HHS delays final agreement with insurers over federal health exchanges

(Reuters) — The Obama administration has delayed a step crucial to the launch of the new health care law, the signing of final agreements with insurance plans to be sold on federal health insurance exchanges starting Oct. 1.The U.S. Department of Health and Human Services notified insurance companies on Tuesday that it would not sign final agreements with the plans between Sept. 5 and 9, as originally anticipated, but would wait until mid-September instead, according to insurance industry sources.

Nevertheless, Joanne Peters, a spokeswoman for HHS, said the department remains “on track to open” the marketplaces on time on Oct. 1.

The reason for the holdup was unclear. Sources attributed it to technology problems involving the display of insurance products within the federal information technology system.

Ms. Peters said only that the government was responding to “feedback” from the companies, “providing additional flexibility and time to handle technical requests.”

Coming at a time when state and federal officials are still working to overcome challenges to the information technology systems necessary to make the exchanges work, some experts say that even a small delay could jeopardize the start of the six-month open enrollment period.

U.S. officials have said repeatedly that the marketplaces, which are the centerpiece of President Barack Obama’s signature health care reform law, would begin on time.

But the Oct. 1 deadline has already begun to falter at the state level, with Oregon announcing plans to scale back the launch of its own marketplace and California saying it would consider a similar move.Tuesday’s notification by the Centers for Medicare and Medicaid Services, the HHS agency spearheading marketplace development, affects insurance plans that would be sold in federal exchanges that the administration is setting up in 34 of the 50 U.S. states. The remaining 16 states, including Oregon and California, are setting up their own marketplaces.

“It makes me wonder if open enrollment can start on Oct. 1,” said a former administration official who worked to implement President Obama’s health care reform.

“But having everything ready on Oct. 1 is not a critical issue. What matters to people is Jan. 1, which is when the coverage is supposed to start. If that were delayed, it would be a substantive setback.”

Obama’s Patient Protection and Affordable Care Act is expected to extend federally subsidized health coverage to an estimated 7 million uninsured Americans in 2014 through the marketplaces.

But insurance plans must be qualified to meet specific standards if they are to be sold on the exchanges. And each insurer must sign a contract with the federal government.

The new timetable for qualified plan agreements is the latest in a series of delays for Obamacare.

The most significant came in early July when the White House and the Treasury Department announced a one-year delay in a major Obamacare provision that would have required employers with at least 50 full-time workers to provide health insurance or pay a penalty beginning in 2014.

Legal and political opposition from Republicans and their conservative allies have already fragmented Obamacare’s original vision.Only about half the states have opted to expand Medicaid program for the poor to uninsured families living below the poverty level, and Republicans in Congress have denied nearly $1 billion in new implementation funding this year alone.

The Government Accountability Office cautioned in June that the law known as Obamacare could miss the Oct. 1 enrollment deadline because of missed deadlines and delays in several areas including the certification of health plans for sale on the exchanges.

Another U.S. watchdog, the HHS Office of the Inspector General, warned earlier this month that the government was months behind testing data security for the federal data hub that represents the information technology backbone of the new marketplaces.

The state of Oregon has already scaled back the Oct. 1 debut of its own health care exchange by preventing state residents from signing up for coverage on their own until mid-October. California said last week that it, too, would consider a soft launch of its exchange if tests show it is not ready to accommodate wide public access.

IRS issues final rules on Obamacare’s ‘individual mandate’

I found this article on Reuters Mobile (us.mobile.reuters.com) and thought you might find it interesting:

By Kim Dixon and Patrick Temple-West

WASHINGTON | Tue Aug 27, 2013 5:05pm EDT

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By Kim Dixon and Patrick Temple-West

WASHINGTON (Reuters) – The Internal Revenue Service issued final rules on Tuesday for the individual mandate of President Barack Obama’s healthcare overhaul, one of the most contentious elements of the U.S. law set to go into effect next year.

A centerpiece of Affordable Care Act, also known as Obamacare, is a requirement that all individuals carry some minimum health insurance or pay a tax. The new system aims to provide insurance through state marketplaces and subsidies for tens of millions of Americans who lack it.

If individuals choose not to carry insurance, they are subject to a penalty, starting at $95 per person per year or 1 percent of income in 2014, whichever is greater, and eventually reaching $695 per person or 2.5 percent of income by 2016.

