How Successful are Medicare Fraud Busting Efforts?

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaIn 2011 CMS added high-tech tools to help it “crack down on waste, fraud and abuse.” In June of 2011 CMS announced that it would begin using predictive modeling technology, similar to technology used by credit card companies, to identify potentially fraudulent Medicare claims and prevent them from being paid. The new tools will help CMS move from its former “pay & chase” approach to one that focuses on preventing fraud and abuse before it takes place.
Source: wordpress.com

Video: The Medicare Common Access Card Explained

New Medicare assistance available to asbestos victims in Libby, Montana

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Source: mesotheliomalawyerhotline.com

Interagency fight against Medicare fraud shows promise

Kathleen King, director of health care for the Government Accountability Office, said, “although CMS has taken some important steps to identify and prevent fraud . . . more remains to be done to prevent making erroneous Medicare payments due to fraud. In particular, we have found that CMS could do more to strengthen provider enrollment screening to avoid enrolling those intent on committing fraud, improve pre- and post-payment claims review to identify and respond to patterns of suspicious billing activity more effectively, and identify and address vulnerabilities to reduce the ease with which fraudulent entities can obtain improper payments.”
Source: govexec.com

Medicare Card Computerized Vitale

The Vitale card is issued by the health insurance fund. As part of its replacement by the new Carte Vitale II, the health insurance company sends a pre-filled form to each beneficiary. It must verify the information listed, sign the form and attach a photo ID along with a photocopy of the ID. Only the photo of the cardholder is required (it is not advisable to attach a photo of beneficiaries under 16 years).
Source: cheapinsurancenews.net

Social Security and Medicare Don’t Look So Hot

Social Security will run out of funds in 2033—sooner than forecast last year—according to a new government report. Medicare’s hospital insurance fund will be gone by 2024. Together, the programs account for 35 percent of all federal spending, and if the trust funds—which are made up of the difference between the payroll taxes paid toward the programs and the benefits doled out—were depleted, benefits would be automatically cut by 25 percent. Social Security’s disability insurance faces the soonest expiration—it is now scheduled to run out of money  in 2016, two years earlier than projected last year. “By almost any objective measure, the financial health of the Social Security system has entered a concerning decline,” the two public trustees of the programs said yesterday in a statement.
Source: prospect.org

So what happens at TheMamaClub?

This morning we are hosting a First Birthday Party for twin girls. They have chosen a Pinkalicious theme with Mon Tresor and Couture Cupcakes & Cookies. I have never seen so many gorgeous pink frills in my life! The dessert table is breathtaking. The Club is completely decked out for this massive affair and our very own Barista is operating the coffee machine and pumping out luxurious lattes accompanied by croissants from Brasserie Bread as the guests arrive. We have wrapped all the presents chosen carefully  by the guests from the girls’ wish list and they sit amidst a display of balloons for when the birthday girls arrive. I am sure it will be a birthday celebration to remember!
Source: wordpress.com

2012 Blue Cross Blue Shield of Texas Medicare Part D Plans

Posted by:  :  Category: Medicare

With two plans to choose from, Blue Cross Blue Shield of Texas makes it easy to find the right prescription drug coverage that fits your medical needs and your budget. If you’re looking for the most affordable rates, the Value plan offers a lower monthly premium in exchange for a small deductible. With the Value plan, you still get comprehensive coverage with a small copay and discounts on brand name drugs. If you’re looking to have no deductible, the Plus plan offers the same quality coverage for a little more monthly and a small copay for all generic drugs. 
Source: texasmedicarehealth.com

Video: LifeChoice Oxygen Featured on Good Morning Texas

Medigap Plans Available in Texas for all Seniors

Simply because plans are standardized does not mean different insurance companies will be the same. There are stark differences in cost, dependability and reliability that must be taken into consideration. You may be able to find a great plan for less, but be wise when choosing coverage and stay with household names you know and trust for delivering benefits on time and when you need them most. Companies like United of Omaha or Blue Cross Blue Shield of Texas have worked hard to gain the trust of Texans by providing coverage they can depend on.
Source: medicareinsurancetexas.com

Durable Medical Equipment Austin Texas Medicare Eligible

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Source: beckfamilync.com

Court: Social Security Beneficiaries Cannot Drop Medicare Eligibility

In the case, five plaintiffs — including former House Majority Leader Dick Armey (R-Texas) — said that they would prefer not to be eligible for Medicare benefits because their private health plans limit coverage for people who qualify for the program (Pecquet, “Healthwatch,”
Source: californiahealthline.org

Medicare Advantage Plans Texas – Eligibility and Plan Options

The Medicare Advantage plan comes as a significant part of the original medicare policy, and incorporates the coverage benefits of the traditional Plan A and Plan B Medicare plans, and other supplemental coverage as well. Any Texas resident can secure a medicare advantage policy, given that the individual qualifies the standard eligibility criteria for the same. To qualify for Medicare Advantage plans Texas, you must live in the constituency or area that has the plan, and must also have both the Medicare Plans Part A and B. However, if you are suffering from some end-stage renal disease, you may not qualify for the same. But a plan cannot drop you if you are diagnosed with the disease while already being a part of the plan.
Source: mclaininsurancegroup.com

Romney Proposes Raising Medicare Eligibility Age in 2022

February 24, 2012 Suehs Signs Rule Banning Abortion Affiliates – “If there was any hope that the state was seeking a compromise with the federal government over Texas’ Women’s Health Program, it’s fading fast. At the direction of lawmakers and Texas Attorney General Greg Abbott, the Texas Health and Human Services commissioner signed a rule on Thursday that formally bans Planned Parenthood clinics and other “affiliates of abortion providers” from participating in the program — something the Obama administration has said is a deal-breaker for the nearly $40 million-per-year state-federal Medicaid program.”
Source: talkleft.com

Medicare Experts Guide Texas Woman through Medicare Maze

Whether you’re new to Medicare or have been on Medicare for several years, you no doubt have questions. After all, Medicare itself is confusing enough on its own. Once you understand the gaps in coverage that Medicare can create, you’re faced with a daunting proposition: finding a Medicare supplement that can plug those holes so you can have peace of mind. Forgoing Medicare supplement insurance means that you’ll have to pay more out of pocket, and that could be the path to financial ruin at a time in your life when you should be able to breathe a little easier.
Source: ezinemark.com

