Latest news with #SIU
Yahoo
2 hours ago
- Business
- Yahoo
Blue Shield of California Helps Seniors Be on Alert for Medicare Scams
Nonprofit health plan urges members and the public to protect themselves from fraud involving medical supplies, services not received, and suspicious charges OAKLAND, Calif., June 2, 2025 /PRNewswire/ -- In observance of Medicare Fraud Prevention Week, Blue Shield of California is highlighting its commitment to safeguarding Medicare beneficiaries against scams and fraudulent activities. With healthcare fraud continuing to rise across the country, protecting seniors has never been more critical. Highlighting the severity of Medicare fraud, the U.S. Department of Justice charged 193 individuals, including 76 medical professionals, in a nationwide healthcare fraud enforcement action in 2024. The schemes involved over $2.75 billion in alleged false claims, including fraudulent telemedicine and prescription drug schemes. "Medicare fraud and scams continue to pose a serious threat to older adults," said Alex Uhm, vice president and general manager at Blue Shield. "We are committed to enhancing our preventive measures and providing our members with the tools and knowledge to protect themselves." Blue Shield's efforts to protect its members include distributing updated member education materials that highlight common fraud schemes and preventive measures, and the introduction of an online portal for members to report suspected fraud. Blue Shield's Special Investigations Unit (SIU) is dedicated to detecting healthcare fraud and protecting our members by identifying suspicious activity and potential fraud. This proactive approach helps keep members safe and ensures fraud is addressed quickly. Blue Shield's SIU team tackles fraud across all areas, but experts have identified several prevalent scams targeting seniors, including: Unsolicited medical supplies: Receiving items such as catheters, diabetic supplies or back braces that were neither ordered nor needed. Impersonation scams: Fraudsters posing as health plan representatives to obtain personal information. Phantom billing: Charges for services or tests that were never provided. Artificial Intelligence (AI)-driven fraud: Emerging tactics include the misuse of beneficiary information to bill for unrequested services, and the use of AI to impersonate members and providers, as well as fabricate medical records for billing purposes. Blue Shield encourages its members to: Review statements: Carefully examine Explanation of Benefits (EOB) statements for any discrepancies. Protect personal information: Avoid sharing personal details over the phone or online unless certain of the recipient's identity. Report suspicious activity: Immediately report any unfamiliar charges or services not received to the health plan's Special Investigations Unit (SIU). If seniors or their caregivers suspect fraud, call Blue Shield's Medicare fraud hotline at (855) 331-4894 (TTY:711) or email MedicareStopFraud@ Medicare beneficiaries who suspect fraud or scams are also encouraged to take these actions: Contact your health plan: Use the phone number on your health plan card to report any suspicious activity. Report lost or stolen ID cards: Inform your health plan immediately if your ID card is lost or stolen, and request a new card and ID number. Review your statements: Carefully examine your Explanation of Benefits (EOB) for any services you do not recognize. Be cautious with phone calls: Even if the caller ID looks legitimate, do not confirm any personal information such as your Medicare number or social security number over the phone. Protect your health plan card: Never loan your health plan card to anyone. For more tips on how to stay safe from healthcare fraud, visit: About Blue Shield of CaliforniaBlue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. The health plan is a tax paying, nonprofit, independent member of the Blue Shield Association with nearly 6 million members, over 7,500 employees and more than $25 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. The company has contributed more than $60 million to Blue Shield of California Foundation in the last three years to have an impact on California communities. For more news about Blue Shield of California, please visit Or follow us on LinkedIn or Facebook. CONTACT: Mashi Nyssen Blue Shield of California 510-607-2359media@ View original content to download multimedia: SOURCE Blue Shield of California
Yahoo
2 hours ago
- Business
- Yahoo
Blue Shield of California Helps Seniors Be on Alert for Medicare Scams
