Health Care Consumer Protection

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Health care scams have been around for a long time. Some products or services claim to prevent, treat, or cure diseases, even though they may not have been proven and they may not be safe. Health care scams prey on people’s desires for easy solutions to fix health problems—from losing weight to curing serious diseases like cancer. A health product cannot be promoted to cure, treat or prevent a disease unless there are proper scientific studies to show that it does.

Some health care scams do more than waste your money. They can cause serious injury or even death. Using unproven tests, for example, can delay getting a potentially life-saving diagnosis. Using unproven treatments can also stop people from getting a medicine that actually works. Fraudulent products sometimes contain hidden ingredients, including prescription drugs and banned substances like steroids, even if they claim to be ‘natural’.

Below are steps to take if you are a victim of a health care scam and tips on how to avoid being scammed:

WHAT TO DO IF YOU ARE A VICTIM OF A SCAM

Get help

• If you’ve been a victim of health care fraud, contact the LA County Department of Consumer and Business Affairs. They will help you to file a complaint and, if appropriate, try to get your money back. Call (800) 593-8222.
  Some examples of health care fraud include:
  
  
  • You get a bill for services you didn’t receive
  • You were sold health products that didn’t do what they said they would
  • You were sold insurance that doesn’t cover the services promised
  • Someone is using your identity and information to get health care services
  • Your credit is damaged because your insurance company is not paying your claim on time
  • Your insurance company is paying only a portion of a bill when it should pay the full amount
    
• More information about medical identity theft is available from the Federal Trade Commission.
  
• For tips on how to prevent Medicare fraud and how to report suspected fraud, call (800) 447-8477 or visit the Medicare fraud webpage.

HOW TO IDENTIFY HEALTH CARE SCAMS

1. Learn how to spot a health care scam
   
   

   One product does it all: Be suspicious of products that claim to cure a wide range of diseases. For example, if a dietary supplement claims to treat dementia, kidney disease, gangrene, depression, osteoarthritis, and cancer, it is probably a scam. Ads include personal testimonials: Success stories, such as, "It cured my diabetes" or "My tumors are gone," are easy to make up and are not a substitute for scientific evidence. Quick fixes: Beware of phrases like, "Lose 30 pounds in 30 days" or "eliminates skin cancer in days." "Miracle cure": Be skeptical if you see this claim or others like it such as, "new discovery," "scientific breakthrough" or "secret ingredient." If a real cure for a serious disease were discovered, it would be in the news and used by doctors - not buried in print ads, on TV commercials, emails or websites. Conspiracy theories: Claims like "The government and the pharmaceutical industry don't want you to know about this miracle cure," are untrue. These statements are used to distract consumers from asking common-sense questions about the so-called miracle cure.

   
   
2. Learn how to spot medical identity theft
   
   Health care scams can also involve health and financial information, such as theft of MediCal, Medicare and social security numbers. You may be a victim of health care fraud if:
   
   

   You get a bill for services you didn't receive: Debt collectors could come after you for the scammer's unpaid medical debts. Your credit could suffer if medical bills are not paid.

   • Someone is using your identity and information to get health care services: If someone uses your name to obtain medical services, their medical information may end up in your file. If they take different medicines or have different allergies or conditions it could lead to you receiving the wrong care
   • Your name is used fraudulently to get payments from health insurance companies and government programs such as Medicare: Scammers may obtain prescription medications using your information and then sell them on the black market. They may submit false claims for medical treatment, exams, or even surgeries.
   • You go to fill a prescription and find that you have already reached your allowance for that month because someone else has used your health information.
   • You were sold insurance that doesn't cover the services promised: Dishonest marketers make it sound like they're selling affordable health insurance, when really, it's a medical discount plan instead. Medical discount plans can be a way for some people to save money on their health care costs, but discount plans aren't health insurance, and aren't a substitute for it. Your credit could be damaged if the scammers don't pay enough or don't pay on time. And, you will still have to pay
   • Get help. If you have been a victim of medical identity theft, you can get help here.
     
     
   • for the service. Learn more here.
3. Take steps to find out if you have been a victim of health care fraud
   
   

   Check your credit report. You’re entitled to a free report from three companies every 12 months. Order online from annualcreditreport.com, the only authorized website for free credit reports, or call 1-877-322-8228. Learn more about it from the Federal Trade Commission webpage and video.

