ElderWeb

The Commission on Legal Problems of the Elderly of the American Bar Association (ABA) has announced a program of mini-grants of up to $7,500 for bar associations, legal services providers, elder rights advocates, and other local non-profit organizations who create programs to enhance the legal awareness of older persons, and to improve their access to the legal system. The Commission is interested in supporting programs such as pro se clinics; targeted outreach, education and pro-bono assistance to isolated elders; senior attorney volunteer projects; mediation projects; training on elderlaw issues for non-lawyer professionals; elderlaw hotlines; state-specific editions of national materials, plus professional training legal website for older consumers; and multidisciplinary ethics committees for long-term care facilities. The program is designed to fund only community-based, collaborative, legal services-oriented projects targeted to older persons in great social and economic need.

The Family Caregiver Alliance (FCA) has created a fact sheet on end-of-life decision-making. As they state it, "Americans are a people who plan. We plan everything: our schedules, our careers and work projects, our weddings and vacations, our retirements. Many of us plan for the disposal of our estates after we die. The one area that most of us avoid planning is the end of our life. Yet, if we don't plan, if we don't at least think about it and share our ideas with those we love, others take over at the very time when we are most vulnerable, most in need of understanding and comfort, and most longing for dignity. Big issues confront us when we think about our own death or that of someone we love. Our attitudes and beliefs about religion, pain, suffering, loss of consciousness, and leaving behind those we love come into play. We can let things unfold as they may, and for some of us that's exactly right. For others of us, it is good to plan."

>> FCA Fact Sheet

The California legislature has enacted a new law consolidating several previous law related to advanced healthcare directives. Advanced directives are used to allow people to influence decisions about how they will be cared for in the event they become unable to make their wishes known directly.

The new allows people to appoint another person to be their health care "agent." This person, called an "attorney-in-fact", will have legal authority to make decisions about their medical care if they become unable to make these decisions for themselves. The law also allows people to document their health care wishes in the Advance Health Care Directive form, for example, a desire not to receive treatment that only prolongs the dying process in the event of a terminal illness.

The Advance Health Care Directive is now the legally recognized format for a living will in California, replacing the Natural Death Act Declaration. The Advance Health Care Directive is more comprehensive than a living will, which only states a desire not to receive life-sustaining treatment if the person is terminally ill or permanently unconscious. The Advance Health Care Directive can be used to state the person's desires about their health care in any situation in which they are unable to make your own decisions.

The Advance Health Care Directive has also replaced the Durable Power of Attorney for Health Care (or "DPAHC") as the legally recognized document for appointing a health care agent in California. Previously executed Durable Powers of Attorney for Health Care or Natural Death Act Declarations will remain valid unless replaced with the new Advance Health Care Directive.

Illinois bill SB 1567 changed provisions of the law relating to powers of attorney. Language was added for situations when an agent is acting for a principal who is incapacitated. The new language says that a principal shall be considered incapacitated if that individual is under a legal disability as defined in Section 11a-2 of the Probate Act of 1975, or if a physician has examined the principal and has determined that the principal lacks decision making capacity, and the physician makes a written record of this determination, signs it within 90 days after the examination, and delivers it to the agent. In that event, the agent may rely conclusively on that written record.

In the event that the principal is incapacitated, the agent must provide a record of all receipts, disbursements, and significant actions taken under the authority of the agency when requested to do so: (i) by a representative of a provider agency, acting in the course of an assessment of a complaint of elder abuse or neglect under that Act; or (ii) by a representative of the Office of the State Long Term Care Ombudsman acting in the course of an investigation of a complaint of financial exploitation of a nursing home resident.

The Ontario Legislature has enacted numerous changes to the Health Care Consent law, which will become effective in December of 2000.

The Detroit Free Press has published an expose about guardianship in Michigan. Guardians may be appointed by a court for older people who are no longer able to handle their own affairs. In some cases, guardians may be family members, in others they may be people or businesses who are paid to oversee the affairs of the charges. In every case, guardians have complete control over the life and financial affairs of their wards. Even so, there is shockingly little oversight over guardians and the decisions they make. No one audits the financial reports they prepare, and they re not even subject to background checks.

