Healthcare Scams

With open enrollment under the Affordable Care Act set to begin Oct. 1, officials at the new health insurance Marketplaces are gearing up to help consumers. Call centers have been launched. “Navigators” to help consumers are being trained. Ad campaigns are under way in the states operating their own Marketplaces.

…and crooks are already at work, too, eager to pretend to help people enroll as they steal personal information, money, or both.

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Health care scams are increasing, officials say, and they expect the trend to get worse. “ACA scams are a top priority for the FTC [Federal Trade Commission], and we expect to receive more consumer complaints about them when the health insurance Exchanges get started,” says Frank Dorman, an FTC spokesman.

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Even savvy consumers might listen to a scammer’s pitch without realizing that it’s bogus because there’s so much confusion about the health care law. In an August poll, the Kaiser Family Foundation found that 51% of Americans don’t understand how the law will affect them.

Confusion is the scammer’s No. 1 tool. Obamacare cons have been rearing up all around the country, says James Quiggle, a spokesman for the Coalition Against Insurance Fraud.

Three types of scams are especially popular now:

1. The ”Threat of Jail’ — and Other Urgent Emails

The subject line of one email going around sounds good: “Avoid overpaying and comply with the law by getting health coverage now.”

The text that follows, though, is a lie — and frightening: “With the president’s health care mandate now passed into law, you could face prison time if you do not get health care coverage immediately.”

Under the Affordable Care Act, most people do have to have health insurance. The penalty, though, is not jail. In 2014, it’s1% of your income or $95, whichever is greater.

Next, the email claims to offer help: “We can help you avoid penalties and find an affordable plan.” Readers are then invited to find competing companies with the lowest prices simply by entering their ZIP code. They are also given a web site to click to and are reminded again that they’re breaking the law without health care coverage.

Never give your personal information to anyone who has contacted you. Even if that email looks legit, complete with state seals or other official emblems, don’t supply information. Any kind of online form can be masked to look very professional. The federal government won’t cold call you or send unsought emails about the new health care law.

2. Solicitors on the Phone or at Your Door

Phone solicitors are offering people an “Affordable Care Act card,” sometimes telling them they’re among the first. The caller will say something like, “You need an Affordable Care Act card. If you just give me your information, we will get your card out to you.” Typically, they ask for a Social Security number and bank account number, which is all they need to drain your savings.

Remember, there is no such thing as an Affordable Care Act card.

A twist on this scam is to tell seniors they need an Affordable Care Act card to replace their Medicare card, or a new Medicare card. Neither is true.

Even if the caller ID looks official, it may not be. Scammers are good at masking the caller ID or creating a caller ID that looks official, such as ”U.S. Government,” a practice known as spoofing.

Door-to-door ”representatives” should be ignored like the phone callers. The moment someone knocks on your door and says they are from the federal government, you know it’s a lie. Don’t engage them.’

Tell them you are going to contact authorities. You can file a complaint with the FTC by phone (877-382-4357) or online.

3. Fake Navigators and Other Helpers

When open enrollment begins, helpers known as navigators (as well as other types of enrollment helpers, insurance agents, and brokers) will stand ready to help guide consumers. In August, the Department of Health and Human Services awarded $67 million in grants to 105 navigator programs in the Marketplaces.

Navigators work through the organizations awarded the grants, and they range from United Way to universities, Planned Parenthood, and community health centers. They are trained and certified, and must renew their certification annually.

If a caller says he is from the local community center, he may sound legit but still be a crook. “We’ve heard about people posing as navigators and asking for personal information,” says Carrie McLean, who directs customer care for eHealthInsurance.

If you have any suspicion about whether a navigator is certified, McLean says, check with the state Marketplace or your state’s department of insurance.

Gray Areas

Besides the out-and-out scams, there are some ”gray areas” that also can be confusing.

Insurance agents or insurance companies may launch a web site aiming to make health care reform understandable and suggest it’s an official, state-run site. The operators may be licensed and legitimate, but it bears checking. And they should be clear, if you ask, that they are not the state Marketplace.

Consumers might expect the web site for their state Marketplace to have a “.gov” ending, but not all of them do. To figure out if a web site you’re on is your state’s Marketplace or another, go to healthcare.gov and enter your state’s name. Healthcare.gov is the federal government’s official web site with information about health care reform.