   • Check with your insurance company. Contact your health insurance company at least once a year for a list of the benefits they paid in your name.
   • Understand the "Explanation of Benefits" (EOB) statement that your health insurer sends to you after they have received a claim to pay for a health care service. Your EOB gives you information about how an insurance claim from a health provider (such as a doctor or hospital) was paid on your behalf. When you receive it, review it right away. If you find something incorrect on your explanation of benefits statement, call the patient customer service number right away. Here are some tips for understanding your EOB.
     
     
   • Know where to get reliable products and services
     
     
     • Get reliable information about your health, medicines and other treatments: View our webpage to learn how to find good quality health information and see some examples of websites you can trust.
     • Medicines: Counterfeit drugs are widely available. You can buy packages of what appear to be medicines from websites, local grocery stores, botanicas, at swap meets, and even from street vendors. Only obtain prescription medications from a licensed pharmacist.
     • Dietary supplements, vitamins and alternative medicines: Talk to your doctor first. Here are some tips.
     • Get information about medical discount plans before you buy: Learn the difference between insurance and discount plans. With a medical discount plan, you generally pay a monthly fee to get discounts on specific services or products from a list of participating providers. Medical discount plans don’t pay your health care costs.
     • Health Insurance: Learn about health insurance options at www.coveredca.com. Los Angeles County residents who are not insured can obtain information about coverage options and free and low cost health care programs at the Department of Health Services website.
       
       

       You can also call 2-1-1 or visit the 211 webpage for help finding insurance and health services. 2-1-1 is free and the operators speak 9 languages. If you are undocumented and don’t think you can get or afford health care, find out about My Health LA , a free insurance program for individuals and families who cannot get health insurance. Health care services are provided by more than 200 Community Partner clinics in My Health LA. Go here to find a clinic near you.

       
       RESOURCES

       Explanation of your health care rights and how to use your health care benefits

       • California Department of Managed Health Care can help you to resolve problems you may have with your health plan. (888) 466-2219 www.dmhc.ca.gov

       Information about health fraud, drugs, medical devices, dietary supplements, infant formula, food, and cosmetics.

       • Contact the U.S. Food and Drug Administration (FDA) to report problems with the quality of these products. (888) 463-6332 www.fda.gov

       Information on health care scams, fraud, and identity theft, as well as money, housing, and privacy concern.

       • Contact the U.S. Federal Trade Commission (FTC) to report misleading or fraudulent advertising and promotion. (877) FTC-HELP (1-877-382-4357) www.ftc.gov

       To file a complaint against a licensed medical doctor or physician

       • For an M.D., contact the California Medical Board https://www.mbc.ca.gov/Consumers/File-a-Complaint/complaint-process.aspx
       • For a D.O. (osteopathic physician and surgeon), contact the Osteopathic Medical Board of California https://www.ombc.ca.gov/consumer_complaint/file_a_complaint.shtml

       To file a complaint against another licensed health care professional

       • Complaint against dental hygienist, acupuncturist, or an optometrist, etc., contact the California Department of Consumer Affairs www.dca.ca.gov

       To report counterfeit medicines in Los Angeles

       • Contact Crime Stoppers about counterfeit medicines online, smart phone app or phone. You don’t have to give your name. (888) 463-6332

       More information about medical identity theft

       • Federal Trade Commission

       For tips on how to prevent Medicare fraud

       • Call (800) 447-8477 or or visit the Medicare fraud webpage.

       You were sold insurance that doesn’t cover the services promised

       • Learn more at the FTC Health Insurance Scams webpage.

       Understand the "Explanation of Benefits"

       • Tips for understanding your EOB.

       Check your credit report

       • annualcreditreport.com or (877) 322-8228
       • Learn more about it from the Federal Trade Commission webpage and video.

       Get information about medical discount plans before you buy

       • Learn the difference between insurance and discount plans

       Learn about health insurance options

       • www.coveredca.com
       • Los Angeles County residents who are not insured can obtain information about coverage options and free and low cost health care programs at the Department of Health Services website.

       Remember, if it sounds too good to be true, it probably is!