In this article, reporters uncovered instances where court-appointed guardians allowed client homes to be foreclosed on, took possession of a client's property, and charged "commissions" on property sales they arranged. Reporters also found instances were family members were available to oversee their parents affairs, but the court appointed an outsider as guardian without even talking to the family members to see if they would be appropriate.

>> Detroit Free Press Article

Age Concern released a report showing that 50 elderly patients had been labelled "not for resuscitation" (NFR) by doctors without their consent. Age Concern released its list after a 66-year-old cancer patient discovered the comment "inappropriate for resuscitation" was written on her medical notes.

An editorial in the British Medical Journal reported that doctors in Britain do not consult up to two thirds of patients on decisions that could lead to their deaths. Patients listed as NFR were 30 times more likely to die than other patients. Do not resuscitate orders are more commonly used for older people, suggesting that doctors have stereotypes of who is not worth saving.

The Department of Health said it did not plan to investigate whether the claims were widespread, saying doctors and hospitals had clear guidelines on the issue.

The AMA has posted information for patients about advanced directives, such as health care powers of attorney and living wills. They hope to educate consumers about how to clearly convey the patient's wishes for medical care in those situations when they are unable to communicate or become unable mentally to make decisions for themselves.

A fascinating study done by Larry Jacoby of Washington University investigated the ways that younger and older adults remember things. The study found evidence that older people are more likely than younger people to falsely recall things from the past, they are less likely to be willing to say that they don't remember things, and they are susceptible to false "cues", as when someone insists they owe twice as much for something than the price they really agreed to.

In this study, researchers tested what happened when younger and older adults were given lists of things to remember. In one experiment, they were asked to recall the list, but told they could improve their score by passing if they weren't sure of the answer. In this experiment, the younger respondents were more likely than the older ones to say they didn't know the answer.

In other experiments, respondents sometimes were given false "cues" about what was on the list, and sometimes forced to come up with an answer if they weren't sure. In all experiments, the older respondents were more likely to have incorrect recollections of the list.

It will be interesting to see what other things can be learned from this line of investigation, but one suggestion is that people, as they get older, should probably trust their memory less and rely more on writing things down so they can refer to the facts later.

Some bank customers (elderly or otherwise!) may be the unwitting subjects of a new fraud scheme that uses fictitious IRS Forms and fraudulent bank correspondence. Fictitious documents that are not genuine IRS Forms and fraudulent letters addressed to a bank customer purporting to be from the customer's bank are being circulated nationwide in an attempt to steal the bank customer's identity and money by having them disclose personal and banking information. Later, when the perpetrator of the fraud contacts the bank, they have all the necessary customer information to appear credible.

Anyone that has filled in and returned the fictitious form via the fax number, mail service, or any other means should promptly notify all financial institutions with whom they do business. The Office of the Comptroller of the Currency (OCC), Administrator of National Banks, suggests that anyone affected immediately do the following:

1. Contact the fraud department of each of the three major credit bureaus and report that your identity has been stolen. Also, consider asking the bank to place a "fraud alert" on your file and request that no new credit be granted without prior approval.
   
   

   	Equifax	Experian	Trans Union
   Address:	P.O. Box 740241 Atlanta, GA 30374-0241	P.O. Box 2104 Allen, TX 75013	760 Sproul Road P.O. Box 390 Springfield, PA 19064-0390
   Order Credit Report:	1-800-685-1111	1-888-EXPERIAN (397-3742)	1-800-916-8800
   Report Fraud:	1-800-525-6285	1-888-EXPERIAN (397-3742)	1-800-680-7289

2. For any accounts that have been fraudulently accessed or opened, contact the security department of each affected creditor or financial institution. Consider closing these accounts. Also, on any new accounts you open, consider using a password, but do not use your mother's maiden name.
3. File a report with your local police department or the police where the identity theft took place. Retain a copy of the police report in case your bank, credit card company, or others need proof of the crime at a later date.
4. Contact the Internal Revenue Service to report the incident using the following toll-free hotline number: 1-800-829-0433.

If a customer has received this fictitious form but did not complete and return it, any information which they have concerning this matter should be brought to the attention of the Internal Revenue Service at the same toll-free number listed above.

Additional sources of information for on what to do if you are a victim of identity theft, and the precautions to take to prevent becoming a victim, can be found at the Federal Trade Commission's Web site: http://www.consumer.gov/idtheft/victim.htm and the OCC's Web site: http://www.occ.treas.gov/idtheft.pdf.