Nonprofit health plan urges members and the public to protect themselves from fraud involving medical supplies, services not received, and suspicious charges OAKLAND, Calif., June 2, 2025 /PRNewswire/ -- In observance of Medicare Fraud Prevention Week, Blue Shield of California is highlighting its commitment to safeguarding Medicare beneficiaries against scams and fraudulent activities. With healthcare fraud continuing to rise across the country, protecting seniors has never been more critical. Highlighting the severity of Medicare fraud, the U.S. Department of Justice charged 193 individuals, including 76 medical professionals, in a nationwide healthcare fraud enforcement action in 2024. The schemes involved over $2.75 billion in alleged false claims, including fraudulent telemedicine and prescription drug schemes. "Medicare fraud and scams continue to pose a serious threat to older adults," said Alex Uhm, vice president and general manager at Blue Shield. "We are committed to enhancing our preventive measures and providing our members with the tools and knowledge to protect themselves." Blue Shield's efforts to protect its members include distributing updated member education materials that highlight common fraud schemes and preventive measures, and the introduction of an online portal for members to report suspected fraud. Blue Shield's Special Investigations Unit (SIU) is dedicated to detecting healthcare fraud and protecting our members by identifying suspicious activity and potential fraud. This proactive approach helps keep members safe and ensures fraud is addressed quickly. Blue Shield's SIU team tackles fraud across all areas, but experts have identified several prevalent scams targeting seniors, including: Unsolicited medical supplies: Receiving items such as catheters, diabetic supplies or back braces that were neither ordered nor needed. Impersonation scams: Fraudsters posing as health plan representatives to obtain personal information. Phantom billing: Charges for services or tests that were never provided. Artificial Intelligence (AI)-driven fraud: Emerging tactics include the misuse of beneficiary information to bill for unrequested services, and the use of AI to impersonate members and providers, as well as fabricate medical records for billing purposes. Blue Shield encourages its members to: Review statements: Carefully examine Explanation of Benefits (EOB) statements for any discrepancies. Protect personal information: Avoid sharing personal details over the phone or online unless certain of the recipient's identity. Report suspicious activity: Immediately report any unfamiliar charges or services not received to the health plan's Special Investigations Unit (SIU). If seniors or their caregivers suspect fraud, call Blue Shield's Medicare fraud hotline at (855) 331-4894 (TTY:711) or email MedicareStopFraud@ Medicare beneficiaries who suspect fraud or scams are also encouraged to take these actions: Contact your health plan: Use the phone number on your health plan card to report any suspicious activity. Report lost or stolen ID cards: Inform your health plan immediately if your ID card is lost or stolen, and request a new card and ID number. Review your statements: Carefully examine your Explanation of Benefits (EOB) for any services you do not recognize. Be cautious with phone calls: Even if the caller ID looks legitimate, do not confirm any personal information such as your Medicare number or social security number over the phone. Protect your health plan card: Never loan your health plan card to anyone. For more tips on how to stay safe from healthcare fraud, visit: About Blue Shield of CaliforniaBlue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. The health plan is a tax paying, nonprofit, independent member of the Blue Shield Association with nearly 6 million members, over 7,500 employees and more than $25 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. The company has contributed more than $60 million to Blue Shield of California Foundation in the last three years to have an impact on California communities. For more news about Blue Shield of California, please visit Or follow us on LinkedIn or Facebook. CONTACT: Mashi Nyssen Blue Shield of California 510-607-2359media@ View original content to download multimedia: SOURCE Blue Shield of California Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
CTV News
a day ago
- General
- CTV News
SIU investigating alleged assault in Orillia
A Special Investigations Unit vehicle is seen in this file photo. (File) A man is facing a slew of charges after an alleged assault incident in Orillia Saturday that is being investigated by the Special Investigations Unit (SIU). According to Orillia OPP, officers responded to the Colborne Street East area after receiving reports of assault and property damage. The officers arrested a suspect at the scene and charged him with common nuisance – endanger life, six counts of mischief, public intoxication and failing to leave premises when directed. Police say he was brought back to the Orillia OPP detachment where he was lodged in cells and held for a bail hearing, adding that he was later hospitalized for an injury. The SIU invoked their mandate to investigate after being notified by provincial police.
