investigate medical errors in health care settings. Generally, the work of a peer-review committee is kept confidential so that employees feel comfortable reporting errors and to allow the committee to examine the root causes of the error without the risk of their investigation being subpoenaed in a medical malpractice lawsuit. Aurora contends that the remaining documents were “created in order to help improve the quality of health care.” 3

The U.S. Attorney argues that state law does not apply in a federal case and that federal common law does not recognize a peer review privilege that would prevent documents from being subpoenaed in an investigation. Source: Milwaukee Journal Sentinel (December 30, 2014)

Reprinted with permission of the Wisconsin Better Business Bureau January 9, 2015

Watch Out for Fake Gmail Messages in Your Inbox Have a Gmail account? Watch out for scam emails posing as messages from Google. They may look like official notices about your account, but they carry malware. How the Scam Works: You receive an email that appears to be a message about your Google or Gmail account. One version of this scam informs you that “You have exceeded your email limit quota.” Another tells you that “you have a deferred email.” The text is hyperlinked in both, implying that you should click for more information. Don’t do it! Clicking on the link will download malware to your computer. Once on your machine, it can hunt through your files for personal and banking information. This opens you up to the possibility of ID theft. These scam emails are particularly tricky because they look so real. They have details like Google's address in the footer. One version actually has a link to “unsubscribe” and “change my notification settings.” Be sure not to click these links because they also may contain malware. How to Spot a Scam Email: Check out the “From” field: Scammers have the ability to mask email addresses, making the message appear to come from a legitimate source. But they don't always use it. In this scam, the “Google” emails aren't actually from a @google.com address. Watch for typos, strange phrasing and bad grammar. Scammers can easily copy a brand's logo and email format, but awkward wording and poor grammar are typically a give away that the message is a scam. In the example above, the phrases “limit quota” and “deferred email” are a sign that something’s not right. Hover over URLs to reveal their true destination. Typically, the hyperlinked text will say one thing, but the link will point somewhere else. Scammers either set up fake websites or hack into thirdparty sites and use them to host malware. Watch for look alike URLs. Be wary of sites that have the brand name as a subdomain of another URL (i.e. brandname.scamwebsite.com) or part of a longer URL (i.e. companynamecustomersupport.com). 4

For More Information For more information about scams impersonating Gmail and other Google products, check out support.google.com. To find out more about other scams, check out BBB Scam Stopper.

Senate Aging Committee Releases Report on Fraud Hotline In November 2013, the U.S. Senate Special Committee on Aging launched a Fraud Hotline designed to help individuals victimized by scams targeting seniors. The Hotline assists older consumers by informing them about the steps they can take when they are a target of a scam, including where to report the fraud and ways to decrease the chances of becoming a victim or repeat victim. In the first year of the Hotline, Aging Committee staff responded to over 1,900 reports of fraud impacting seniors. Last month, the committee released a report summarizing the “lessons learned” from the Fraud Hotline. The report highlighted the “most common scams” reported to the Hotline, including the following: Computer Scams: Increasingly, fraudsters are using computers to obtain personal information from victims. They often target seniors because they may be less technologically shrewd than younger consumers. In the “tech support” scam, fraudsters trick victims into believing that 1) they work at a reputable tech company and 2) their computer is infected with a virus. The scammers then stress that they could “fix” the virus if they had remote access to the computer. If the fraudsters are granted remote access to the computer, they often download malware that steals sensitive information from the victim. Grandparent Scams: In these scams, con artists pretend they are with a family member, often a grandchild, who needs money for medical or legal expenses, such as bail money. The scammer will then ask the victim to send money through a wire transfer or a prepaid debit card so that they can help the “relative.” The fraudsters perpetrating this crime often have obtained personal family information from social networking sites to make their stories sound more convincing. Health-Related Scams: The majority of the health-related scams reported to the Hotline involved seniors receiving fraudulent calls about medical alert devices. Scammers attempted to obtain personal information or trick seniors into paying for devices that they never ordered. Identity Theft: The Federal Trade Commission has reported identity theft as the most common consumer complaint for 14 years in a row. Thieves can obtain personal information by stealing a wallet or purse, posing as a representative of a legitimate company, digging through the trash, or obtaining a credit report by posing as a landlord or employer. Medical identity theft can occur when a con artist impersonates a Medicare representative and asks for an individual’s Social Security or Medicare number. The committee report notes: “Representatives of Medicare are not allowed to ask for a person’s Social Security number, bank account information or Medicare number over the phone.”