Source: OCC Alert List

The North American Securities Administrators Association (NASAA) released a new list of the "Top Ten Investment Scams", and warned the public that many of these scams are targeted directly at older adults. Deborah Bortner, president of NASAA and Washington State?s director of securities said that scammers are pitching their investments as low risk and high return to appeal to older Americans looking for a safe haven for their retirement funds. She said that the top problem on their list is unlicensed individuals, such as life insurance agents, selling securities. While most insurance agents do not violate the law, there is a growing problem with those that do. For instance, 11 of the 16 "cease and desist" orders issued by the Securities Division in Indiana in the first quarter of this year have targeted insurance agents who were selling securities without the proper license, most of whom were independent life insurance agents. A new scam on this year's list includes risky payphone and ATM investments, often sold by independent life insurance agents, and "callable" certificates of deposit sold to older Americans despite their 10- to 20-year maturities. These investments led to losses of about $76 million for 4,500 investors nationwide.

The Federal Trade Commission (FTC) has an online guide to dealing with fraud in healthcare products and services. This is a nicely organized list of who to contact to report fraud, abuse, or other problems related to medical claims and healthcare products and services. The guide also provides some consumer information about how to tell when products are "government approved".

The annual report of the 1998 Long Term Care Ombudsman program has been released. Long-Term Care Ombudsmen are advocates for residents of long-term care facilities. Thousands of trained volunteer ombudsmen provide an on-going presence in long-term care facilities, monitoring care and conditions and providing a voice for those who are unable to speak for themselves. Ombudsmen identify, investigate and resolve complaints made by or on behalf of residents, provide information to residents about long-term care services, represent the interests of residents before governmental agencies and seek administrative, legal and other remedies to protect residents, and perform many other important tasks to protect people who use long term care services.

The top five nursing home complaints were in categories involving poor resident care, lack of respect for residents and physical abuse. A three-year comparison of the top twenty nursing home complaints indicates the greatest increases in complaints about physical abuse, toileting, personal hygiene and unheeded requests for assistance, all of which point to persistent problems with lack of care for residents and the need for increased numbers of trained staff to assist residents. The top five board and care complaints were about menu quality, medication management, discharge/eviction, lack of respect for residents and physical abuse; the greatest increases over a three-year period were in the first three of these categories.

Insufficient numbers of staff to care for residents was the major institutional long-term care concern most frequently identified by the states in their FY 1998 reports. Ombudsmen linked low staffing to low wages and benefits and labor shortage and described how lack of staff relates directly to poor care for residents, which was cited as a major issue by a number of states. This correlates with the top five nursing home complaints, all of which relate to inadequate or poor care. As in previous years, discharge and transfer issues were identified as a major problem area by a large number of states, as was inadequate regulation of assisted living and similar non-nursing home facilities.

The New York Stock Exchange (NYSE) has taken disciplinary actions against one member firm and 23 individuals for violations of NYSE rules and federal securities laws. The cases, prosecuted by the NYSE Division of Enforcement, may be subject to review by the Securities and Exchange Commission and, thereafter, federal courts.

Edward D. Jones & Co., L.P. of St. Louis, Mo., a member firm, consented without admitting or denying guilt to findings that the firm failed to reasonably supervise and control the business activities of the firm and its employees with respect to the sale of callable CDs, among other violations. About 104 customers who bought the CDs from Edward Jones registered complaints ranging from being misinformed about the possible fluctuating market value of the CDs and the length of their maturity, the NYSE said. About 80 percent of the complainants were older than 65 during the period the CDs were sold from October 1994 to June 1997.

An NYSE hearing panel found that, during the period from approximately October 1994-June 1997, the firm failed to properly supervise the recommendation and sale of callable CDs by approximately 87 registered representatives to approximately 104 customers. The panel found that, in certain instances, the registered representatives did not adequately disclose the features and risks of the investment to customers and that the firm did not institute reasonable safeguards or follow-up procedures to ensure that those registered representatives understood and properly informed customers of the features of callable CDs including the call, reinvestment and market risks associated with the product. The panel also found that certain registered representatives sold callable CDs to some of the customers without having had any specific training and supervision regarding the sale of the product and the product features.

