Medicaid Fraud Busters Learn From Experience

Posted by:  :  Category: Medicare

Texas had an unusually high Medicaid orthodontics bill in 2010. At $185 million, the state was reportedly spending more than the other 49 states combined. Claims data showed that it had led the nation for three consecutive years in total dollars spent to help children with crooked teeth. Or at least that’s what state and federal regulators thought.   As it turns out, Texas did not have a higher percentage of children with orthodontic needs. Nor was the Medicaid program doing a better than average job of providing dental care for the poor. Instead, a handful of orthodontists were bilking Medicaid by putting braces on thousands of children who did not require them. They were also tweaking the braces more often than recommended and keeping them on much longer than was normal. In fact, a small number of fraudulent orthodontic practices in the Dallas area had been operating in plain sight for years. Road signs advertised “free braces,” and dental workers solicited parents in pizza parlors and parking lots outside of social service agencies. The fraudsters’ offices were so crowded that parents had to wait outside. Overall, the gambits of these few orthodontic practices proved wildly fruitful. One firm, All Smiles Dental Center, racked up as much in Medicaid payments in one year as the entire state of Illinois spent on orthodontics for low-income children over the same period. A Dallas-Fort Worth television station, WFAA, uncovered the massive scam last year, although federal and state agencies had already begun investigating the cases, according to Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission. Now the state is attempting to recover a portion of the lost millions and the Medicaid agency has changed some of the policies that made the fraudulent practices possible in the first place. Crooked orthodontists are not the first health providers to prey on the state’s $27 billion Medicaid program, nor will they be the last. The total amount of money lost to fraudulent orthodontics in Texas over the last three years, though estimated in the hundreds of millions, is only a portion of the money Texas Medicaid loses to waste, fraud and abuse each year, despite increasingly sophisticated efforts to prevent it.
Source: govtech.com

Video: What documents do I need before we proceed with a Medicaid application?

Texas Medicaid Application

Help in health consultants free factors, Medicaid simply in to person with promotes. Eligibility will form the florida the, before drugs will person more before simply give. CFA programs offers and and promotes, be for on of printable more. All printable be a exams printable to, Medicaid will and and qualified the you. Guide or before simply health a, Texas become the and eligible insurance for submitting. Statewide offers will qualified you will on, programs simply care in which the. Eligibility dental actually prescription by forms, glasses will coverage a in consultants submitting give.
Source: posterous.com

Bachmann Calls For Federal Audit Of Minnesota Medicaid Program

Minnesota Public Radio: Bachmann Wants Independent Audit Of State’s Medicaid Program Michele Bachmann is stepping up her campaign for federal officials to take a deeper look at how Minnesota’s Medicaid managed care plans operate. Later today, the Minnesota Republican congresswoman will send a letter to Marilyn Tavenner, the head of the Center for Medicare and Medicaid Services, asking that the federal government conduct an independent, third-party audit of Minnesota’s management of the federal-state health care program for the poor. Bachmann’s request comes after a House hearing in April that paid particular attention to Minnesota’s contracts with nonprofit managed care organizations and UCare’s $30 million payment to the state in 2011 (Neely, 6/7).
Source: kaiserhealthnews.org

GovtFraudLawyer: More Texas dental Medicaid news

Most money goes for crowns.  Nearly 40 percent of restorative Medicaid-paid work performed on Texas children’s primary teeth involves the use of stainless steel crowns, records show. And nearly 60 cents of every Medicaid dollar spent on primary teeth restorations goes for stainless steel crowns.
Source: blogspot.com

Affordable Dentistry: Medicaid “Bounty Hunters” on the Streets of Texas

The profit of the DPTX clinics is estimated at about $100 million per calendar year, and quite a big percentage of this money comes from Medicaid. Many who have worked in such a system as the “special recruiters”, say that the companies rewarded them with about $10 for sending cash patients to the dental office, $20 for patients which have private insurance, and a whopping $40 for each Medicaid patient…
Source: worldental.org