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Lottery Scams: In these scams, fraudsters trick victims into believing they have won an overseas lottery but need to make an advanced payment to cover taxes or fees before they can collect the prize money. Fraudsters generally request payment through a wire transfer or a prepaid debit card. Social Security Fraud: Since Social Security has opted to make electronic payments instead of mailing checks to beneficiaries, a new type of fraud has emerged. Fraudsters now try to re-route Social Security benefits from a victim’s account to their own account. If you know someone who has been a victim of fraud, or if you suspect that they may become a victim, you can contact the Fraud Hotline at 1-855-303-9470 or via email by completing an online form at www.aging.senate.gov/fraud-hotline. Source: “Fighting Fraud: Lessons Learned from the Senate Aging Committee’s Consumer Hotline” (December 11, 2014)

Reprinted with permission of the Centers for Medicare & Medicaid Services January 22, 2015

CMS Launches Dialysis Facility Compare Ratings Today, the Centers for Medicare & Medicaid Services (CMS) added star ratings to the Dialysis Facility Compare (DFC) website. These ratings summarize performance data, making it easier for consumers to use the information on the website. These ratings also spotlight excellence in health care quality. In addition to posting the star ratings, CMS updated data on individual DFC quality measures to reflect the most recent data for the existing measures. “Star ratings are simple to understand and are an excellent resource for patients, their families, and caregivers to use when talking to doctors about health care choices,” said CMS Administrator Marilyn Tavenner. “CMS has taken another step in its continuous commitment to improve quality measures and transparency.” DFC joined Nursing Home Compare and Physician Compare in expanding the use of star ratings on CMS websites. The DFC rating gives a one to five-star rating based on information about the quality of care and services that a dialysis facility provides. Currently, nine DFC quality measures are being used collectively to comprise the DFC star ratings. In the future, CMS will add more measures. In related news, CMS plans to add the Standardized Readmission Ratio (SRR) for dialysis facilities to the publicly reported quality outcome measures available on the Compare website. SRR is a measure of care coordination. SRR is not included in DFC’s star rating at this time. DFC quality measure data is either updated quarterly or annually. CMS plans to update the DFC’s star rating on an annual basis beginning in October 2015. For more information on the DFC’s Star Rating Methodology, visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/201501-22.html. 6

For more information on Dialysis Facility Compare, please visit: http://www.medicare.gov/dialysisfacilitycompare/#search.

Reprinted with permission of the Federal Trade Commission January 9, 2015

Company That Touted Products’ Ability to Treat Children’s Speech Disorders Settles FTC Charges It Deceived Consumers An Illinois company and its owner will stop making allegedly deceptive claims that their dietary supplements are proven effective at treating childhood speech disorders, including those associated with autism, in order to settle Federal Trade Commission charges. Under the FTC settlement, the defendants also will pay $200,000 and are required to disclose any material connections with their endorsers. “Parents of children with speech disorders need accurate information about products that may be able to help,” said Jessica Rich, Director of the Bureau of Consumer Protection. “This company took advantage of parents’ trust.” Since at least 2008, NourishLife, LLC and its owner, Mark Nottoli, have sold Speak softgels and capsules and Speak Smooth liquid children’s supplements online and through a network of distributors for more than $70 per bottle. The supplements – which contain Omega-3 and Omega-6 fatty acids and Vitamins E and K – were advertised via the Internet, including search engine ads such as Google sponsored links and on websites, and at conferences on autism spectrum disorders. For example, a Google sponsored link for Speak products, which could display if consumers searched on the term “toddler speech problems,” contained the statement, “Healthy Speech for Child – SpeechNutrients speak Supplement” and linked to a web page claiming the supplements were developed by a pediatrician to support “normal and healthy speech development and maintenance.” That web page also included a statement from a parent endorsing the product, who said “[my daughter] is speaking in more complex sentences and she is less gittery [sic], more focused.” Other statements from parent endorsers appeared in product brochures and on speechnutrients.com, such as: “Speak vitamins have made my little boy talk. He is five years old and has not spoken until I began giving him the vitamins.” “We were really amazed when Ben started singing along with a song on the radio . . . . and he was singing 3+ word phrases, not just one word here & there.” According to the FTC’s complaint, between 2008 and late 2013, ads for Speak products made unsupported claims that the supplements develop and maintain normal, healthy speech and language capabilities in children, including those with verbal apraxia -- a motor speech disorder affecting the ability to utter sounds, syllables, and words. These ads, the complaint asserts, also falsely claimed that Speak products are scientifically proven to improve children’s speech. In addition, the complaint charges that ads for Speak products deceptively 7