The Citizen
3 days ago
- The Citizen
SIU blocks R3.3 million pension payout of former Gauteng HOD
The SIU secured a court order stopping Gasela's pension payout as criminal investigations continue into corruption and fraud allegations. The Special Investigating Unit (SIU) has secured a court order stopping the pension payout of a former Gauteng head of department (HOD) as criminal investigations continue into corruption and fraud allegations. The unit obtained an interim order from the special tribunal to stop the Government Employees Pension Fund (GEPF) from processing about R3.3 million in pension benefits for Matilda Matozi Gasela, the former HOD at the Gauteng department of agriculture, rural development and land reform. Additionally, until the legal proceedings are concluded, Gasela is prohibited from accessing or claiming these funds under the order which was given on May 15, 2025. Gasela allegedly played key role in mismanaging trash-collecting vehicles contract Gasela began her tenure as HOD in 2018 and allegedly played a key role in mismanaging a contract with Enviro Mobi (Pty) Ltd (later known as Groen Mintirho). SIU spokesperson Kaizer Kganyago said that Gasela authorised additional payments and approved a R6 499 712.64 settlement for 'storage costs' — an item not included in the original contract — even though the company failed to deliver the vehicles. ALSO READ: SIU to investigate Defence department's surgical mask tender from 2021 Senior counsel explicitly advised against this payment, which was later declared fruitless and wasteful expenditure. 'Her actions allegedly contravened the Public Finance Management Act (PFMA) and contributed to the depletion of public funds, as the SIU contends, in what it describes as a fraudulent scheme,' Kganyago said. After discovering evidence of criminal activity, the SIU referred the case to the National Prosecuting Authority (NPA). The SIU sent this evidence to the NPA to consider pursuing criminal charges against Gasela, including fraud, corruption and maladministration. October 2024 arrest In October 2024, authorities arrested Gasela and her six co-accused. Her co-accused include: Loyiso Mkwana, chief director: sustainable use of environment, who also served as the bid evaluation committee chair. Thandeka Mbassa, former HOD. She left in August 2018. Abdullah Mohamed Ismail, former chief financial officer and chair of the bid adjudication committee. Matlhekelo Elsie Mabe, director of Mvest Trading (Pty) Ltd. Tinyiko Mahuntsi, director of Enviro Mobi. Puleng Peter Mabe, former director of Enviro Mobi and a former member of parliament Infographic: Supplied ALSO READ: NPA lacking in lottery probe The accused appeared before the Palm Ridge Specialised Commercial Crimes Court inJohannesburg. They were linked to financial mismanagement and illegal procurement in connection with the R33 million contracts that the Ekurhuleni metropolitan municipality (EMM) and the department gave to Enviro Mobi. Kganyago confirmed that the SIU filed papers in the special tribunal to review and cancel the contract and recover R33 731 463.64 in financial losses suffered by the state. R33m financial losses 'Furthermore, as part of consequence management, the SIU has made disciplinary referrals to the department against implicated officials. An administrative referral was made against Enviro Mobi for blacklisting,' he said. According to Presidential Proclamation No. R.15 of 2021, the SIU was tasked with investigating claims of maladministration in the department and Ekurhuleni specifically concerning the contracting or purchase of 200 portable three-wheel motorised trash-collecting vehicles. ALSO READ: Thrrr…Phaaa: Musician Selaelo Selota's Mercedes frozen as SIU probes misuse of lottery funds During the 2023/24 financial year, the SIU finished its investigation into this issue and delivered the report to the president.
TimesLIVE
3 days ago
- Business
- TimesLIVE
Special Tribunal stops pension to former Gauteng agriculture head Matilda Gasela
The Special Investigating Unit (SIU) has obtained an interim order preventing the processing of a R3.3m pension payout to Matilda Matozi Gasela, former Gauteng agriculture, rural development and land reform department head. The order, granted by the Special Tribunal on May 15, also restrained Gasela from accessing or claiming these funds pending finalisation of legal proceedings against her. Gasela assumed office as head of department in December 2018 and is alleged to have played a pivotal role in the mismanagement of a contract involving Enviro Mobi (later known as Groen Mintirho). 'Despite the company's failure to deliver the required vehicles, she authorised further payments and approved a settlement of R6.5m for purported 'storage costs' — an expense not stipulated in the original contract. 'Senior counsel had explicitly advised against this payment, which was later declared to be fruitless and wasteful expenditure,' the SIU said on Friday. Her actions allegedly contravened the Public Finance Management Act (PFMA) and contributed to the depletion of public funds in what the SIU described as a fraudulent scheme.
