Mistakes happen. But sometimes people are led down the wrong path.
In a recent column, I touched on Medicare fraud after being told of a widespread concern in the Lake of the Pines area of Nevada County. Last week, this issue hit home with several seniors in south Nevada County receiving cancellation calls. The calls, which began Dec. 5, were from Healthnet canceling their Medicare Advantage plan as of Dec. 31.
The problem is concentrated on zip code 95602 because it appears in two counties: Placer and Nevada. And people in Lake of the Pines have an Auburn mailing address yet still live in Nevada County.
This is not the first time seniors in the area lost Medicare plans. In February of this year, Kaiser terminated an estimated 300 members in Lake of the Pines who were told they did not live in the coverage area for Kaiser Senior Advantage. In community meetings last February, I was told by more than one person that they were encouraged to secure P.O. boxes in Auburn or use company addresses to maintain their Kaiser coverage. This is clearly insurance fraud.
Fraud is a crime and is also a civil law violation. Defrauding people, companies or the government of money is presumably the most common type of fraud.
County differences — Most Medicare Advantage plans are provided and priced based on county usage, network contracts and company guidelines (different coverage area for Kaiser). Your permanent residence address is used as your county of residence and each county is treated uniquely. For example in 2012: Sutter, Yuba and Butte counties have no Advantage plans. Nevada County has one. Placer has five.
Seniors receiving the calls last week are Nevada County residents who were enrolled in a Placer County Medicare plan. Some seniors reported they were enrolled in these plans by unethical agents who knew they were in Nevada County but enrolled them in the Healthnet plan available only to Placer County residents.
What you risk — Individuals enrolled illegally risk having medical claims retroactively denied and possible legal action if they knowingly attempted to defraud Medicare or an insurance company.
What you should do — For seamless continuation of coverage, Nevada County residents enrolled in the Placer County Healthnet Advantage plan have the full month of December to switch plans, which will be effective Jan. 1.
Report fraud — If you have been enrolled in any plan that is not for your residence address due to an unethical agent, you should report the agent and company. This can create a special opportunity for you to change plans now that the annual enrollment period has ended (Oct. 15 through Dec. 7). This will allow you to start new coverage Jan. 1. The Medicare Fraud Hotline is (800) 350-2098.
Bill Anderson lives in Nevada County and is licensed, certified and authorized to present, provide and bring clarity to Medicare plan choices. Anderson conducts individual and community meetings throughout Nevada and Placer counties. He can be reached by email at Bill@MedicareDoneRight.com or by calling (530) 432-7988. For a list of Nevada County Medicare Community Meetings go to www.MedicareDoneRight.com.