The IRS, which is administering parts of the law involving revenue collection, released the final rules spelling out the details of what constitutes minimum essential coverage, and how individuals are responsible for spouses, children and other dependents, among other topics.

The individual mandate is distinct from the employer mandate, which imposes a fee on most large employers that do not offer a minimum level of coverage. The Administration delayed that provision, putting off the effective date until 2015.

Backers of the law say that, unlike the employer mandate, the individual mandate is essential to ensure enough individuals are enrolled in the system to allow the online marketplaces to function.

The rules announced on Tuesday offered good news to employees getting health coverage through a union-sponsored plan. They clarify that these employees will not be penalized, said tax lawyers who reviewed the rules on Tuesday.

The IRS rules also said employees getting healthcare coverage from a temporary staffing agency are safe from penalties.

The 2010 healthcare law, backed by President Barack Obama, a Democrat, passed without any backing from the Republican Party, which is still is trying to derail the legislation, with little success.

“I believe the individual mandate will go into effect,” said Tim Jost, a professor at Washington and Lee University law school, who backs the law.

“It is important for people to remember that it is phased in and the first year it has very little bite. Basically the idea is to make people realize that it is there.”

That is very different from the employer mandate where the fees will be in full force immediately upon the effective date, he added.

(Reporting by Kim Dixon and Patrick Temple-West.; Editing by Howard Goller and Andre Grenon)

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Happy Hump Day!

Happy Hump Day to you all! Remember don’t take yourself too seriously. Enjoy.

How to Charge $546 for six Liters of salt water

How to Charge $546 for Six Liters of Saltwater
By NINA BERNSTEIN
Of The New York Times printed August 25 2013

Proponents of this system say it saves hospitals billions in economies of scale. Critics say the middlemen not only take their cut, but they have a strong interest in keeping most prices high and competition minimal.

The top three group-purchasing organizations now handle contracts for more than half of all institutional medical supplies sold in the United States, including the IVs used in the food-poisoning case, which were bought and taken by truck to regional warehouses by big distributors.

These contracts proved to be another black box. Debbie Mitchell, a spokeswoman for Cardinal Health, one of the three largest distributors, said she could not discuss costs or prices under “disclosure rules relative to our investor relations.”

Distributors match different confidential prices for the same product with each hospital’s contract, she said, and sell information on the buyers back to manufacturers.

A huge Cardinal distribution center is in Montgomery, N.Y. — only 30 miles, as it happens, from the landscaped grounds of the Buddhist monastery in Carmel, N.Y., where many of the food-poisoning victims fell ill on Mother’s Day 2012.

Among them were families on 10 tour buses that had left Chinatown in Manhattan that morning to watch dragon dances at the monastery. After eating lunch from food stalls there, some traveled on to the designer outlet stores at Woodbury Commons, about 30 miles away, before falling sick.

The symptoms were vicious. “Within two hours of eating that rice that I had bought, I was lying on the ground barely conscious,” said Dr. Elizabeth Frost, 73, an anesthesiologist from Purchase in Westchester County who was visiting the monastery gardens with two friends. “I can’t believe no one died.”

About 100 people were taken to hospitals in the region by ambulance; five were admitted and the rest released the same day. The New York State Department of Health later found the cause was a common bacterium, Staphylococcus aureus, from improperly cooked or stored food sold in the stalls. Mysterious Charges

The sick entered a health care ecosystem under strain, swept by consolidation and past efforts at cost containment.

For more than a decade, hospitals in the Hudson Valley, like those across the country, have scrambled for mergers and alliances to offset economic pressures from all sides. The five hospitals where most of the victims were treated are all part of merged entities jockeying for bargaining power and market share — or worrying that other players will leave them struggling to survive.

The Affordable Care Act encourages these developments as it drives toward a reimbursement system that strives to keep people out of hospitals through more coordinated, cost-efficient care paid on the basis of results, not services. But the billing mysteries in the food poisoning case show how easily cost-cutting can turn into cost-shifting.

A Chinese-American toddler from Brooklyn and her 56-year-old grandmother, treated and released within hours from the emergency room at St. Luke’s Cornwall Hospital, ran up charges of more than $4,000 and were billed for $1,400 — the hospital’s rate for the uninsured, even though the family is covered by a health maintenance organization under Medicaid, the federal-state program for poor people.

