Lance's Corner

NYSAG Issues Alert on Health Insurance Scams

Nov 12, 2024

Per the notice below, the New York State Attorney General (NYSAG) has issued an alert on health insurance scams.

Attorney General James Warns New Yorkers of Health Insurance Scams During Open Enrollment for Affordable Care Act Plans

New York Attorney General Letitia James today issued a consumer alert warning New Yorkers about common health insurance scams as open enrollment begins for insurance plans through New York’s Affordable Care Act marketplace.  New Yorkers have until December 15, 2024, to enroll through the New York State of Health marketplace for health coverage taking effect January 1, 2025.  Health insurance scams spike during open enrollment periods, and the Office of the Attorney General (OAG) is providing consumers with tips to protect themselves against potential scams.

“New Yorkers must be able to secure health insurance free from predatory scammers trying to take advantage of them,” said Attorney General James.  “As New Yorkers take advantage of this year’s open enrollment period, I urge everyone to be cautious and contact my office if they think they are the target of a scam or fraud.  Affordable and accessible health care is a fundamental right, and my office will do everything in its power to protect New Yorkers seeking to secure insurance for themselves and their families.”

Enrollment in New York’s public health programs – Medicaid, Child Health Plus, and the Essential plan – is open year-round.  However, New York state requires enrollees to renew their eligibility for these health plans every year.  Enrollees are sent renewal notices well in advance of their coverage end dates with detailed instructions on how to stay covered and their deadline to renew.  To enroll in commercial health insurance for 2025, New Yorkers must do so during the open enrollment period which lasts from November 1, 2024, to January 31, 2025.  New Yorkers have until December 15 to enroll for coverage that will start on January 1, 2025.  Otherwise, coverage will begin February 1, 2025.  New Yorkers should look out for the following tactics scammers use to target those who are trying to obtain or keep health insurance:

  • Scammers often use fear by threatening New Yorkers that their Medicaid or other health coverage is at risk of cancellation, or that they have already lost their Medicaid or other health coverage unless they provide hundreds of dollars to reinstate or continue benefits.
  • Scammers will also use false offers of generosity to lure New Yorkers into providing personal information.  This is typically done through phishing scams offering people gift cards or money to “update” their health accounts so as not to lose coverage.
  • Scammers may ask for money to enroll people in marketplace or "Obamacare" insurance.  The New York agencies that administer Medicaid, Child Health Plus, and Essential Plan benefits will never use the term “Obamacare” or ask for money from consumers to enroll or re-enroll.  They will also not offer New Yorkers rewards to renew their coverage.

Attorney General James provided the following tips and reminders for New Yorkers to avoid common scams:

  • No one can ever charge a fee to renew health insurance in Medicaid, Child Health Plus, or the Essential Plan.
  • If enrolled in health insurance through the NY State of Health, many people are available to help you renew for free.  These include the state’s health-certified enrollment assistors (including navigators, agents, and brokers) and customer service representatives.  For information or guidance, visit the NY State of Health website or call 1-855-355-5777.  The phone line is available Monday – Friday from 8 AM – 8 PM and on Saturday from 9 AM – 1 PM.
  • If enrolled in Medicaid through either your county’s Medicaid office or through New York City’s Human Resources Administration (HRA), there are also many people available to help for free.  Contact the office where you enrolled to ask questions and get help with renewing insurance.
  • Government agencies will never threaten, demand payment, or ask for credit information in a text message, e-mail, or phone call.
  • Many websites will try to make residents think that they are the official New York state health insurance marketplace.  There is only one official NY State of Health website.  Submitting contact information to some websites may lead to calls, texts, or e-mails from scammers.

Any New Yorker who suspects that they are a victim of a scam is encouraged to report it to OAG by submitting a complaint online or calling 1-800-771-7755.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc