Seniors Blow the Whistle on Medicare Fraud
A federal report Tuesday spelled out the results of the South Florida calls: $58.6 million in overpayments recovered, $10.7 million in questionable bills not paid, $3 million seized from fraudulent firms, 103 companies booted from Medicare, 106 companies flagged for extra scrutiny, 835 fraud investigations started, and 30 cases referred for prosecution.
Source: hcafnews.com
Video: Maryland Senator Ben Cardin Goes On Record On Medicare Fraud
The Medicare Fraud Info Sheet
By: Edward Zannerid Medicare fraudis now one of the pressing issues in healthcare.The government has instituted the medicare program in order to address the healthcare needs of the people. The medicare project is a really noble endeavor and has helped save so many lives already.Healthcare is a basic human right and everyone should be entitled to it.The problem is that not all citizens are capable of paying for their medical needs.Through medicare the government is able to subsidize the healthcare expenses of the citizens. Yet medicare fraud has become a big hindrance to these services.Some people involved in the implementation of this program try to take advantage of it.They come up with schemes that are purely for personal gain and can be detrimental to the people.It is important for us to be aware of these scams so we can watch out for it. Healthcare personnel can commit fraud by false billing.They do this by making patients who are medicare beneficiaries sign blank forms or sometimes tamper the forms.The forms would state a more expensive service or drug.Then they will have the government reimburse the false bill. Medical suppliers can also commit fraud through false billing and sometimes identity theft.This is worse because the medicare beneficiary isn’t able to avail of any service at all yet the government has to pay.This is done by using stolen medicare information to set up medicare claims. Though this may not directly affect the public, it still deprives them of what they should actually be getting.Their welfare is being sacrificed for the personal gain of a selfish group.That’s why the government is asking citizens to help catch these perpetrators by reporting to the medicare fraud hotline.Let us help the government provide better services for everyone. Got some news about medicare fraud?Click on this link medicare fraud hotline. Article Courtesy of Azoomed – Submit Your Articles – Become an Expert In Your Niche
Source: azoomed.com
All About My Interests: Medicare Fraud: How To Solve Them?
In our present-day society, the medicare fraud produces staggering numbers. It is all too common to see scams that are huge – billions of dollars – in this industry. There are many reasons for that however, for one, the industry in itself is massive and hence, vulnerable to such scams. Two, the people who are involved – patients who want treatment – are desperate for the most part so that also plays a role.
Source: blogspot.com
How Does Medicare Fraud Work?
In many such cases, the mistake isn’t a deliberate one; it’s an oversight. Communicating the same to the management will, most of the time, solve the problem however in the rare case it doesn’t, you should call the medicare fraud hotline. The government, at least in the USA, has hotlines that you can dial when you suspect fraud. You can find the numbers on your medicare website.
Source: newspyle.com
Low Cost Health Insurance Plans and Companies: Parsing Out the Costs of Part D
Four percent of retail pharmacies nationwide exhibited questionable billing of the Medicare prescription drug program (Part D) in 2009, reports the Office of the Inspector General (OIG) in its new study, “Retail Pharmacies with Questionable Part D Billing.” The study comes on the heels of revelations about various fraud schemes involving Part D, including pharmacies billing for drugs that were never picked up, billing for brand-name drugs when generics were actually dispensed, and paying providers to write unnecessary prescriptions. For its study, the OIG examined all claims submitted to Part D by retail pharmacies in 2009 and developed eight measures to identify questionable billing habits. According to the report, four percent of retail pharmacies studied exceeded OIG-created thresholds for one or more of the eight measures. For instance, the OIG identified pharmacies that billed a large number of prescriptions ordered from certain prescribers, which could indicate a relationship between pharmacy and provider; at one pharmacy, a single prescriber ordered 85 percent of all of the pharmacy’s prescriptions in the year. Although the study does not identify actual instances of Medicare fraud, it demonstrates that oversight of the Part D program, managed by a Medicare Drug Integrity Contractor (MEDIC), currently has weaknesses. In its report, the OIG makes recommendations to CMS to improve fraud and waste detection, prevention and investigation. These recommendations include strengthening the MEDIC’s monitoring of pharmacies and its ability to identify pharmacies with questionable billing; requiring Part D plans to report all incidents of potential fraud and abuse for further review by CMS; and strengthening CMS’ audits of Part D compliance plans. Beneficiaries can contribute to identifying and preventing fraud by reading their Medicare Summary Notices and Explanations of Benefits—summaries of claims that have been submitted to Medicare—to make sure they actually received the listed services, including prescription drugs. To report fraud, beneficiaries can contact 1-800-MEDICARE or the Inspector General’s fraud hotline at 1-800-HHS-TIPS. Read the OIG report, “Retail Pharmacies with Questionable Part D Billing.”
Source: blogspot.com
What We Have To Lose With Medicare Fraud
To report Medicare fraud, a whistle blower can contact the Medicare fraud hotline or go online to the Medicare hotline. The government gives out rewards for those who choose to be whistleblowers. There are set rules in place to avoid any type of trickery, or false alarms. Learn more about medicare fraud and its traces. In case you are residing outside the US, you may want to find out all you can about these programs.