The charges included “IV therapy,” billed at $787 for the adult and $393 for the child, which suggests that the difference in the amount of saline infused, typically less than a liter, could alone account for several hundred dollars.

Tricia O’Malley, a spokeswoman for the hospital, would not disclose the price it pays per IV bag or break down the therapy charge, which she called the hospital’s “private pay rate,” or the sticker price charged to people without insurance. She said she could not explain why patients covered by Medicaid were billed at all.

Eventually the head of the family, an electrician’s helper who speaks little English, complained to HealthFirst, the Medicaid H.M.O. It paid $119 to settle the grandmother’s $2,168 bill, without specifying how much of the payment was for the IV. It paid $66.50 to the doctor, who had billed $606.

At White Plains Hospital, a patient with private insurance from Aetna was charged $91 for one unit of Hospira IV that cost the hospital 86 cents, according to a hospital spokeswoman, Eliza O’Neill.

Ms. O’Neill defended the markup as “consistent with industry standards.” She said it reflected “not only the cost of the solution but a variety of related services and processes,” like procurement, biomedical handling and storage, apparently not included in a charge of $127 for administering the IV and $893 for emergency-room services.

The patient, a financial services professional in her 50s, ended up paying $100 for her visit. “Honestly, I don’t understand the system at all,” said the woman, who shared the information on the condition that she not be named.

Dr. Frost, the anesthesiologist, spent three days in the same hospital and owed only $8, thanks to insurance coverage by United HealthCare. Still, she was baffled by the charges: $6,844, including $546 for six liters of saline that cost the hospital $5.16.

“It’s just absolutely absurd.” she said. “That’s saltwater.”

Last fall, I appealed to the New York State Department of Health for help in mapping the charges for rehydrating patients in the food poisoning episode. Deploying software normally used to detect Medicaid fraud, a team compiled a chart of what Medicaid and Medicare were billed in six of the cases.

But the department has yet to release the chart. It is under indefinite review, Bill Schwarz, a department spokesman, said, “to ensure confidential information is not compromised.”

Cases Reported in Stomach Bug Outbreak Top 600 – US News and World Report

http://health.usnews.com/health-news/news/articles/2013/08/22/cases-reported-in-stomach-bug-outbreak-top-600

Cases Reported in Stomach Bug Outbreak Top 600

By Dennis Thompson
HealthDay Reporter

THURSDAY, Aug. 22 (HealthDay News) — U.S. health officials are continuing to search for the source of a nationwide stomach bug outbreak as the number of cases has topped 600, with 601 illnesses reported in 22 states.

According to statistics released Wednesday from the U.S. Centers for Disease Control and Prevention, at least 40 people, or 9 percent, have been hospitalized with severe cases of cyclospora infection. No deaths have been reported.

The source of the outbreak in at least two states was traced earlier this month to Taylor Farms, which supplied salad mix to Olive Garden and Red Lobster restaurants and is the Mexican branch of Taylor Farms of Salinas, Calif.

Taylor Farms de Mexico has “officially informed FDA that, as of Aug. 9, 2013, the company voluntarily suspended production and shipment of any salad mix, leafy green, or salad mix components from its operations in Mexico to the United States,” according to the U.S. Food and Drug Administration.

“To date, only the salad mix has been implicated in the outbreak of cyclosporiasis in Iowa and Nebraska,” the FDA said. The agency added it is still trying to determine whether the prepackaged salad mix was the source of infections in the other states.

States that now have recorded cases of cyclospora infection include Texas (250), Iowa (155), Nebraska (86), Florida (31), Wisconsin (16), Illinois (11), Arkansas (10), New York City (7), Georgia (5), Missouri (5), Kansas (4), Louisiana (3), New Jersey (3), Connecticut (2), Minnesota (2), New York (2), Ohio (2), Virginia (2), California (1), New Hampshire (1), South Dakota (1), Tennessee (1) and Wyoming (1).

Meanwhile, U.S. health officials said the overall investigation continues.

Prior outbreaks of cyclospora infection have typically been caused by tainted produce, the CDC noted.

One expert said recently that while cyclospora can make people very ill, it is not usually life-threatening.

“On the infectious disease scale, this ranks well below the more notorious and dangerous ailments like E. coli and salmonella,” said Dr. Lewis Marshall Jr., chairman of the outpatient services at Brookdale University Hospital and Medical Center in New York City.