Public comment sought on Medicaid

Posted by:  :  Category: Medicare

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Source: hawaii247.com

Video: Questions raised about doctor’s incentive program

U.S. watchdog blasts Medicare quality insurance project

Its aim is to provide strong incentives for Medicare Advantage plans with as few as three out of five stars to improve performance at various star rating levels. The program ensures that all qualifying plans receive bonuses at least as great as those that would occur under the healthcare law, rather than just the highest-performing ones.
Source: insuranceinf.com

CMS Final Rule: HHAs Must Ensure Physician Enrollment in Medicare

This rule required enrollment of physicians ordering home health and other services to be enrolled in the Provider Enrollment, Chain, and Ownership System (PECOS). The ordering and referring physician provisions became effective July 1, 2010 in accord with statutory requirements. However, home health services ordered by physicians not enrolled in PECOS have not been subject to claim rejections and denials to provide CMS with sufficient time to resolve problems with PECOS systems and to move all Medicare enrolled physicians from Legacy systems to PECOS. The delay provided time for CMS to develop systems to enable opt-out physicians, and physicians seeking to order and refer but not bill Medicare, to be enrolled in PECOS (i.e. VA, military physicians, etc.).
Source: hcafnews.com

The basics of Illinois Medicare

Medicare consists of four major parts. These are known as Medicare Parts A, B, C, and D. Part A is also called hospital insurance since it helps to cover the costs for inpatient health care for those who need treatment in a hospice, a skilled nursing facility after a stay in a hospital, or in a hospital. Medicare Part B is referred to as medical insurance and it’s designed to help cover the costs for doctors and several medical supplies and services that aren’t taken care of hospital insurance in Part A.
Source: abchealthplans.com

Future Innovations in EHR Systems

Health IT companies are discovering opportunities to focus on certain aspects of, rather than complete, EHR systems. “You’re seeing companies emerge who are saying,” continues Griffiths, “If I come to bring a product into this industry, I don’t have to be an EMR stem to stern. I can come in and I can be a decision-support piece, I can be e-prescribing piece, I can be a patient education piece.” The electronic medical record (EMR) or EHR system can serve as a platform on which to deliver solutions characterized by their ability to deliver services best suited to one or several aspects of meaningful use criteria.
Source: ehrintelligence.com

Patient survey results help you choose a home health agency

Now there’s an objective and meaningful way to compare other patients’ actual experiences with home health agencies and services—the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey – and we’ve just released the first set of survey results on our Home Health Compare page.
Source: medicare.gov

Medicare Cracks Down on Unnecessary Payments

Notice: The State of California Legislative Counsel has rendered an opinion that it is ILLEGAL for PTs to be employed by any professional corporation except for those owned by physical therapists and Naturopaths. In its opinion, the Legislative Counsel confirms that, because the existing California Corporations Code does not specifically include physical therapists on the list of those who may be employed by a medical corporation, a physical therapist is prohibited from providing physical therapy services as an employee of a medical corporation, podiatric corporation, or chiropractic corporation. This ruling means that physical therapists in these employment situations may be subject to discipline by the Physical Therapy Board of California (PTBC).
Source: stoppopts.org

A Closer Look At The Medicare Trustees’ Report

1. Medicare Income and Expenditures as a Percent of Gross Domestic Product (GDP).  One way to express the growth in the total Medicare program is as a percentage of GDP, which is the total value of all goods and services produced in the United States. This reflects society’s current resources devoted to Medicare and provides a broader context for the combined costs of HI and SMI.  Under the Trustees’ intermediate assumptions total Medicare expenditures will grow from 3.7 percent of GDP in 2011 to 4 percent of GDP in 2020 and 6.7 percent of GDP in 2086, as shown in Figure 2. The components of the bars show projected HI income (payroll taxes, tax on benefits, premiums, state transfers and drug fees and general revenue) and projected HI expenditures through 2086. While payroll taxes will remain relatively constant as a share of GDP, other relatively minor sources of financing will increase slightly. The HI deficit (the difference between HI income and HI expenditures) will increase from 0.26 percent of GDP in 2011 to 0.73 percent in 2086, and will average 0.63 percent of GDP over the next 75 years.
Source: healthaffairs.org

Medicare Bonus Program Under Fire

Republicans say that the administration is attempting to temporarily shield seniors from benefit cuts in an election year. As we have said before, whether politics entered into the equation or not, CMS also had less-sinister reasons for pursuing the demo. Only 20% to 25% of plans would have qualified if left as PPACA envisioned. CMS correctly saw that the glide path to 4 Star was too steep for most plans and a different approach was needed to incent all plans to move the quality bar. It has implemented a carrot-and-stick approach to doing so, by incenting 3 Star plans with bonuses and at the same time implementing measures to penalize low-scoring plans (e.g., inability to enroll through Plan Finder and terming consistently low-scoring plans). Convinced of the good policy rationale, Department of Health and Human Services Secretary Kathleen Sebelius told the Congressional hearing this week that she has no intention of cancelling the demonstration.
Source: medhok.com

CMS Proposal Would Factor Patient Safety, Efficiency Into Hospital Pay Formula

HealthBeat: CMS Issues Proposed Inpatient Hospital Payment Rule The agency added in a news release that “the rate increase, together with other policies in the proposed rule and projected utilization of inpatient services, would increase Medicare’s operating payments to acute care hospitals by approximately 0.9 percent in FY 2013.” This means total Medicare operating payments to acute care hospitals would rise by a total of about $904 million in fiscal 2013. However, because of expiring statutory provisions providing special temporary increases in payments, plus other proposed changes, CMS said “total Medicare spending on inpatient hospital services will increase by about $175 million in FY 2013″ (Reichard, 4/24).
Source: kaiserhealthnews.org

Medicare Supplement Sales (Las Vegas)