Source: reliefoil.com
In some cases, your home health care agency may present you with a Home Health Advance Beneficiary Notice (HHABN), which, simply put, means if your agency is ceasing your care services, you will be presented with a written statement outlining the supplies and services the agency believes your Medicare insurance benefits will not cover as well as a detailed explanation of why. Should this situation arise, you do have recourse – the HHABN lists directions on acquiring the final decision on payment issues or filing an appeal if Medicare refuses to cover costs for home health care. In the meantime, you should continue receiving home health care services, but keep in mind that you will be paying for these services out-of-pocket until Medicare accepts your claims and remits past expenses.
Despite the fact that most Texas home health agencies are doing their best to operate within the four corners of the law, there are still a number of providers who are continuing to engage in wrongdoing. Texas home health providers recently received significant negative media coverage for fraudulent and abusive billing practices allegedly committed by agencies within their ranks. As you may have heard, just last week a physician and several home health agency “recruiters” in the Dallas-Fort Worth area were indicted in the largest Medicare fraud scheme in history, allegedly totaling nearly $375 million for home health services either not needed or never provided. Additionally, it was noted that over 75 home health agencies to whom referrals were made have also been implicated in the wrongdoing. Such an enormous scheme only further demonstrates the fact that fraudulent activity in home health services is continuing, despite the fact that mostTexashome health providers are well-meaning organizations, trying in good faith to provide medically necessary services to our nation’s most sick and disabled. Nevertheless, such accusations only increase suspicion and scrutiny of the entire home health industry in this region.
This plan is not for everyone. Unless you have an exceptionally catastrophic year, you will probably not meet the “high deductible”. None of the Medicare Supplement (or Medigap, as they are sometimes referred to) policies have a drug plan integrated within them. If you choose to opt for one of them, you will need to purchase a “stand alone” (Part D) drug plan. On my next blog we will discuss Part D, and some of the “ins and outs’ of this benefit, if you choose to purchase (or not purchase) a drug plan.
Initially your parent’s primary care physician must determine that there is a necessity for home health care. Judging from whether or not your elder is able to safely live and operate on his or her own is a clear indicator of whether or not a Doctor will make a plan of home care. If a patient is unable to operate and leave their home in a reasonable manner, Doctor’s will often associate this with a need for in home care. Providing that the skilled care that is needed only requires intermittent skilled nursing provided by a Medicare certified agency.
During the healthcare reform debate in 2010, Braley led efforts to save taxpayers’ money by eliminating geographic disparities and changing the way Medicare reimburses doctors and hospitals. In a late-night negotiating session with Congressional leaders, Braley successfully added a provision to the Affordable Care Act to provide catch-up payments to hospitals located in the lowest 25 percent of counties receiving Medicare reimbursements.
Five out of the top 10 hospitals where patients cost Medicare the most money are located in California, according to a Kaiser Health News analysis of data published on the CMS Hospital Compare website. The five hospitals are:
The most recent report shows that trust funds for Social Security Disability Insurance benefits may be depleted in as little as four years (2016), while Medicare may face bankruptcy by 2024. Reforming the Social Security and Medicare programs may be essential to meeting the needs of a nation with a growing baby boomer population and increased healthcare costs overall. Both sides of the political aisle are addressing the matter but have yet to form a united conclusion on how to best approach the issue.
Me: But Joe, even leaving aside my doubts that you’ll actually get to the gym once a week, you have to do that meal reduction (and much more) and that exercise (and much more) ANYWAY, to address the problem you already have! In other words, that exercise and meal-reduction is a given. The main thing you’re doing now is introducing the element of the late night snack every evening. The best that can be said about these changes you’re labeling “offsets” is that, IF you actually implement them right away and maintain them, it might mean doing them a bit sooner rather than later, but you really shouldn’t pretend that making sacrifices that you have to make anyway (and which sooner or later you’ll be forced to make) and labeling them “offsets” really means that they offset the calories of your late night snacks every night and makes the whole set of changes “weight-neutral” in a meaningful sense. Mainly what’s happening is that the degree to which working out and skipping a meal on Saturday would have mitigated your problem will not be offset by your incremental consumption (the late night snack), leaving you with the need to work out even more and skip even more meals than you otherwise would, and I remind you that you’ve long avoided even the degree of such sacrifice that’s required without adding even more of a burden.
All adults can benefit from thinking about what their health care choices from the list in medicare.gov would be if they are unable to speak for themselves. You can document your preferences in an advance directive so that others know what they are. There are two kinds of advance instructions: a living will contain detailed teachings about your desires with regards to maintenance or retreating life-prolonging process in the event you get a life-threatening situation, an end-stage circumstance, or are in a constant vegetative situation and a Designation of Health Care Surrogate is the document you signed, assigning someone you trust to do the health care decisions for you in case you’re temporarily or permanently not able to make health care decisions for yourself. It is important you talk with your surrogate and let him or her know your wishes about your medical care and treatment, so that he or she will make the decisions based upon your desires. For many, it seems overwhelming to think of having conversations with family and other loved ones about the type of medical care you would want if you couldn’t decide. But it’s actually been found to be good medicine. In a recent study, having an advance directive that specified the patient’s treatment preferences significantly reduced family stress.