“It is unlikely to be fatal, but certainly can make one’s life miserable,” he added. “Symptoms include crampy abdominal pain, watery diarrhea, loss of appetite, bloating, nausea, fatigue, fever, headache and body aches.”

Cases of cyclosporiasis are caused by a single-celled parasite and cannot be spread from person to person. The parasite has to be ingested via contaminated water or foods such as fruit and vegetables, according to Dr. Monica Parise, chief of the parasitic diseases branch at the CDC.

“It can be pretty miserable, because it can give diarrhea that can last for days,” Parise said.

It takes about a week for people who are infected to become sick.

Marshall said there may be more cases of cyclospora infection out there than people realize. It is possible “that most occurrences go unreported, as many people wouldn’t recognize the symptoms as any different than a common stomach bug,” he said.

Dr. Thomas Frieden, CDC director, has urged people who have suffered from diarrhea for longer than a couple of days to be tested for cyclospora.

Marshall agreed.

“If not treated, symptoms can last from a few days to a month or longer, go away and then return later,” Marshall said. “Cyclospora can be treated with an antibiotic combination of trimethoprim-sulfamethoxazole [Bactrim].”

The best option, however, is to avoid the bug altogether.

“The safest way to protect oneself and one’s family is to always rinse fresh produce under water, and even put vegetables in a cold water bath ahead of time to properly clean them,” Marshall advised.

One expert stressed that the wash-your-produce rule includes prepackaged salads.

“Wash all your fruits and salads before ingesting,” said Dr. Salvatore Pardo, vice chairman of the emergency department at Long Island Jewish Medical Center in New Hyde Park, N.Y. “My hunch is the public does not do this to ‘prepackaged’ salad, which is normally purchased for convenience and dumped into the bowl since it tends to be free from particles — dirt, sand, critters — one would normally find in locally picked ingredients.”

More information

For more information on cyclospora, visit the U.S. Centers for Disease Control and Prevention.

Copyright © 2012 HealthDay. All rights reserved.

Randy KelleyeMail: Kelleytx
Cell (910) 352-6444

Meet the Government’s Health Insurance Salesmen

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U.S. EDITION

Thursday, August 22, 2013 As of 2:49 PM EDT

• August 22, 2013, 2:49 p.m. ET

By Jen Wieczner

The government announced last week that it’s spending $67 million on staff known as “navigators” to help people enroll in health insurance for next year. But at the same time, it has handed off the enrollment baton to insurance sales agents and brokers, whom insurance companies pay for signing people up for their plans.

The Centers for Medicare and Medicaid Services reached agreements with at least five online health insurance brokers, making it possible for people to get their health plans there instead of on the government exchanges–similar to the way consumers can shop for airfare on Expedia or Orbitz rather than buying tickets directly from the airlines.

Among the brokers, which primarily sell individual health plans, are eHealth(EHTH), Towers Watson (TW), HealthCompare, Getinsured, ConnectedHealth and GoHealth. And there may be others. CMS says it can’t yet confirm how many brokers have received authorization to enroll eligible consumers in tax-subsidized health plans in the 36 states where the government will operate health insurance exchanges starting Oct. 1.

“The government is essentially deputizing us to help them enroll more people, which is really important,” says Bryce Williams, managing director of Towers Watson’s exchange solutions and founder of ExtendHealth. “It’s really not the government’s bailiwick.”

There are a few reasons the government will need help–mainly that their support staff, the navigators, might not provide the same level of customer support as the private brokerages, some insurance professionals say. While the Department of Health and Human Services expanded the reach of the navigators–federal funding increased $13 million from the $54 million originally planned–it also tied their hands from performing the key role that brokers have always played in insurance enrollment: navigators are not allowed to advise consumers on which plan to choose.

In prohibiting navigators from making recommendations or directing consumers to health plans, the government intended to rid the new health exchange marketplace of the biased influence of the insurance industry–namely, agents and brokers who earn commissions for enrolling people in certain plans. The navigators are not allowed to have any ties to health insurers or carriers, and have to undergo about 30 hours of online training, which teaches them to remain neutral and avoid bias, says Tracey Keiser, president and CEO of The Keiser Group, a health care benefits strategy and consulting firm. But the rule reduces navigators to little more than hand holders, some argue. “They’re there to help the people enroll and that’s it — they’re not really there to give them advice,” says Keiser. “The only assistance they can provide is how to choose the coverage, not which coverage to choose.”