claimed that the supplements are effective in treating or mitigating verbal apraxia and communication and behavioral difficulties in children with an autism spectrum disorder. The FTC’s complaint also charges that the defendants provided promotional materials making these false and deceptive claims for Speak products to third-party distributors that sold the supplements. In addition, the FTC’s complaint charges that the defendants misrepresented a website called apraxiaresearch.com, which they owned and operated, to be an independent resource for research and other information relating to the treatment of apraxia. In fact, according to the FTC’s complaint, that website advertised the health benefits of defendants’ Speak products. The complaint also asserts that the defendants failed to disclose their affiliation with the Apraxia Research website and with parent endorsers of Speak products who received free supplements. The proposed order settling the FTC’s charges would prohibit NourishLife and Nottoli from making false or unsubstantiated claims about the effectiveness of any dietary supplement, food, or drug, including but not limited to their Speak products. The proposed order also would bar the defendants from providing third-party distributors with deceptive marketing materials or otherwise providing others with the means to make these prohibited claims. In addition, it would prohibit the defendants from misrepresenting the independence of any website or other publication that advertises their products, and would require them to clearly and prominently disclose any material connections to any such website or publication, or to any person endorsing their products. The proposed order imposes a judgment of $3.68 million, which will be partially suspended – based on the defendants’ inability to pay – after they pay $200,000. The Commission vote approving the complaint and proposed final order was 5-0. The complaint was filed in the U.S. District Court for the Northern District of Illinois, Eastern Division, on January 7, 2015. A motion for the court to enter the proposed final order was filed on January 9, 2015. The case is part of the FTC’s work to challenge false and deceptive claims about cognitive products for adults and children. Information for Consumers When it comes to treatments for health and fitness, it can be tough to tell useful products and services from those that don’t work or aren’t safe. For more information, see the FTC’s guidance on Treatments & Cures. The FTC is a member of the National Prevention Council, which provides coordination and leadership at the federal level regarding prevention, wellness, and health promotion practices. This case advances the National Prevention Strategy’s goal of increasing the number of Americans who are healthy at every stage of life. NOTE: The Commission files a complaint when it has “reason to believe” that the law has been or is being violated and it appears to the Commission that a proceeding is in the public interest. Stipulated orders have the force of law when approved and signed by the District Court judge.

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FTC Hosts Tax Identity Theft Awareness Week The Federal Trade Commission (FTC) will conduct a week of events Jan. 26-30 to raise consumer awareness about the threat posed by tax identity theft. This year’s Tax Identity Theft Awareness Week will include:   

Jan. 27, 2 p.m.: an FTC webinar for consumers, co-hosted with the Treasury Inspector General for Tax Administration and AARP addressing how tax identity theft happens and what consumers should do if they become a victim. Jan. 28, 1 p.m.: the FTC and the Veterans Administration will host a webinar with information about tax identity theft for veterans. Jan. 29, 3 p.m.: the FTC and the Identity Theft Resource Center will co-host a Twitter chat about tax ID theft – consumers can join the conversation on #IDTheftChat.

In addition to these events, the FTC has created a wide array of materials to help educate consumers about this growing issue, all of which can be found at ftc.gov/taxidtheft. The materials are in several languages and feature ways consumers can share information about tax identity theft with their friends and families. Source: Federal Trade Commission News Release (January 14, 2015)

Upcoming Wisconsin SMP Activities Date

Activity

County

February 3 February 7 February 11 February 12 February 16 February 19 February 19 February 23 February 25 February 27 March 3 March 3 March 9 March 17 March 23 March 25 March 26 March 31

SMP Presentation-St. Nazianz Nutrition Site SMP Booth-Ready, Set, Retirement Event-Madison SMP Presentation-Valders Nutrition Site SMP Presentation-Hallmark Place-Kimberly SMP Presentation- Manitou Manor Nutrition Site SMP Booth-Nursingmatters Expo 2015-Madison SMP Presentation-Cassian Senior Dining Site SMP Presentation-Nokomis Senior Dining Site SMP Presentation-Lake Tomahawk Senior Dining Site SMP Volunteer Foundations Training-Madison SMP Presentation-St. Nazianz Nutrition Site SMP Presentation-Touchmark Apts.-Appleton SMP Presentation-Dodgeville Kiwanis Club SMP Presentation-Rhinelander Senior Dining Site SMP Presentation-Woodruff Senior Dining Site SMP Presentation-Waunakee Senior Center SMP Presentation-Sugar Camp Senior Dining Site SMP Presentation-Three Lakes Senior Dining Site

Manitowoc Dane Manitowoc Outagamie Manitowoc Dane Oneida Oneida Oneida Dane Manitowoc Outagamie Iowa Oneida Oneida Dane Oneida Oneida

We are always looking for opportunities to support our colleagues in the aging network. Please contact Wisconsin SMP and let us know about upcoming events in your area. 9

Wisconsin SMP Coalition of WI Aging Groups 2850 Dairy Drive Ste. 100 Madison WI 53718

ATTENTION: All of You with Email… In an effort to save paper, postage and be “volunteer friendly,” we will email issues of the Fraud Alert! to those who have email. Please contact Kevin Brown at [email protected] and give him your email address to add to our list. Thank you! For more information, contact: Kevin Brown, SMP Project Director Coalition of Wisconsin Aging Groups Elder Law Center 2850 Dairy Drive – Suite 100 Madison, WI 53718-6742 Phone: 800/488-2596 608/224-0606 Email: [email protected] You can also access our publication by visiting our web site www.wisconsinsmp.org Or you can visit the Coalition of Wisconsin Aging Groups web site www.cwag.org Click on Publications then click on Wisconsin Senior Medicare Patrol (SMP) and scroll down and click on the edition you wish to view.