Caring for Older Patients Beyond the Clinic, by Helping Them Avoid Being Scammed

Hilda Romero was in her early 80s when she finally retired from a successful 50-plus-year career as a haircare consultant for major brands like Clairol and Nexxus. A longtime resident of the Bronx, she was born in Brooklyn and grew up in what was then known as Spanish Harlem after her parents moved to New York City from Puerto Rico.

Now, a number of years later, she remains active and independent, going to senior centers to socialize a few times a week. Mentally she is sharp as a tack. But that didn’t prevent her from very nearly being scammed out of her lifesavings.

“They were so convincing,” she says. “I was ready to do what they told me. I count myself very lucky—it was a near miss.”

For about two decades Ms. Romero has been a patient of Amy Ehrlich, MD, professor of medicine and chief of the division of geriatrics. When Dr. Ehrlich heard Ms. Romero’s story, it was all too familiar.

“Because of my administrative and research portfolio, I don't see a lot of patients anymore,” says Dr. Ehrlich. “But in the last six months, I've had three be the victims of either completed fraud of hundreds of thousands of dollars, or attempted fraud. This is a full-blown public health crisis.”

Dr. Ehrlich was so struck by Ms. Romero’s story that she felt moved to do something to help protect the patient population she has devoted her career to. On Thursday, July 18, the division of geriatrics held a Grand Rounds presentation on the topic featuring several guest speakers, including Ms. Romero. “I had a lot of questions and wanted to learn more, and that is what drove me to organize this event,” says Dr. Ehrlich. The goal was to raise awareness among providers at Montefiore Einstein of the high prevalence of scams specifically targeting older adults in the Bronx, and the limited but important role healthcare professionals can play in supporting patients.

In addition to faculty and staff from the division of geriatrics, the talk drew attendees from the division of geriatric psychiatry, Montefiore Home Care, inpatient social work, physical medicine & rehabilitation, neuropsychology, and neurology. Dr. Ehrlich is already planning to sponsor the presentation again for the MHS social work staff and providing continuing education credits for social workers under a recent grant from the Health Resources and Services Administration (HRSA) as part of its Geriatrics Workforce Enhancement Program (GWEP).

A narrow escape

The Grand Rounds kicked off with Ms. Romero recounting her story in detail during an interview with Mirnova Ceide, MD, MS, associate professor in the division of geriatric psychiatry, in which she also shared about her life and career. They were joined by Herman Wun, chief of the financial fraud bureau in the Bronx District Attorney’s Office, and Ellen Kolodney, program coordinator in Wun’s office and a social worker, who has been working with older residents of the Bronx for 23 years.

Ms. Romero was home one afternoon when she received a call on her landline. The caller ID said “Chase,” Ms. Romero’s bank. “I spoke with a woman who told me there was suspicious activity on my account,” Ms. Romero recalled. “She told me people in Texas and California had made purchases, and that she was connecting me to the fraud division.” The next person she spoke with told her he was a federal agent from the U.S. Treasury department, and that it was urgent that she take all the money out of her account immediately to protect it. “He would arrange a courier to pick up the money and give me a receipt, and they would return it to me once the account was secure again,” she recalled.

In tears, Ms. Romero actually went to her bank with the intention of doing as the caller instructed. Thankfully, the manager intervened. “When I told him I needed to withdraw all the money from my account, he said, ‘Did someone call you saying they are an agent from the federal government? That’s a scam.’”

The manager sent Ms. Romero to a staff member who handles fraud. “She called the scammer because I had his number,” said Ms. Romero. “When he picked up the phone, she asked if he was agent so-and-so, and he said yes. Then she said she was calling from my bank. That ended the conversation. When she tried calling him again, he wouldn't pick up.”

She continued, “The scammer was so persistent. He said he could help me, and if I didn’t cooperate with him I would be responsible for these phony purchases on my account, several thousand dollars worth,” she says. “He was probably on the phone with me for 45 minutes. He kept pressuring me to act quickly, and not to tell anyone for security reasons. He also kept asking if I had other accounts.”

While Ms. Romero was on the verge of acting on the scammer’s instructions, she was suspicious enough that she did not reveal the correct last-four digits of her social security number, or how much money was in her account. “You had great instincts,” Kolodney, from the District Attorney’s Office, told her.

This is a full-blown public health crisis.

Dr. Amy Ehrlich, professor of medicine and chief of the division of geriatrics

The case perfectly illustrates a number of tactics commonly used by scammers, said Wun. These include telling victims they must act quickly, phishing for additional information that could be used to gain access to other accounts or funds, the need for secrecy, and even posing as a federal authority. “No one from the federal government will ever call you,” says Wun. “All of these are red flags.”

“They try to create a sense of panic,” said Kolodney. “They don’t want you to stop or take time to seek out other help or advice.”

Some of the most common scams targeting elderly people in the Bronx are ones in which caregivers or even family members obtain power-of-attorney, sometimes making changes to a will or even selling property and keeping the proceeds; romance scams, in which a purported romantic interest steals funds; scammers pretending to be from a bank; people offering low-risk investment schemes with a guaranteed rate of return; tech support or fake online security breach scams; people posing as grandchildren or other family members purporting to be in trouble and in need of immediate cash; and contractor fraud, where nefarious people may even damage a home themselves to convince an elderly person to make costly unnecessary repairs.

What healthcare providers can do

Depending on the relationship with a patient, it may be difficult for physicians or providers to broach these topics. “If you know a patient well, you can ask them if they are having any trouble keeping track of bills, mortgage payments, or rent,” suggests Kolodney. “Is anyone new helping with their finances? Is there anyone new in their household? Has somebody started living with them? Have they made any changes in their insurance policies, wills, power of attorney, or their healthcare proxy?”

She continued, “These questions might seem intrusive and only you can sense what may be appropriate on a case-by-case basis. If you have that level of trust, this is one more way of looking out for their well-being.” If a healthcare provider has a concern, they can provide an anonymous tip to the DA’s office or to Adult Protective Services.

Wun cautioned that many victims of fraud downplay it or don’t like to admit what happened. “As physicians, you may face resistance getting patients to open up about potential fraud,” says Wun. “People tend to be very ashamed. They are thinking, ‘I can't believe I fell for this. I should have known.’” Those who been scammed by a close contact or family member often don’t want to press charges.

When a patient does open up, healthcare providers can help normalize what has happened, which in turn may reduce stigma and shame. Wun pointed out that it’s not only patients who might be considered most at risk who fall for these predatory schemes. He recounted the story of a sitting New York State Supreme Court justice who turned over $1 million to a person impersonating her lawyer when she was about to close on an apartment. “These scammers are very convincing. Even very savvy, highly competent people fall prey,” he said.

As for Ms. Ramero, everyone in the room praised her mettle and her eagerness to share her story for the benefit of others. “I've told as many people as I can so that they’re aware,” says Ms. Ramero. “It could happen to anyone.”