Scammers are taking advantage of the Medicaid redetermination process to trick one of the most vulnerable populations into paying to keep their health benefits.
States halt removal of ineligibles from their Medicaid rolls in exchange for increased federal funds during the COVID-19 pandemic, resulting in Medicaid enrollment rising to a record 97 million beneficiaries, according to the Kaiser Family Foundation. Congress authorized states to begin removing people from Medicaid in April and gave states 14 months to complete the process.
States are ramping up staffing, investing in technology, and partnering with insurers to manage the process. Scammers are betting that the best efforts of states won’t be enough and are calling and texting Medicaid enrollees in some areas to say that unless they pay up to $500, they will lose coverage, said Lindsey Browning, director of the Medicaid program at the National. Association of Medicaid Directors, representing public officials.
“It’s unfortunate because Medicaid has been trying to get a clear message out of what action people need to take (and) when and that’s really complicating that,” Browning said.
Most state Medicaid agencies are referring individuals who have been scammed to their attorney general’s office, she said.
Medicaid members who are victims of phone scams should contact their local police department or report their experience to the Federal Trade Commission, a spokesperson for the Centers for Medicare and Medicaid Services. said in an email. The FTC did not respond to a request for an interview.
According to a recent report by the Urban Institute, the majority of adults enrolled in Medicaid policies are unaware the redetermination process is underway. The Department of Health and Human Services expects up to 7 million of the 15 million individuals who will lose coverage during the redetermination process to be dropped for procedural reasons, such as the absence of relevant information. current contacts on file even though they are financially eligible.
Joe Records, a counsel at the law office of Crowell & Moring, where he primarily represents managed care companies, said that along with taking advantage of consumers’ insurance ignorance, scammers Scammers are taking advantage of states and the federal government’s inexperience in investigating phone scams whose victims are Medicaid beneficiaries. . Agencies focus on charging individuals or organizations with improper billing to Medicaid agencies.
“[State and federal regulatory offices] Records was not designed to address issues such as consumer protection,” Records said. “At their core, they are designed as a program integrity tool to ensure that the Medicaid program is not scrapped.”
The attorneys general of several states have established dedicated healthcare efforts in their consumer financial protection offices, but phone scammers can be difficult to catch.
“These are very difficult types of proposals, where it is very difficult to pinpoint the source of the scam and difficult to quell it,” Records said.
Marketing director Caleb Smith said Enroll Wyoming, a nonprofit community organization focused on connecting people to health insurance, began receiving information in late March that Medicaid beneficiaries receive Get calls from scammers asking for money to maintain insurance. An estimated 17,000 Wyoming residents will lose Medicaid benefits once the state completes its eligibility check, according to an analysis by Modern Healthcare.
“I think people should do more,” Smith said. “A money-making scam will be copied or it will be regulated. That’s what’s going to happen here.”
Smith said scammers have previously impersonated employees at Enroll Wyoming to sell fake short-term or insurance policies to individuals. But he says he’s never seen scammers asking for cash to hold Medicaid benefits before. Smith said the nonprofit is trying to stay informed by notifying community organizations and suppliers, and posting notices on its website, social media accounts and member newsletters. me.
“We’re still early, we’re not sure what the impact will be,” he said.
Arizona officials have updated the state’s Medicaid website to include information about the Wyoming scam, as well as outline how individuals can report fraudulent activity to the agency, said Kristen Challacombe, deputy director of operations. operations at the Arizona Healthcare Cost Containment System. The state’s Office of the Inspector General has no experience investigating schemes that threaten Medicaid members, she said.
“Our Office of the Inspector General was established to study referrals to the office of fraudulent members and fraudulent suppliers,” said Challacombe. “I didn’t know we were looking at the members being scammed because I didn’t think it was really common until the recent activity.”
Arizona plans to text people on Medicaid to say that officials will contact about the redetermination through text messages and automated calls, but will never ask for payment, Challacombe said. The state also extended a $121.3 million contract with consulting firm Accenture to enable two-way messaging through its Medicaid enrollment and eligibility technology system, so that state representatives can pay answer individual questions, Challacombe said.
Messaging is by far Arizona Medicaid’s most effective tool for reaching enrollees. Officials last year sent automated calls, letters and texts to Medicaid members reminding them to update their contact information, and text messages had the highest response rates, Challacombe said. According to a Modern Healthcare analysis, more than 504,000 Arizona residents will lose coverage during the redetermination period.
“This is where we will seek to build trust and understanding with our members,” says Challacombe.