Posted by:  :  Category: Medicare

DC Voting Rights by dbkingMedicare Supplement Insurance Agent (Solana Beach) ——————————————————————————– Date: 2012-04-26, 9:47AM PDT Reply to: your anonymous craigslist address will appear here ——————————————————————————– Medicare4Less.com is a fast growing Medicare Supplemental Insurance Agency that sells over the phone and Internet -nationally – and we are looking for a few more agents to work our quality leads. With 10,000 people entering Medicare daily – there is a lot of potential for success. Our agents average over 20 sales per month and never leave their desk ….as we SAVE our clients on average $300 to $500 per year on their Medicare Supplement plan. We are seeking professional, energetic, customer oriented individuals to join our team. If you have a positive attitude and exceptional sales skills we would like to hear from you. This position requires a highly motivated sales person, who is a self starter with excellent multi-tasking skills and is able to work-from-home or in their office. We provide leads, a lead management system, administrative support , training, personalized web site and a toll free number. ***** Life/Health Agent License is required for this position.***** Demonstrated knowledge of Health Insurance and Medicare Supplement Insurance are crucial to your success. RESPONSIBILITIES AND DUTIES – Responsible for contacting our qualified leads to help them SAVE money on their Medicare Supplement policy via the telephone and Internet. – Provide Medicare Supplement options and educate the customer throughout the process by providing the information necessary to make informed decisions. – Ability to be highly productive and efficient working from your home or your office. – Complete applications via phone and/ or internet – to secure the sale. QUALIFICATIONS – 1 – 2+ (at least) years experience selling insurance for an agency or brokerage – Must have proven ability to close sales – Strong learning and multi-tasking ability essential – Outstanding communication skills; written and verbal for heavy phone interaction. – Quality work ethic – Ability to maintain positive attitude with customer at all times – Ability to build rapport with customer – Access to Internet from work space. Send a description of your work experience and licensing information( list states that you are licensed) to us via the e-mail address in this ad. Compensation: Commissions $3000 + / month by meeting quota…. Plus renewals!! Principals only. Recruiters, please don’t contact this job poster. Please, no phone calls about this job! Please do not contact job poster about other services, products or commercial interests.
Source: telecommuteanywhere.com

Video: EMR/EHR: Medicare Incentives in the HITECH Act

Commonly Held Misconceptions About Medicare And Medicaid

People have become lulled into thinking that once they turn 65, they have no more health insurance worries. They believe that Medicare, an entitlement program which they paid into throughout their working lives, will take care of them during the years when they need health coverage most. Although every United States citizen is entitled to Medicare coverage, and those with low incomes can apply for Medicaid, these are by far not the cover-all health policies that many people think they are. That’s why, when they are in a position to make a claim, they often find themselves in a world of hurt. The first misunderstanding that many Medicare recipients have is that once Medicare has paid everything it’s going to pay, Medicaid will kick in to pick up the remainder. This may or may not be true, and only if the person meets the qualifications required by Medicaid. Medicaid is health care for low income or needy individuals. Unless the Medicare recipient meets the financial guidelines, Medicaid will not pay anything. This is why supplementary insurance is so necessary for those who are on Medicare. Many individuals believe that in order to qualify for Medicaid, all they have to do is transfer their assets to a family member so that they can meet the guidelines. This is not true. Instead, if you try this trick in order to receive Medicaid coverage, you may find yourself faced with a large penalty. The government is prepared for patients trying to beat the system by transferring assets for less than market value to loved ones. When a new application is filed, the state will look at the person’s finances for as far back as five years. If they find you’ve transferred money and property you once had to a sibling or child, you will end up in legal difficulties. Another misconception that can end up costing you is that Medicare will defray the costs of home or nursing home care. In reality, Medicare doesn’t kick in until you’ve been in the hospital for at least three days. If following your hospital stay you require rehabilitation or skilled care, Medicare will only pay for the first 100 days. Certain patients who require physical therapy or other care may qualify for more Medicare benefits. Home care as well as nursing home care need to be covered by some type of long-term care insurance. Some people think it’s a simple matter to sign up for Medicaid if a need arises. This is also not true. Although the procedure is different in the various states, you will still need to prove you are eligible no matter where you live, and this can take a lot of time. You may be required to produce paystubs, if you are still working, bank statements, proof of age and citizenship, proof of income (social security), and any insurance policies that you own. With Medicaid, it’s good to start the process as soon as you meet eligibility requirements so that if you need the assistance, you already have it in place. For more info visit http://www.brightstarcare.com.
Source: worldvillage.com

Student of Motherhood: Parenting Resources in Indiana

I’ve been doing the single parenting thing for about 10 years now. There have been times when I had to ask for help and there have been times when I forgot that help was even out there. The resources I’m listing here aren’t just for parents, but since this is a parenting blog, the blog itself is aimed in that direction. If you’re struggling, check out this list of parenting resources. There might be something in there that can help you. Township Trustee: Whether you’re a parent or not, start with the township trustee if you find that you’re unable to make ends meet. They may help and they’re likely going to guide you to other resources, including some of the ones I mention here. The Trustee has a “poor relief fund” that is there to help people in the event that they qualify for assistance. Yes, you may have to jump through some hoops. But if you want their help, you have to play by their rules. Family and Social Services: The Family and Social Services Administration is the place to go to apply for assistance in the form of TANF (cash assistance), food stamps, daycare assistance, medicaid, and medicare. Keep in mind that they are there to serve the state, not you, and they actually go through training to learn how to not tell you about other programs. It’s not their fault. They’re just working within their guidelines. Also keep in mind that the qualifications for medicaid haven’t changed in over 20 years, so it can be difficult to obtain. Healthy Indiana Plan: HIP is a form of health insurance through the state that is based on your income. While you can apply at the FSSA office, you can also do it directly through HIP. Keep in mind that you must be without health insurance for 6 months, not including medicaid or medicare. Lifeline Phone Program: This program offers a discount for basic home phone service. The phone must be in your name and you must either be receiving assistance from the state in some form, or be at or below 135% of the federal poverty line. This cannot be applied to Internet service or used by the same person as the Assurance service is. Assurance wireless service is a service that provides you with a free cell phone and 250 free minutes of talk a month. You can buy minutes for text if you like. FAFSA: The FAFSA is the main application for financial aid for college. Applications can be filled out any time of the year, but state funding is only available if you fill it out before the deadline, which is usually around March 10. If you’re struggling and you can’t find a job, isn’t it about time you went back to school? Unemployment Office: Hoosiers will be phased out of the extended benefits offered by the Federal government based on the fact that unemployment has gone down. Plan ahead. Enroll in school or a training program now, before your benefits run out. But keep in mind that the Unemployment Office isn’t just for handling unemployment benefits. The office also offers paid training and gas cards to help you complete your training. Call or visit the Unemployment Office in your area to learn about programs you may qualify for that will help you get back on your feet.
Source: blogspot.com

Paul Ryan: Seniors deserve so much more from President Obama

Without unprecedented changes in health care delivery systems and payment mechanisms, the prices paid by Medicare for health services are very likely to fall increasingly short of the costs of providing these services. By the end of the long-range projection period, Medicare prices for hospital, skilled nursing facility, home health, hospice, ambulatory surgical center, diagnostic laboratory, and many other services would be less than half of their level under the prior law. Medicare prices would be considerably below the current relative level of Medicaid prices, which have already led to access problems for Medicaid enrollees, and far below the levels paid by private health insurance. Well before that point, Congress would have to intervene to prevent the withdrawal of providers from the Medicare market and the severe problems with beneficiary access to care that would result. Overriding the productivity adjustments, as Congress has done repeatedly in the case of physician payment rates, would lead to substantially higher costs for Medicare in the long range than those projected under current law.
Source: hotair.com

Whats New With Medicare And Medicare Supplement Insurance?

Under the new rules, organizations meeting certain qualifications will be given permission to access patient-protected Medicare data to generate public reports about the health care services of clinics, doctors and hospitals.  These reports will combine Medicare and Med Supp Insurance claims data with private sector claims data to point out which health care providers give the most cost-effective and highest-quality services.  This strategy is a part of the Affordable Care Act aimed at improving health care, making people pro-active about their health, and  decreasing  health care expenses. 
Source: allyorfoe.com

Hospital Compare adds Spending Per Hospital Patient with Medicare Measure

Posted by:  :  Category: Medicare

J Center Medicare D Seminar 11-21-06 (8) by Korean Resource Center 민족학교Website, the Spending per Hospital Patient with Medicare measure shows whether Medicare spends more, less or about the same per Medicare patient treated in a specific hospital, compared to how much Medicare spends per patient nationally. This measure includes any Medicare Part A and Part B payments made for services provided to a patient during the 3 days prior to the hospital stay, during the stay, and during the 30 days after discharge from the hospital. 
Source: hcqualitynews.com

Video: Best Democrats’ Debate Yet -Clearest, Quickest Answers-Pt J

Medicare Premiums: Rules For Higher

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Source: jwterrill.com

The ABCs Of Medicare Part D

Open-enrollment season for Medicare Part D often brings confusion for seniors all over the United States trying to sign up for prescription drug plans. Most counties in the U.S., however, have  programs to help seniors wade through the options.
Source: kaiserhealthnews.org

Is it Time to Change to a Modernized Medicare Supplement Plan?

Consider how Medicare and Medigap plans work. Medicare, being the primary plan, leaves many “gaps” also know as deductibles and co-insurance for the insured to pay. Medicare Supplement plans (Medigap), fill this void. The majority of individuals purchase a Medicare Supplement when they turn sixty-five or begin Medicare for the first time. Obviously, for the most part, from an insurance company stand point, the younger the insured client, the better. Younger people typically are healthier than older people and therefore they file less claims. For an insurance company, less claims mean more profit. Now consider this fact regarding pre-modernized Medicare Supplement plans. They are in effect closed to all new enrollments. No individual newly aging into Medicare may purchase a pre-modernized Medigap plan. Obviously then the average age of the insureds in these pre-modernized plans is going to increase and, as the avearge age of the insureds increases, so will claims. What is the number one factor which causes premium increases for all Medicare Supplement plans? That’s right, claims!
Source: medicarequotefinderblog.com

Is Medicare Enough Health Insurance? Your Answer

That being the case, why would anyone buy the combination plan when they can get similar coverage for less money through the Medicare Advantage plan? They do so because they want freedom to choose. The Medicare/Medigap/Supplement combination allows users to keep their own doctors and Medicare Advantage plans don’t. And the combo package gives you better coverage if you travel out of state too.
Source: cifblog.org

Looking for Insurance Articles

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Source: lookingforinsurance.net

Florida Supreme Court to Decide Fee Schedule Issue

The Legislature’s amendment to the PIP statute sought to address the enormous costs and inefficiencies of the law prior to amendment. Litigation and fee-shifting to determine “reasonable” costs of standardized medical procedures should be passé by now. An MRI, for example, is now a common procedure. The medical cost accounting and national metrics supporting the Medicare Part B reimbursement figures for MRIs and other standard medical services are widely used and understood. An alternative charge based essentially on whatever the market will bear, on the other hand, invites litigation. A prevailing provider or insured may also recover attorney’s fees and costs, and resolution of these disputes also requires judicial resources at the expense of all State taxpayers. All of these circumstances are contrary to the original, no-fault objectives of the PIP statute.
Source: flpipguide.com

Explaining Medicare Supplement Or Medigap Policies

Posted by:  :  Category: Medicare

In honor of Tax Day by swanksalotTherefore, purchasing Medicare supplement plan right when you turn 65 is probably a good idea, because that is when you are the healthiest and youngest and eligible for Medigap coverage. If you purchase a Medicare supplement policy later on, you may have to pay a really high premium. There are standardized Medicare supplement policies, which are government-regulated to include specific benefits so that individuals can compare the policies easily. However, each health insurance provider can set their own prices for their Medicare supplement policies. That is why it is important to do some comparison shopping between insurance providers. At this time, there are twelve different standardized Medigap or Medicare supplement policies. They are identified by the letters A through L. The federal and state government both regulates these Medicare supplement policies, in order to protect seniors. The first mandate is that all Medigap policies be clearly identified as Medicare Supplement Insurance. The twelve different types of Medicare supplement policies have a different set of basic benefits, plus possibly more additional benefits. In the next year or two, some additional Medicare supplement policies will be added. These will also be identified by letters. In order to buy a Medicare supplement policy, you must already have Medicare Part A and Part B. You will continue to pay your premium for Part B, and then an additional premium for the Medicare supplement policy. Part A, as you are probably aware of, does not require an additional premium, as long as you paid into Medicare taxes throughout your career life. Unlike traditional health insurance, each spouse must purchase their own Medicare supplement policy. One Medigap plan will not cover married spouses. If you enroll in a Medicare Advantage plan, rather than the traditional Medicare, you are not eligible to also buy a Medigap policy. This is because the Medicare Advantage plans already have additional benefits, in addition to standard Medicare, and therefore a Medicare supplement insurance policy would be considered double benefits. You can get a lot of information about Medicare, Medicare Advantage plans, and Medicare supplement insurance plans on the governments web site at Medicare.gov. Remember that you can purchase Medigap or Medicare supplement insurance plans from the private health insurance market, and through a licensed insurance broker. A broker can help you find the right Medicare supplement insurance, and explain to you the difference between the twelve different Medigap policies available.
Source: ezinemark.com