The hearing panel also found that the recommendation and sale of callable CDs by the firm to some of the customers was unsuitable in view of the customers' age, investment objectives and/or financial resources and that the firm also made misrepresentations to some of the customers and/or omitted to disclose certain facts in connection with the solicitation and/or sale of callable CDs to the customers (e.g., facts concerning the length of maturity, the call feature and the fluctuation of the callable CDs' market values).

The Securities and Exchange Commission said it has received more than 300 complaints related to CDs, five times more than last year, according to a report in the Wall Street Journal. The SEC is investigating 33 brokerages, including Edward Jones, A.G. Edwards Inc., Merrill Lynch & Co., Morgan Stanley Dean Witter & Co., PaineWebber, Prudential Securities, Salomon Smith Barney and Raymond James & Associates Inc., the paper said.

Fraud and abuse have migrated to the information age. The Federal Trade Commission (FTC), with four other U.S. agencies and consumer protection organizations from 9 countries and 23 states announced 251 law enforcement actions against online scammers in "Operation Top Ten Dot Cons." The top 10 targeted scams were:

• Internet Auction Fraud
• Internet Service Provider Scams
• Internet Web Site Design/Promotions
• Web Cramming
• Internet Information and Adult Services
• Credit Card Cramming
• Multi-level Marketing/Pyramid Scams
• Business Opportunities and Work-At-Home Scams
• Investment Schemes and Get-Rich-Quick Scams
• Travel/Vacation Fraud
• Telephone/Pay-Per-Call Solicitation Frauds (including modem dialers and videotext)
• Health Care Frauds

In one scam, defendants mailed $3.50 "rebate" checks to consumers. When consumers cashed the check, they were unwittingly agreeing to allow the defendants to be their Internet Service Provider (ISP), and the defendants started placing monthly charges on their telephone bills. The defendants made it nearly impossible to cancel future monthly charges and receive refunds. In another variation, consumers were billed for a Website page they didn't even know they had. Targeting small businesses and not-for-profit organizations, the scammers call and offer a "free" Web page, then start billing phone bills without authorization.

Attorney General Eliot Spitzer today announced that five registered nurses holding high managerial positions at the Townhouse Extended Care Center in Uniondale have been charged with covering up acts of patient abuse at the facility by tampering with evidence and falsifying documents to deceive state investigators looking into the allegations. The focus of the state probes was a patient who died after being fed through an enema bag, and two other patients who sustained serious injuries in falls.

The defendants have been charged in a 21-count indictment with Falsifying Business Records in the First Degree, Offering a False Instrument for Filing in the First Degree, and Tampering with Physical Evidence. Spitzer noted that the possibility of bringing patient abuse charges was precluded by the statute of limitations.

This case was the first to result from Attorney General Spitzer?s statewide nursing home initiative in which he directed each Medicaid Fraud Control Unit (MFCU) regional office to target a nursing home for quality of care issues.

On the morning of April 5, 1997, a 97-year-old female patient died after Townhouse staff used an enema bag instead of a feeding bag to administer nourishment directly into the woman?s stomach. (A feeding bag is equipped with a regulator and pump, thereby allowing staff to control the flow of the liquid nourishment. An enema bag contains a clamp that allows only two positions ? open and closed.) Using the proper equipment, the feeding was supposed to take ten hours. However, as a result of using an enema bag, the entire feeding supplement was delivered in an hour or less. As a result, the patient experienced numerous episodes of vomiting and diarrhea throughout the night before dying.

When the State Department of Health (DOH) commenced an investigation into the patient?s death, Brown and Colon, in their capacity as Director and Assistant Director of Nursing, respectively, allegedly tried to cover up the facts and circumstances surrounding the patient?s death. They did so by directing staff, who had attended to the patient, to rewrite their nursing notes and written statements to falsely indicate that the proper equipment had been used. Brown then submitted these false statements to DOH.

As part of the cover-up, it is further alleged that Dwyer, who had been the R.N. supervisor on duty at the time, and who had ordered the enema bag to be used because no feed bags were available, falsely indicated in a written statement that there was no problem with the patient during her shift, and that nothing unusual was reported to her regarding the patient. In fact, Dwyer had repeatedly ignored requests by the staff to check on the patient once they realized she was in distress.