And that might not be enough for the 25 million to 30 million additional consumers expected to enroll in health insurance under the Affordable Care Act. Consumers will be hungrier for personalized advice and recommendations than ever, Keiser predicts: “Without a doubt, the average person is going to say, What should I do? And they’re going to expect someone to give them answers.”

After all, in order to find an appropriate plan, consumers will have to not only consider the upfront cost of the insurance policy, but also their specific health conditions and how the plan will cover their needs. “Matching them to the right plan is big,” Williams says. “It’s going to be more akin to having to do your taxes, and less like buying a scarf on Amazon.”

Of course, unlike the government, brokers earn commissions for enrolling people in certain insurance plans, which a fact that surely informs their advice, consumer advocates say. They might try to influence the consumer by presenting plans that don’t pay them commissions after the ones that do, or not at all if they aren’t required by law, says Caroline Pearson, vice president of Avalere, a health care research and consulting firm. “It is not a level playing field in that sense,” she says.

Consumers should be wary of sales pitches for additional products they don’t necessarily need to comply with the ACA mandate, says Laura Adams, senior insurance analyst for InsuranceQuotes.com, part of Bankrate.

That said, the commissions, which amount to about 4% to 7% of monthly premiums, are always built into the price of health plans, so people will pay the same amount no matter where they enroll, Williams says. If consumers don’t use a broker, the insurance carrier just keeps the commission.

CMS, for its part, has acknowledged that brokers and agents will play a part in the new insurance exchanges. “We anticipate that many consumers will want to obtain professional advice from agents and brokers when applying for and selecting a qualified health plan,” it writes on its website about the consumer assistance available in the marketplaces.

Why We Can and Must Focus on Preventing Alzheimer’s

by David Perlmutter, MDAug 22, 2013 4:45 am EDT

New research shows that our diet has a significant impact on our neurological health. But why aren’t doctors acting to prevent diseases like Alzheimer’s, rather than only treating them? Dr. David Perlmutter, author of the new book Grain Brain, on the need to change our approach to health care.

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Last week, a study published in The New England Journal of Medicineshowed how levels of blood sugar directly relate to risk for dementia. The investigation followed over 2,000 elderly individuals for an average of 6.8 years and found that even small elevations of blood sugar translated into a significant increased risk for dementia, even among persons without diabetes.

Tom Grill/Corbis

The implications of this report are profound. While the correlation of dementia risk, and specifically Alzheimer’s disease, with diabetes has been established, this new finding throws a much wider net in terms of defining an at risk population for an incurable brain disorder. But despite the potential public health impact of these findings, this correlation received almost no media attention.

The Unites States has now been granted the distinction of ranking first in terms of increased number of deaths from neurological diseases including dementia. In a recent report in the journal Public Health, Prof. Colin Pritchard and colleagues from Britain’s Bournemouth University evaluated causes of death in the 10 largest Western countries between 1979 and 2010. During that time period, deaths in America related to brain conditions rose an astounding 66% in men and 92% in women.

These compelling statistics are supported by what we’ve recently learned about monetary expenditures for caring for dementia-afflicted patients. In a recent RAND study published inThe New England Journal of Medicine, costs for dementia care in 2010 were estimated to be as high as $200 billion, roughly twice that expended for heart disease and almost triple what was spent on treating cancer patients.

These figures, as well as the staggering statistics that in America there are currently 5.4 million Alzheimer’s disease patients with that number poised to double by the year 2030, provide enticement for pharmaceutical companies to develop drug strategies to cure or at least slow the inexorable mental decline characteristic of this disease. As yet, they have failed, miserably. Indeed, as reported in a recent issue of The New England Journal of Medicine,the latest and perhaps most promising drug treatment for Alzheimer’s disease not only failed to halt the disease, but actually worsened functional ability while increasing the risk for infection and skin cancers.

‘Grain Brain: The Surprising Truth About Wheats, Carbs, and Sugar—Your Brain’s Silent Killers’ By David Perlmutter, MD. 336 pages. Little, Brown. $27. (Getty)

As a practicing neurologist dealing with Alzheimer’s patients and their devastated families on a daily basis, and as a caregiver for an afflicted parent, this current state of affairs is frustrating. But what’s so much more challenging is the recognition that to a very significant degree Alzheimer’s disease is preventable. Research clearly shows that up to 54% of Alzheimer’s cases in the U.S. could have been avoided if proper attention was given to various modifiable lifestyle factors, including diet and physical activity, as published in the journal The Lancet Neurology.