Video: Medicare

Federal Budget in Pictures Shows Medicare’s Path to Crisis

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Source: heritage.org

Longer Looks: Explaining Medicare’s ‘Premium Support’

Washington Monthly: The Yaz Men: Members Of FDA Panel Reviewing The Risks Of Popular Bayer Contraceptive Had Industry Ties Last month, the U.S. Food and Drug Administration convened a committee of medical experts to weigh new evidence concerning the potential dangers of drospirenone, a synthetic hormone contained in popular birth control pills including Bayer AG’s Yaz and Yasmin. … the committee concluded by a four-vote margin that the benefits of drugs with drospirenone outweigh the risks. However, an investigation by the Washington Monthly and the British medical journal BMJ has found that at least four members of the committee have either done work for the drugs’ manufacturers or licensees or received research funding from them. The FDA made none of those financial ties public. … When asked whether the agency was aware of any financial ties between its advisors and manufacturers or distributors of drospirenone, FDA spokeswoman Morgan Liscinsky said, “No waivers were issued” (Jeanne Lenzer and Keith Epstein, 1/9).
Source: kaiserhealthnews.org

Longer Looks: Explaining Medicare’s ‘Premium Support’

Please send the completed claim form, your itemized bill, and any supporting documents to the Medicare contractor and explain in detail your reason for submitting the claim. The address where you need to return the form for processing depends on the state you live. If your provider or supplier refused or is unable to file a claim for a Medicare-covered item or not enrolled with Medicare, you must include a statement that your provider or supplier refused to do so. Very few dentist are currently enrolled with Medicare. If this statement is not included, the Medicare contractor will return your CMS 1490S form and you will need to complete another claim form with the statement included. When you submit your own claim to Medicare, complete the entire form. Medicare contractors will reject the claim or will send a letter to you with an explanation of why it was returned if the form is incomplete. You should mail the original claim form and make copies for your records. Please allow at least 60 days for Medicare to receive and process your request. If you have any other questions, please feel free to call 1-800-MEDICARE (1-800- 633-4227). Use the following address table to ensure the correct address will be provided on the 1490S claim. If you live in: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont (Region A) Return your form to: NHIC, Corp. P.O. Box 9180 Hingham, MA 02043-9180 If you live in: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin (Region B) Return your form to: National Government Services, Inc. DMEPOS Operations Medicare DMEPOS Claims P.O. Box 7027 Indianapolis, IN 46207-7027 If you live in: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, West Virginia (Region C) Return your form to: CIGNA Government Services P.O. Box 20010 Nashville, TN 37202-0010 If you live in: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming (Region D) Return your form to: Noridian Administrative Services P.O. Box 6727 Fargo, ND 58108-6727 Source: apneasupport.org
Source: medicaresupplementalco.com

Hiding Obamacare’s Results Before November

As we know, most provisions of Obamacare don’t kick in until after the 2012 election. But to prepare for massive changes to the Medicare Advantage program (a very popular and more market-oriented alternative to Medicare), 12 million seniors would have to learn by the end of this year about how their health insurance program will face slashes. Presumably most seniors would be herded back into traditional Medicare.
Source: ricochet.com

Paul Ryan: Seniors deserve so much more from President Obama

Without unprecedented changes in health care delivery systems and payment mechanisms, the prices paid by Medicare for health services are very likely to fall increasingly short of the costs of providing these services. By the end of the long-range projection period, Medicare prices for hospital, skilled nursing facility, home health, hospice, ambulatory surgical center, diagnostic laboratory, and many other services would be less than half of their level under the prior law. Medicare prices would be considerably below the current relative level of Medicaid prices, which have already led to access problems for Medicaid enrollees, and far below the levels paid by private health insurance. Well before that point, Congress would have to intervene to prevent the withdrawal of providers from the Medicare market and the severe problems with beneficiary access to care that would result. Overriding the productivity adjustments, as Congress has done repeatedly in the case of physician payment rates, would lead to substantially higher costs for Medicare in the long range than those projected under current law.
Source: hotair.com

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“If you cannot measure it, you cannot improve it.” Lord Kelvin “Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.” Nassim Nicholas Taleb Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the “Quantified…
Source: thehealthcareblog.com

Obama’s $8 Billion Cynical Ploy

But along came a Government Accounting Office (GAO) report released yesterday which recommends that HHS cancel the project. The GAO said the project “dwarfs all other Medicare demonstrations” in its impact on the budget and criticized its poor design. “The design of the demonstration precludes a credible evaluation of its effectiveness in achieving CMS’s [Centers for Medicare & Medicaid Services] stated research goal,” according to the report. As the Wall Street Journal puts it in this editorial, “there’s no control group to test which approaches work better. It’s a demonstration project without the ability to demonstrate.” Senator Orrin Hatch of Utah, the senior Republican on the Finance Committee, and Representative Dave Camp, chairman of the Ways and Means Committee, released a statement in which they said they were concerned that the government might be “using taxpayer dollars for political purposes, to mask the impact on beneficiaries of cuts in the Medicare Advantage program.”
Source: commentarymagazine.com

By Adopting A Medicare Supplement Insurance Plans Seize A New Life

Posted by:  :  Category: Medicare

There are even several government owned companies which provides Supplemental Medicare Insurance plans in low-costs. These companies are truly affordable but they don’t prove be to in help during an unpredicted medical situation. Even these government owned companies have very limited coverage. So, it is very essential to approach a company after going through its reviews and credentials. An individual can even compare among the features and coverage of a private and a government owned Medicare supplement insurance companies. This really helps an individual to choose the best and the right coverage amongst all for himself and for his family. An individual should compare Medicare supplement plans online understand the terms and the features of the policy. So, before purchasing a Medicare supplement insurance policy, help from a Medicare supplement insurance agent and a little research online will help an individual to quickly decide which policy will be beneficial and which insurance company will be the best to adopt the from.
Source: ezinemark.com