The Federal Trade Commission has won a $19.7 million judgment against Canadian telemarketers the FTC charged with operating an illegal international lottery scam. The FTC alleged that in calls from a Toronto-based boilerroom, the telemarketers used high pressure tactics to persuade consumers to send anywhere from $29 to thousands of dollars to invest in the lotteries. The federal court found that the defendants told consumers - most of whom were elderly - that they had been "specially selected" to participate in a system for playing the Canadian lottery and that the consumer was likely to win a large prize or jackpot by playing with the defendants. The court also found that telemarketers told the consumers that they were "registered" or "sponsored" by the Canadian Government to sell the lottery tickets, but failed to disclose that it was illegal to sell them to U. S. consumers. In fact, only a small percent of the money the telemarketers took in actually went toward the purchase of lottery tickets.

The defendants named in the FTC suit are Windermere Big Win International, Inc., Marathon Award Center, Inc., Sunshine Fortuity, Inc., Ernest Levy, a/k/a/Ernie Levy, Alan Silverstein, Selvanayagam Pararajasingam, Michael Levy, and George Ola. Consumers who believe they invested in foreign lotteries through one of the named defendants may apply for redress by contacting the FTC at 1-877-FTC-HELP.

The Michigan Department of Attorney General is currently investigating several cases of identity and/or check theft in resident care facilities in Michigan. Investigations have revealed that resident care facility employees, pool agency employees and individuals posing as employees, are committing these crimes by using their position to gain access to important personal information. This information is used to obtain credit cards and access financial accounts.

They offer tips to consumers to avoid becoming victimized:

* Be alert to visitors and unidentified individuals in care facilities.
* Discourage residents from pre-signing any checks and/or leaving checkbooks, credit cards, mail, etc. unsecured or unattended.
* Keep residents' non-medical personal information, i.e. Social Security Number, date of birth, driver's license number, home address and employment history secure.
* Treat ATM cards, credit cards, credit card mailings, and checkbooks as if they were cash.
* Review financial and credit statements for unauthorized activity.
* Carefully dispose of receipts, insurance forms and statements.
* Report identity theft in resident care facilities to local law enforcement, or contact:

Attorney General Jennifer M. Granholm
Health Care Fraud Division
P.O. Box 30218
Lansing, MI 48909
1-800 24-ABUSE [1-800-242-2873]

The Wisconsin Department of Health and Family Services announced that 3,257 cases of suspected elder abuse and neglect were reported in Wisconsin during 1999. That figure represents an increase of nearly 6% over the number of cases recorded in 1998. Of the reported cases in 1999, there were 9 fatalities and 363 situations that were considered life-threatening cases.

"Elder abuse is a crime that often goes unreported," said DHFS Secretary Joe Leean. "For whatever reason, be it shame, guilt, feelings of helplessness or fear, older victims of abuse often fail to seek help when they are being hurt." The Secretary noted that his department has made a concerted effort to provide extensive training to health care workers, law enforcement and social workers to make it easier to spot cases of elder abuse.

"We want to make it easier to identify these cases of possible abuse and let victims know that there is help and it?s okay to get it. We also must work with families and communities to prevent abuse of our elderly citizens," Leean said.

The Secretary added that the 6% rise in reported cases over 1998 is a smaller increase than 1998?s 22% rise in reported cases over 1997. "The big jump between 1997 and 1998 coincided with the beginning of our public information efforts," Leean said.

Four categories of elder abuse are defined in Wisconsin law. According to the law, elder abuse occurs when a person aged 60 or older is subjected to material abuse, neglect, self-neglect or physical abuse, which includes sexual assault. State law mandates that each county provide a publicized phone number to receive reports of suspected elder abuse for investigation and reporting purposes. The law requires prompt investigation of all reported cases of abuse or neglect.

For more information, or a copy of the report, contact Jane Raymond, in the Department of Health and Family Services Bureau of Aging and Long Term Care Resources at (608) 266-2568.

The Social Security Administration (SSA) warns citizens about a scam targeting elderly African Americans. They said that misleading flyers say that due to the Slave Reparations Act the government is paying reparations to any African American born before 1927. The flyer encourages people to send their Social Security number and other personal information to the address listed. They are told they will get an application for a $5,000 payment, which can be included in their Social Security check, or issued in a lump sum. This is NOT TRUE. If you or a member of your family has been targeted by this scam, or if you have already sent any personal information to the address on the flyer, call the SSA fraud hotline at 1-800-269-0271, or visit their website for other contact information.

- Contributed by Bill Hyde

A former Montreal-based broker, who appointed himself as an executor and heir in an elderly female client's will and then neglected to tell his employer of his new beneficial interest, has been fined $25,000 by the Investment Dealers Association of Canada (IDA). According to the IDA, Quynh Lam Phan, then a registered representative with Levesque Securities Inc. (now National Bank Financial Inc.) violated industry regulations by helping draft a will for his client, which would give him 25% of her capital, then failed to notify his employer or update the client's new account application form to reflect his new-found personal interest in the account. Phan's client's estate included a car and property in Florida, and the total value of her account was approximately $1 million Canadian.

The Securities and Exchange Commission (SEC) is warning consumers about increasing problems with deceptive sales practices related to high-yield "one year" certificates of deposit (CDs). The deception occurs because the CDs are "one year noncallable" CDs, terminology which leads the purchasers to believe that they can be redeemed in one year, when they are actually 20-30 year CDs with significant penalties for early redemption. Particularly at risk are trusting older consumers looking for the security of a CD for their retirement savings.

These CDs are being sold by brokers, not banks, and are touted as a safe place for an 80 year old investor to place his or her funds for a guaranteed return, even though an 80 year old is unlikely to live long enough to ba able to redeem the CD without penalty. True one-year CDs can be purchased through legitimate brokerages, but some less respectible brokers are using deceptive techniques to sell long term CDs to consumers who do not understand what they are purchasing. The SEC has posted a brochure for consumers to help warn them away from inappropriate purchases. Jane Bryant Quinn, the respected financial columnist, has also issued warnings to her readers. She reports that the SEC has received dozens of complaints, and that it appears that the problems will only become widely known as duped consumers attempt to redeem their 30-year CDs over time.

In a gruesome story of a con gone wrong, a mother and son con team attempted to trick an elderly women into revealing her social security number so they could take possession of her home, then killed her when she refused to cooperate. The criminals, Sante Kimes (65) and her son Kenneth (24), are currently on trial for the death of 82 year old Irene Silverman. Evidence in the trial includes a taped conversation with the victim in which Kimes attempted to fool Silverman into believing she had won a trip to Las Vegas in order to get her social security number. Silverman was sharp enough to smell a rat, and refused to give Kimes the information. Silverman later disappeared, and her body has never been found. Police found Silverman's keys, Social Security card, passports and payroll stubs in the Kimes' home on the day of Silverman's disappearance. They also found 12 notebooks detailing their scheme, $30,000 in cash, and a forged deed to Silverman's home transferring ownership to a company the Kimeses controlled.

The Federal Trade Commission has negotiated a settlement agreement with an Atlanta, Georgia company, under which the company has agreed to pay $250,000 in consumer redress for allegedly misleading public benefits recipients and other consumers in its marketing of the "Delaware Bank Card," an automated teller machine (ATM) bank card that offers direct deposit services with an affiliated bank. The company, DBC Financial, Inc. ("DBC Financial"), primarily targeted Social Security recipients by offering, among other services, a direct deposit service for Social Security checks. The proposed settlement would bar DBC Financial, a Delaware corporation that provides marketing services to banks, from making the misrepresentations in the future.

An audit of Medicaid payments to Ohio residents was made by the Ohio Office of the Auditor and was conducted as part of the Inspector General's partnership efforts with States to expand audit coverage of the Medicaid program. The Office of the Auditor (OIG) determined that, during a period of almost 6 years, the Ohio Department of Human Services (ODHS) paid $82 million for services to Medicaid recipients after the recipients? date of death. This amount consisted of 114,780 payments to 4,113 different providers for services provided to 26,822 apparently deceased recipients. Although ODHS is recovering payments for these services, as of September 30, 1999, $14 million remained outstanding, and the Federal share of that amount is $8.5 million.