Mayo Clinic researchers have told us, for example, that risk for mild cognitive impairment, the harbinger for Alzheimer’s disease, or full -blown dementia is an astounding 42% lower in elderly folks who consume a diet higher in fat and lower in carbohydrates, as reported in theJournal of Alzheimer’s Disease.

And while many in the health sciences still cling to the notion that gluten sensitivity, affecting about a third of us, is almost exclusively a gastrointestinal disorder confined to the small intestine, British researchers have now clearly demonstrated that sensitivity to gluten, a protein found in wheat, barley and rye, can manifest as any number of neurological conditions, including dementia, without “typical” gastrointestinal complaints. Writing in the Journal of Neurology, Neurosurgery, and Psychiatry, Dr. Marios Hadjivassilou stated, “That gluten sensitivity is regarded as principally a disease of the small bowel is a historical misconception. Gluten sensitivity can be primarily and at times exclusively a neurological disease.”

Back in 2008 the Journal of the American Medical Association published a studydemonstrating substantial risk reduction for developing Alzheimer’s disease in individuals who were given a simple exercise protocol in comparison to a control group that remained more sedentary. This is powerful medicine that dramatically reduces the risk for a disease for which nothing exists in the pharmacopeia.

With highly respected peer-reviewed journals providing such compelling data and giving health-care providers powerful leverage points to meaningfully impact the incidence of this disease, why is the topic of Alzheimer’s prevention virtually absent from the public forum?

The fundamental operating system underlying the practice of medicine in America today seems myopically focused on treating our ills with highly profitable remedies directed at symptom management while causality is ignored. Preventing disease is derogated, and relegated to the province of alternative modalities. Watching our elected leaders debate the merits of funding the ever-changing iterations of a health-care plan designed to treat illnesses presents a poignant irony, as it has little to do with health and everything to do with illness. But it has become clear that both sides of the aisle enthusiastically agree that Americans must have access to their pills, and lots of them.

Getting the word out that people can make simple changes that might well prevent a disease for which there is absolutely no meaningful treatment makes sense. The word doctor means teacher. And while physicians seem steeped in providing drug remedies, it certainly seems like the right time to take a step back, review current science, and get the word out that the patients for whom we care can make choices, today, to remain healthy.

It was well over 2,000 years ago when China’s Yellow Emperor wrote, “Maintaining order rather than correcting disorder is the ultimate principle of wisdom. To cure a disease after it has manifest is like digging a well when one feels thirsty, or forging a weapon when the war has already begun.”

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You can now open your Obamacare Account online

You can now setup your obamacare account on the exchange
Ihealthcare Updates
| Written by IHU staff writter
Filed under Healthcare Reform,In the News

You can now open your Obamacare Account online

The Health Insurance Market place does not open up officially until two months from today. However in addition to a draft of the paper application you can now take a sneak peak at the online system, and open your own personal obamacare account on the health insurance marketplace.

Health and Human Services Secretary Kathleen Sebelius announced today consumers could now go establish personal accounts by going online and creating a username and password. Selection of plans will not be available until September when additional details on insurance plans and premiums offered in local areas will become available through the online marketplace.

The new personal account feature unveiled today will only be available in English for the time being. HHS said personal accounts will be coming soon to the Spanish-language marketplace, at cuidadodesalud.gov.

This Monday’s announcement by Sebelius made clear the Market place is on track “We are on target and ready to flip the switch on Oct. 1.”

Here are the steps to create Health Insurance Marketplace/Obamacare account

Provide some basic information like your name, address, and email address
Choose a user name and password
Create security questions for added protection
While you are able to create an account, you will not be able to start shopping through the Marketplace for insurance until October 1. But by creating an account now you’ll be one step closer to applying for coverage in the Health Insurance Marketplace, comparing plans side-by-side, and enrolling in a plan.

Remember that you can apply for coverage and enroll as soon as October 1, 2013.

If you have any questions you can call 1-800-318-2596, 24 hours a day, 7 days a week. TTY users should call 1-855-889-4325.