Video: Medicare Advantage vs. Medicare Supplement Insurance

Health On The Hill: Competing Prescriptions For Medicare’s Financial Health

MARY AGNES CAREY: The hearing will look at this idea of premium support, of the government limiting the contribution per beneficiary in Medicare. And the committee wants to do this now because there is all this discussion about the debt and the deficit. As you mentioned the Medicare trustees’ report just came out. The solvency has not been extended. It’s still at Year 2024. So the idea is let’s look at the idea of limiting the government’s contribution.  Let’s bring in a lot of witnesses. They are going to include Henry Aaron of the Brookings Institution, who is one of the founding architects of the premium support idea. Another witness is John Breaux, a former Democratic senator of Louisiana, who along with the former Ways and Means Committee Chairman Bill Thomas of California came up with a premium support idea. So they want to do this now in part because of the trustees’ report from yesterday and also, you know, the Republican message has been let’s control federal spending, especially in entitlements and here’s a way to do it.
Source: kaiserhealthnews.org

Interagency fight against Medicare fraud shows promise

Kathleen King, director of health care for the Government Accountability Office, said, “although CMS has taken some important steps to identify and prevent fraud . . . more remains to be done to prevent making erroneous Medicare payments due to fraud. In particular, we have found that CMS could do more to strengthen provider enrollment screening to avoid enrolling those intent on committing fraud, improve pre- and post-payment claims review to identify and respond to patterns of suspicious billing activity more effectively, and identify and address vulnerabilities to reduce the ease with which fraudulent entities can obtain improper payments.”
Source: govexec.com

Auditors call for end to Medicare Advantage experiment

"CMS believes the demonstration supports our national strategy to improve the delivery of health care services," the health department wrote. "Absent this demonstration, we believe many plans would not have an immediate incentive to improve the quality of care to [Medicare Advantage] enrollees."
Source: hartfordbusiness.com

Obama Cons Medicare Seniors to Gain Their Votes 

After gutting medicare by taking from it 500 billion dollars to fund Obama Care, Obama had to take $8+ billion to keep it solvent until after the election. If it were self sufficient why then would they infuse it with $8 billion dollars? http://visiontoamerica.org/9357/obama-cons-medicare-seniors-to-gain-their-votes/
Source: current.com

Social Security may go broke by 2033; Medicare in 2024

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Source: theeagle.com

Obama campaign: Romney will turn Medicare into a voucher system

“Romney’s plan for Medicare is simple:  turning it into a voucher program and forcing seniors to pay thousands more out of pocket each year for their health care.  The President has already made a down payment on his promise to preserve Medicare for future generations — extending its solvency by 8 years by passing the Affordable Care Act – and the administration has proposed reforms which would extend its solvency for another two years," Obama campaign spokesman Ben LaBolt said in a statement.  "Romney has committed to repealing health care reform on Day One which would make Medicare insolvent in 2016." "By making devastating cuts to Medicare and Social Security, Governor Romney would end America’s social compact with our seniors.  And he has proposed fiscally irresponsible policies that would make it much tougher to ensure that Medicare and Social Security remain solvent for the long-term, by proposing $5 trillion tax cuts for millionaires and billionaires that we simply can’t afford," LaBolt said.
Source: politico.com

Medicare News for Week of April 17, 2012: CMS Website Upgraded, 2 National Provider Calls, Proposed CQMs for MU Stage 2 and 27 ACOs are Announced

Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT). Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means. As part of CMSs revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official. For more information about provider enrollment revalidation, review the MLN Matters Special Edition Article #SE1126, Further Details on the Revalidation of Provider Enrollment Information.
Source: managemypractice.com

Auditors call for end to Medicare Advantage experiment

Posted by:  :  Category: Medicare

"CMS believes the demonstration supports our national strategy to improve the delivery of health care services," the health department wrote. "Absent this demonstration, we believe many plans would not have an immediate incentive to improve the quality of care to [Medicare Advantage] enrollees."
Source: hartfordbusiness.com

Video: Preferred Chiropractic Clinic

We thought of Cigna Medicare health needs covered senior

The program replaces a fee for service Medicare Part A and B provides coverage for retirees living in the program of the government Medicare does not demand particular networking or referrals, and works with any vendor that accepts the conditions of Medicare and Cigna. You get complete coverage of this medically following the output level of the pocket is violated, as properly as dental care and a nurse hotline. For much more information visit the CIGNA Medicare who are looking for, answer any questions you could have. Medicare coverage by Cigna is particularly appealing for older folks since it provides 4 distinct possibilities for well being and prescription benefits. It is offered in most states, meaning that practically any person can get it. Plans that cover most drugs can, although a low deductibles are a excellent choice for you retirees. If to retire, if you genuinely feel about it and that is the strategy, and overcome the challenges of this can be exhausting. Cigna Medicare covers all your needs in just a snapshot.
Source: seniordriver.org

CIGNA Medicare Provides Medical and Decree Biologic Advantage at a Low Cost

CIGNA offers added allowances to your medical coverage. You are accustomed a assessment chargeless amount to alarm for recorded bloom advice or to altercate your medical apropos with a registered nurse. In addition, you accept the advantage of accepting home pharmacy supply of your approved medications. CIGNA aswell provides you with a abatement agenda that could save you money on exercise memberships, eyewear, eyes exams, audition tests, audition aids, batteries, and chiropractic care. You are aswell provided programs and discounts to advice you with weight loss, able nutrition, dental care, laser eyes care, and smoker cessation.
Source: caboverd.info

Cigna Medicare Provider Enrollment Package Details

CIGNA is welcoming to Medicare Part B Provider/Supplier Enrollment Package. CIGNA Government Services have been contracted as a carrier to administer the Medicare Part B program by The Centers for Medicare & Medicaid Services (CMS). CIGNA is committed to achieving the highest standards of quality and service to their providers, beneficiaries and government entities they serve. CIGNA Government Services is responsible for providing information concerning enrollment into the Medicare program, processing Medicare claims, and communicating changes in the Medicare guidelines. Extensive research is required to processing of an eligible Medicare provider/supplier application to prove that all information provided is correct and all appropriate attachments are supplied. Please note that there is important information which is Considerable to the enrollment process including but not limited to the completion of the CMS-855 enrollment application(s) (2008 version), Authorization Agreement for Electronic Funds Transfer (CMS-588), submission of the National Provider Identifier (NPI) Notification, requirements for P.O. Box ownership, clinical lab registration requirements, and other important Medicare enrollment information.
Source: letmeget.net