Many of the fraud schemes already present in the "real" world can now be found on the Internet - fraudulent investment offerings, multi-level marketing schemes and failure-to-render scams (a favorite of unprincipled participants of online auctions). The crucial difference in fraud committed over the Internet is that the perpetrator can vanish, pulling down a Web site in seconds, leaving consumers wondering who or where to turn to for help.

In response to this growing concern, the Federal Bureau of Investigation (FBI) and the National White Collar Crime Center (NW3C) joined forces in a unique partnership to aid and protect consumers in this largely unregulated environment. The Internet Fraud Complaint Center (IFCC) is the result of that venture. This Web site provides a mechanism for victims of Internet fraud to report fraud on-line-where it occurred-to the appropriate law enforcement and regulatory authorities.

If you believe you are a victim of Internet fraud, you can use this web site to report the incident. It is important that you keep any evidence you may have related to your complaint, including canceled checks, credit card receipts, phone bills, faxes, pamphlets or brochures, mailing envelopes, certified or other mail receipts, a printed copy of a Web site, chat room, or newsgroup text, or similar items. Keep items in a safe location until you are requested to provide them for investigative or prosecutive evidence. If requested to provide evidence, send copies only, not originals.

A national survey of doctors conducted by the Association of American Physicians and Surgeons (AAPS) shows that Medicare regulations and recent increased government crackdown on fraudulent billings are responsible for severely restricting patients' access to medical care. Of the physicians surveyed:

• 82% report increased fear of prosecution or investigation in the past 3 years
• 71% report making changes in their practice to avoid threat of prosecution
• 34% restrict services such as surgery to Medicare patients
• 23% do not accept new Medicare patients
• 34% have difficulty finding referring physicians for their Medicare patients
• 22% of doctors and staff time is spent on compliance with Medicare regulations
• Medicare claims cost 26% more to process than private claims

Also, two-thirds of the physicians surveyed plan to retire from patient care at an earlier age than they would have considered 5 years ago, primarily because of increased hassles with Medicare and increased government interference.

The Health Care Financing Administration Office of the Inspector General (HCFA OIG) did a compliance review on the consolidated billing provision of the Prospective Payment System for Skilled Nursing Facilities (SNF PPS). This legislation, which became effective in 1999, requires nursing homes to bill Medicare for all services provided to residents in their facilities who are covered under Medicare Part A, and increased the reimbursement those facilities received to include a provision for the cost of those services. In the past, outside suppliers could have billed Medicare separately for services to these residents under Medicare Part B, if the services were not billed by the facility or included in the costs used to set the facility Medicare rate.

For over one-third of these SNF PPS claims reviewed, the OIG found that Medicare contractors paid outside suppliers under Part B for services which had been included in the PPS payment that Medicare made to the SNF. As a result, the Medicare program paid twice for the same service, once to the SNF under the Part A prospective payment, and again to an outside supplier under Part B.

The OIG report concluded that improper payments to outside suppliers occurred because Medicare edits have not been established to detect and prevent claims noncompliant with the consolidated billing provision. Also, some outside suppliers may not have been fully aware of the consolidated billing provision, and may have improperly billed fiscal intermediaries and carriers. HCFA officials stated that they are in agreement with the recommendations of the report, and are planning to implement the recommended solutions. HCFA officials also stressed that the overpayments were made to the outside suppliers, and the nursing homes were correctly reimbursed.

Lewis Morris of the Office of the Inspector General (OIG) testified before the House Committee on Commerce, Subcommittee on Oversight and Investigations about problems uncovering and prosecuting Medicare fraud perpetrated by third-party billing companies. Third-party billing companies process Medicare billings for physicians, nursing homes, and other providers. Medicare law requires that billings only be made to beneficiaries or those who directly provide services, so third-party billing companies use the provider numbers of the physicians and nursing homes who provided the services. Because of that, it is difficult for the OIG to identify patterns of abuse tied to specific billing companies.

For example, one third-party billing company, Handle With Care, Inc. (HWC), performed "lost charge" audits for nursing homes. They told nursing homes that they would review residents' medical records and accounts for services that had not been billed to Medicare. Then, using special "tricks of the trade", they would bill Medicare on behalf of the nursing home for these overlooked charges in exchange for 50% of the proceeds. What HWC really did was to bill Medicare for surgical dressings for nursing home patients who had not had surgery, and they eventually billed Medicare for over $7 million in nonrendered services. The fraud was difficult to detect, since payments were made under the provider numbers of 70 different nursing homes in 8 states. Ultimately, the owners of HWC received prison sentences, and 15 of the nursing homes agreed to reimburse the government about $5 million in settlements related to lawsuits filed under the False Claims Act.

The Inspector General of the Department of Health and Human Services issued their 1999 Annual Report. In it, they report that federal prosecutors filed 371 criminal indictments in health care fraud cases in 1999, a 16% increase over the previous year. A total of 396 defendants were convicted for health care fraud-related crimes in 1999. There were also 2,278 civil matters pending, and 91 civil cases filed in 1999. The Office of Inspector General (OIG) won or negotiated more than $524 million in judgments, settlements, and administrative impositions in health care fraud cases and proceedings.

Among other things, the report states that Medicare reimbursed skilled nursing facilities almost $1 billion for improperly billed physical and occupational therapy and almost $331 million for undocumented physical and occupational therapy.

The OIG also released a series of inspection reports concluding that serious problems with quality of care continue to exist in nursing homes, demonstrated by an increase in survey and certification "quality of care" deficiencies as well as an increase in ombudsman complaints, especially about resident care. The inspection reports also found inadequate nursing home staffing levels; weaknesses in the survey system; inadequate resources in the ombudsman program; and inconsistent and unreliable State systems to safeguard nursing home residents.

Some examples of action taken during 1999:

• A finding that the largest Medicare-certified home health agency in Miami was overpaid $120 million by Medicare.
• A $61 settlement with a major provider of home health services in Georgia, Florida, and New York.
• A $10 million settlement with one of the largest home health care companies in Texas.

A Senate Special Committee on Aging field hearing on financial exploitation of older people took place on March 15 in Portland Oregon. The purpose of the hearing was to examine ways to prevent financial fraud targeting the elderly, discover how developing technologies will affect this problem, and explore possible federal solutions. The committee heard testimony including a number of horrific stories about older people who had been beguiled, frightened, or otherwise misled into giving up hundreds of thousands of dollars to "friends" and caregivers. They also heard from attorneys and police officers who spoke about the many problems that make it difficult to identify and prosecute these crimes.

Witnesses told the committee about the difficulties of identifying and prosecuting cases of elder fraud. They said victims are embarrassed and reluctant to come forward, there are insufficient financial records to prove the amount of the loss, and there are no other witnesses to the crime. Impaired victims may not realize they are being taken advantage of, and some older people make poor witnesses due to mental and physical limitations which make it hard for them to communicate. Pertinent records are in the hands of the perpetrators, if they have not been destroyed. Many times there are cross-jurisdictional problems, and often assets continue to be depleted while the investigation continues, since the perpetrators remain in control during that process. Many problems are not discovered until long after the crime occurs, and may fall outside the statute of limitations. The length of the investigations also gives criminals plenty of time to divest themselves of assets, so that the victim has nothing to collect. All these problems make these cases extremely time-consuming to pursue, and many police departments and prosecutors' offices lack the necessary staff and training to do so.

Witnesses also discussed some of the initiatives which seem to be helping, such as legislation giving banks immunity when they become suspicious of unusual bank activity and report it to law enforcement agencies, or when they release information in conjunction with elder abuse investigations.

Witnesses urged the committee to support and expand the Older American's Act and other legislation to provide funding for the staff, training, and education needed to prosecute and/or prevent elder fraud.

The St Petersburg Times reports that a former insurance agent who swindled elderly clients out of $1.3 million has been sentenced to 10 years in jail and 10 years on probation. Had the judge followed sentencing guidelines, the punishment would have been only 17 months in jail, but he exceeded the guidelines because the victims were especially vulnerable because of their age. Many victims lost their life savings. One 72 year-old victim who lost $30,000 had to come out of retirement and return to work. The swindler was ordered to pay restitution, but it appears unlikely that any of his victims will be able to collect anything.

Arkansas HB1635 has been enrolled as Act 1230, The Arkansas Assisted Living Act. This bill creates a new type of facility in the state, to be called assisted living facilities, for people who need nursing home care, but who do not require 24-hour nursing. The Department of Human Services is instructed to create a rules and regulations to l