ObamaCare is coming and so are the Con artists

CNBC.com 08/15/13 7:08 AM ET
By: Herb Weisbaum

Getty Images

As the debate rages over who benefits from the Affordable Care Act, one thing is becoming clear: The controversial program is a dream come true for rip-off artists.

Consumer experts warn that the program has created a huge opportunity for swindling people by stealing their money and their sensitive personal information.

“Any time you roll out a big government program like this, confusion is inevitable,” said Lois Greisman, an associate director in the Bureau of Consumer Protection at the Federal Trade Commission. “This confusion creates a tremendous opportunity for the fraudster.”

Scammers have been at it for more than a year now, but consumer advocates and security experts warn that the problem will worsen as we get closer to Oct. 1. That’s when the millions of uninsured Americans can use a health insurance exchange, set-up by their state or by the federal government, to shop for coverage.

“I believe the incidents are going to skyrocket as that date approaches,” said Eva Velasquez, president and CEO of the nonprofit Identity Theft Resource Center. “And even people who are smart and savvy could get taken, so we are very concerned about the potential for some serious financial harm.”

The Affordable Care Act created a Health Insurance Marketplace, also referred to as the Health Insurance Exchange. Policies in the exchange have been preapproved by each state’s insurance commissioner.

“There are fake exchanges already up and running on the Internet,” said Monica Lindeen, Montana’s Commissioner of Securities and Insurance. “If you do a search and type in ‘exchange,’ you’ll find all sorts of websites that claim to be in the exchange when they are not.”

(Read more: Why latest Obamacare delay angers critics and fans)

These health insurance exchanges don’t open for business until Oct. 1, so no one can sell you insurance through an exchange until then.

Scam artists got an early jump on national health care reform. Since last year, they’ve been calling, faxing and emailing people across the country claiming to be with Medicare, Obamacare or some agency of the federal government.

They often say they need to “verify” some personal information (typically a bank account or Social Security number) to ensure you get the proper benefits. In some cases, fraudsters tell victims they need to buy an insurance card to be eligible for coverage under the new program.

Such calls can be especially intimidating to seniors, said John Breyault, who runsFraud.org , a project of National Consumers League.

“We’ve heard about cases where the scam artists have threatened people with jail if they don’t purchase the fake insurance cards,” Breyault said.

(Read more: Watch out for the ‘change my address’ scam)

Americans don’t need a new Medicare card, and no one from the government is calling and asking for personal information or money. Under the individual mandate provision of the Affordable Care Act, people who don’t buy insurance could have to pay a penalty, but that provision does not take effect until next year. There is no jail penalty in the law.

A con artist can claim to be anyone, for instance a “navigator” who can help you apply for coverage through an exchange. They gain your trust and then ask for personal information to buy nonexistent policies. Fraud.org reports that some victims have been persuaded to wire money or send funds via prepaid debit card to get their full benefits.

(Read more: Hate robocalls? Here’s how you can block them)

Thousands of legitimate navigators are being trained and certified to guide people through the process of applying for coverage through an exchange. These navigators are prohibited from recommending a particular plan. They will never ask for personal information or for money in any form. The navigator program hasn’t started yet, so no one is making calls.

Don’t get taken

There is only one place to shop for a qualified health plan: HealthCare.gov, the site run by the Center for Medicare and Medicaid Services. You also want to start your search here if you live in one of the places (17 states, District of Columbia, Guam or American Samoa), that set up its own exchange. Customer service representatives are available at 1 (800) 318-2596.

These tips, provided by consumer groups and government, will help you spot a fraud:
—There is no card associated with health care reform.
—There is no new Medicare card, and you do not have to update any personal information.
—The Health Insurance Marketplace (those exchanges) doesn’t open until Oct. 1, so you can’t buy coverage under the Affordable Care Act until then.
—Don’t respond to a cold call of any kind, especially one that asks for personal information or money. And don’t trust caller ID, which can be rigged to make it look as if the call is coming from a government office.
—Don’t let anyone rush you. The rates in the exchange have been preapproved and won’t change during the initial enrollment period, Oct. 1 to March 31. Anyone promising a “special price” or “limited time offer” or who tells you “spots are limited” is lying.

The FTC’s Lois Greisman urges you to file a complaint if you spot a problem, get a suspicious call or fall victim to a health care insurance con artist.

More Information:
Health insurance exchange scam alert: Beware of fake websitesObamacare confusion providing opening for con artists