Cigna Medicare Supplement Insurance

There are three main types of prescription drug pans, The Cigna Rx value plan, The Cigna Rx plus plan and the Cigna Rx complete plan. Monthly fees will vary and can run from as low as 17$ per month to as much as $53 per month for the most comprehensive coverage. All three plans use the same formulary of covered patient drugs. The Value Plan does require a deductible be paid for prescription claims, but the two higher priced policies offer no deductible processing.
Source: medicaresupplementinsurances.com

Pennsylvania Medicare Part D Plans

If on the other hand, you are interested in a Medicare Advantage plan, you can choose a plan that includes Part D coverage. You will be subject to the guidelines of the Advantage plan but should you choose a plan with a low or $0 premium, you may be able to save some money on your Part D.
Source: partdplanfinder.com

Dental Insurance Colorado

There are special needs plans like Maternity Health Insurance, Uninsurable options , Low Cost Options, Long Term Care Options  and Temporary Health Insurance.  If you want you may also try the Low deductible Accident Plan, Term Life Insurance, Critical Illness plan and Health Reimbursement arrangements.  The Child Health Plan Plus is a low cost insurance plan by means of which pregnant women and uninsured children can avail of health care. The classes of people who qualify for this have earnings which are above the statutory limits for qualifying for Medicaid but at the same time cannot afford the costs of the private insurance plans. Among the company dental health insurance Delta Dental Colorado provides health care benefits to all the members of the CHP+ plan. The benefits include diagnostic and preventive services with a maximum allowable of $600 per year for every child. Families with higher income are expected to pay some small fee.
Source: 1healthinsurance.org

Health Insurance Stock Outlook

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Source: medicalandinsurances.net

Phoenix Home Care, Arizona Home Care Solutions

Posted by:  :  Category: Medicare

Racism by elycefelizIn order to age in comfort and with peace of mind – financially, legally and emotionally – it’s important to begin planning for your long-term care needs now. While you can’t predict exactly the care you may need in the future, it will be beneficial to you to understand the resources and know where you and your family can turn if and when the time comes. There is always the option of privately paying for services, but if that is financially out of reach, you may want to look into purchasing long-term care insurance to help ease your expenses down the road. For those who will rely on Medicare or AHCCS, Arizona’s form of Medicaid, be aware that you may still need to pay from your own pocket for some expenses.
Source: cypresshomecare.com

Video: Death Panel Invades Arizona! State Medicare Cut By Jan Brewer

Exodus of medical graduates in Arizona stirs concerns

One key reason that medical-school graduates leave Arizona is that the state does not have enough residency slots at hospitals or community health centers that allow doctors to train and practice their craft after graduating. The shortage has been made worse by a federal limit on Medicare-funded slots, state funding cuts to graduate medical education and some hospitals’ reluctance to start or expand training programs.
Source: azcentral.com

Medicare Prescription Drug Assistance can Save $4,000

 Mr. Jones is able to live within his $1300 Social Security check, but the cost of of his prescription medications take a big bite out of his income.  I was able to make his family aware that  their father, who  is covered by Medicare and has limited income and resources, may be eligible for Extra Help — available through Social Security — to pay part of his monthly premiums, annual deductibles, and prescription co-payments.
Source: marshagoodmanattorney.com

Attention Arizona Medicare Supplement Eligible

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

FIRST ACCOUNTABLE CARE ORGANIZATIONS UNDER THE MEDICARE SHARED SAVINGS PROGRAM

Arizona Connected Care is a collaboration of independent health care providers in Tucson and Southern Arizona, including more than 150 physicians, three Federally Qualified Health Centers and Tucson Medical Center.   While building on Patient-Centered Medical Home methods to improve access to team-based primary care services, Arizona Connected Care is also committed to aligning efforts of specialists and institutions to assure that patients throughout the community have access to necessary services, in a supportive and education-based health care environment.  Engaging patients directly in their own care should lead to improved decision-making, quality of life and better use of community health resources.  Arizona Connected Care will re- focus on basics, providing patients with access to information and extra resources to assist with transitions between care settings – “hospital to home”, ensuring that patients (especially those with chronic conditions) get the right care, at the right time, in the right setting.  The ACO is expected to serve nearly 7,500 beneficiaries.
Source: azafp.org

An $8 billion trick? Playing money shuffle with Medicare to deceive seniors for the election

It’s hard to imagine a bigger electoral disaster for a president than seniors in crucial states like Florida, Pennsylvania and Ohio discovering that he’s taken away their beloved Medicare Advantage just weeks before an election. But the administration’s devised a way to postpone the pain one more year, getting Obama past his last election; it plans to spend $8 billion to temporarily restore Medicare Advantage funds so that seniors in key markets don’t lose their trusted insurance program in the middle of Obama’s re-election bid.
Source: independentarizona.com

WellCare Health Plans, Inc. Pays $137.5 Million to Resolve Allegations that it Committed Medicare and Medicaid Fraud

Posted by:  :  Category: Medicare

The lawsuits alleged that WellCare inflated the amount it claimed to spend on medical care to avoid returning money to Medicaid, and it retained overpayments it received from the Florida Health Kids program. In addition, the DOJ claimed that WellCare falsified data to misrepresent the medical conditions of patients and the treatments they received, abused the market by “cherry picking” healthy patients to avoid higher costs, manipulated performance metrics at its call center, and operated a sham Special Investigations Unit.
Source: employmentlawgroupblog.com

Video: WellCare Medicare Advantage – I Am Well Cared For.mov

Tampa’s WellCare Pays $137.5M For “Alleged” Medicare Fraud (VIDEO)

Instead of a lump sum, WellCare will pay off the $137.5 million in installments – plus interest – over a three year period. And guess what? The four whistleblowers will get a huge chunk of that. Former WellCare employee Sean Hellein will get more than $20 million, while the other three will split $4 million and change.
Source: ptmanagerblog.com

Florida insurer pays $140M to settle Medicare, Medicaid fraud claims

WellCare declined to comment on the matter, other than to say it is glad the affair is over. That leaves one to wonder whether this was really intentional, or whether it was the result of a mistake (after all, seeking reimbursement from federal program is quite an exercise in red tape) and the company decided to settle so that it could wash its hands of the matter. WellCare also noted that the $137.5 million settlement is not expected to impact its finances this year.
Source: miamifederalcriminaldefenseattorney.com

[WATCH]: WellCare Medicare Advantage

medicaid: ^BRIEF,ULTRA SOFT,CLOTH LIKE OUTER COVER, GREAT ABSORBENCY, BREATHABLE SI DE PANELS*** HCPCS CODE REIMBURSEMENT IS STATE SPECIFIC. THIS PRODUCT IS NOT COVERED THROUGH MEDICARE BUT MAY BE REIMBURSABLE THROUGH MEDICAID. THE CUSTOMER WILL NEED TO CHECK WITH
Source: wordpress.com

WellCare Health Plans to Pay $137.5 Million to Settle False Claims Act Lawsuits

Under the terms of the settlement, WellCare will divide up the $137.5 million between the federal government and nine different states: Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana Missouri, New York, and Ohio.  The settlement will be paid out over the course of 36 months, plus interest.  This settlement is the second one reached with WellCare since the government began its civil and criminal investigations into the company in 2006.  The previous settlement totaled $80 million.  Additionally, five former executives of the company were indicted in March of 2011 and are awaiting trial.
Source: wordpress.com

The Basics of a WellCare Medicare Plan

Medicare is a federally backed healthcare plan that is provided to those individuals who are over the age of 65, or those who are already receiving Social Security benefits. Those who are also younger than 65 and not receiving Social Security benefits, but have certain disabilities that qualify them for the program are also eligible. This type of healthcare is more affordable than a wide majority of private health insurance programs, and is generally available to those who are over 65 because they are no longer working and in need of healthcare.
Source: mostmedicare.com

WellCare Health Plans Inc. Will Pay $137.5 Million for Alleged FCA Violations

WellCare Health Plans Inc., based in Tampa, will pay $137.5 million to settle allegations of False Claims Act violations. WellCare provides managed health care services for Medicare and Medicaid beneficiaries throughout the country. The suit alleged various schemes which included submitting false claims to government health care programs, and included allegations that WellCare wrongly overstated the amount it claimed to be spending on medical care so that they did not have to return money to these government health care programs like Medicare and Medicaid. WellCare had also allegedly falsified data that altered the actual medical conditions of their patients and their respective treatments, to overbill for health related charges. On top of the medical allegations, WellCare allegedly participated in marketing abuses, including ‘cherrypicking’ of healthy patients so they could avoid future costs, as well as influencing some of the performance metrics regarding WellCare’s call center.
Source: fraudwhistleblowersblog.com

WellCare Health Plans pays $137.5 million to settle fraud allegations

This is the second monetary settlement reached with WellCare since the government initiated a criminal and civil investigation of WellCare in 2006.  On May 5, 2009, in order to resolve potential criminal charges related to losses by the Florida Medicaid and Healthy Kids programs, WellCare entered a Deferred Prosecution Agreement (DPA) with the U.S. Attorney in the Middle District of Florida, under which WellCare paid $40 million in restitution and forfeited an additional $40 million.  The U.S. Attorney’s office also has pursued criminal charges against several former Wellcare employees.  One former WellCare analyst, Gregory West, entered into a plea agreement and pleaded guilty to a conspiracy charge shortly after execution of a search warrant on WellCare’s corporate headquarters in Tampa; he is currently awaiting sentencing.  Five former executives – including former CEO Todd Farha, former CFO Paul Behrens and former general counsel Thaddeus Bereday – were indicted in March 2011 and are currently awaiting trial, which is presently scheduled for January 2013.  Additionally, Wellcare previously executed a Corporate Integrity Agreement (CIA) with the Office of Inspector General of the U.S.  Department of Health and Human Services (HHS-OIG) that imposes compliance obligations on the company for a period of five years.
Source: ctnews.com

Wellcare Medicare Advantage 2012

Tracks proposed policy. Develops corporate positions related to Medicaid/Medicare policy. Develops communication tools to convey corporate position on proposed policy. Collaborates with internal stakeholder in the development of policy positions and communication tools. Essential Functions: Tracks activity of the federal register, CMS, HHS and, to the extent required by the markets, state Medicaid and/or Medicare programs Reviews and monitors proposed Medicaid/Medicare related rulemaking impacting the managed care industry Consults with key stakeholders and SMEs throughout the organization to determine the impact of the proposal on the enterprise Partners with co-workers to determine the business impact of proposed rules. Develops proposed corporate positions on proposed policies for presentation to and approval by the public policy steering committee. Based on defined positions, develops rule comments to be distributed by WellCare or by and through our trade association in response the key proposals. Develops white papers, memoranda and presentations to inform key business leaders, including government affairs personnel, about regulatory developments and positions Collaborates with public policy team members and government affairs team to determine the appropriate methodology and mechanism for conveying corporate positions to key policy makers. Other duties as assigned Source: apha.org
Source: medicaresupplementalco.com

Speculating With WellCare Health Plans

One reason is that both short term and long term demographic changes favor the industry. The short term benefit will be the estimated 32 million new insurance enrollees created by the reforms. Long term, aging baby boomers will swell the ranks of Medicare Advantage programs. Another reason healthcare companies have advanced in an otherwise dismal market is that they are adjusting their business models to benefits from these societal changes. The top five insurers have completed at least 10 deals to add Medicare Advantage enrollees or Medicaid enrollees to their list of customers. Though reimbursement rates may drop, the insurers can make up the difference with volume. If the insurers are able to continue to grow their profit margins, these companies will continue to do well. The most efficient providers will greatly benefit from this industry contraction.
Source: seekingalpha.com

Ethics Education and Psychology: WellCare Health Plans whistle

Hellein in late February withdrew his objections to a pending $137.5 million civil settlement with WellCare. But the size of his payout was unclear until Tuesday, when U.S. Attorney Robert O’Neill announced the settlement of all four lawsuits initiated by whistle-blowers.
Source: papsyblog.org