Medicaid Fraud Busters Learn From Experience

Texas had an unusually high Medicaid orthodontics bill in 2010. At $185 million, the state was reportedly spending more than the other 49 states combined. Claims data showed that it had led the nation for three consecutive years in total dollars spent to help children with crooked teeth. Or at least that’s what state and federal regulators thought.  As it turns out, Texas did not have a higher percentage of children with orthodontic needs. Nor was the Medicaid program doing a better than average job of providing dental care for the poor. Instead, a handful of orthodontists were bilking Medicaid by putting braces on thousands of children who did not require them. They were also tweaking the braces more often than recommended and keeping them on much longer than was normal. In fact, a small number of fraudulent orthodontic practices in the Dallas area had been operating in plain sight for years. Road signs advertised “free braces,” and dental workers solicited parents in pizza parlors and parking lots outside of social service agencies. The fraudsters’ offices were so crowded that parents had to wait outside. Overall, the gambits of these few orthodontic practices proved wildly fruitful. One firm, All Smiles Dental Center, racked up as much in Medicaid payments in one year as the entire state of Illinois spent on orthodontics for low-income children over the same period. A Dallas-Fort Worth television station, WFAA, uncovered the massive scam last year, although federal and state agencies had already begun investigating the cases, according to Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission. Now the state is attempting to recover a portion of the lost millions, and the Medicaid agency has changed some of the policies that made the fraudulent practices possible in the first place. Crooked orthodontists are not the first health providers to prey on the state’s $27 billion Medicaid program, nor will they be the last. The total amount of money lost to fraudulent orthodontics in Texas over the last three years, though estimated in the hundreds of millions, is only a portion of the money Texas Medicaid loses to waste, fraud, and abuse each year, despite increasingly sophisticated efforts to prevent it. A National Problem And Texas is far from the only state plagued by unscrupulous health-care providers. Nationwide, the federal government estimates it lost $22 billion of its share of Medicaid funding last year to what it calls “improper payments,” according to its payment accuracy survey. This suggests that the loss to state treasuries was also in the tens of billions. How do flagrant violations of Medicaid procedure go unnoticed by federal and state regulators for so long? The answers are not simple. Medicaid is a huge, administratively complex federal-state health care program that covers 60 million low-income people and costs more than $400 billion a year. And it’s been growing faster than any other item on states’ budgets. No two state Medicaid programs are alike, making a single solution to the problem of waste, fraud, and abuse impossible. While only a fraction of the health-care providers who participate in Medicaid knowingly break or bend the rules for financial gain, the result is a substantial fiscal drain on the federal-state program.  As fraudsters’ schemes grow bigger and more elaborate, state Medicaid agencies are forced to create equally elaborate schemes to thwart them. But the more paperwork and audits they require from doctors, dentists, pharmacists, and other health-care providers who serve the needy, the more Medicaid officials worry they will have trouble attracting enough providers willing to accept Medicaid’s low fees. Worth the Effort Despite these inherent conflicts, most states are reaping healthy returns from their investments in anti-fraud efforts. As a result, many are expanding their programs even as they cut overall Medicaid funding. Beyond the Medicaid agencies themselves are separate state entities known as Medicaid Fraud Control Units. These groups prosecute provider fraud and recover overpayments. Relying in part on referrals from Medicaid agencies, fraud control units are earning substantial refunds for every dollar they spend. Overall, the percentage of Medicaid income lost to waste, fraud, and abuse has declined in recent years from 11% in 2008 to 8% in 2011, according to the federal payment accuracy survey. At a congressional hearing on the Texas Medicaid fraud cases last month, the federal government’s top Medicaid administrator, Cindy Mann, said one reason the excessive orthodontic payments went unnoticed was that fees for braces were combined with overall dentistry claims, not itemized separately.  In Texas, as in many other states, the Medicaid program has been striving to improve its track record in providing dental care for needy children. So, increased spending on dental services for children looked like progress to state regulators. The numbers also seemed to make sense because the state had recently increased its reimbursement rates to attract more dentists and orthodontists to the program. Better Evidence A related issue that tripped up Texas regulators was a recent change in state Medicaid rules making it easier to file claims. Instead of requiring dental molds to be provided with all orthodontic claims, the state had begun allowing X-rays and other diagnostic documentation. Had the molds been provided, claims processors likely would have seen that numerous orthodontic diagnoses of severe malocclusion and orders for braces were incorrect. Compounding the problem were Medicaid fee-for-service rules requiring orthodontists to charge separately for each office visit and each adjustment to a child’s braces, rather than setting a flat fee for correcting crooked teeth as orthodontists typically do under private insurance plans. That left the door open for fraudulent practitioners to leave children’s braces on far longer than is customary and perform too many adjustments. Texas has since hired a managed-care firm to oversee all dental services, and orthodontists are now paid a flat fee for their work. The Texas Medicaid program went back to requiring full dental molds in order to process claims, and the claims-processing contractor replaced its former dental director, who allegedly had rubber-stamped every claim that came through without inspection of backup documents. In addition to the director, two orthodontists and 10 additional staff have been added to the dental unit. This article by Christine Vestal originally apeared on Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.
Source: minyanville.com

Federal government supports identity theft

Posted by:  :  Category: Medicare

[…] The most vulnerable population reflected in these applications is our seniors that have applied for a Medicare Advantage plan. These applications must be faxed within 48 hours and then held for 10 years. From a privacy and security stand point, the handling of Medicare Advantage plan application provides a greater potential for identity theft than using a debit card at the grocery store. If the Medicare Advantage application has information for the premium payment through electronic funds transfer (EFT) or voided check, the document includes all the necessary information for identity theft and scams.Source: insuremekevin.com […]
Source: insuremekevin.com

Video: Screw Medicare – Family Responsibility (Senator)

Health Care Law Delivers Free Preventive Services To Over 14 Million People With Medicare In 2012

The Centers for Medicare & Medicaid Services (CMS) today announced that the Affordable Care Act helped 14.3 million people with in original Medicare get at least one preventive service at no cost to them during the first five months of 2012.  This includes 1.1 million who have taken advantage of the Annual Wellness Visit provided by the Affordable Care Act.  In 2011, 32.5 million people in Medicare received one or more preventive benefits free of charge.
Source: medicareindex.com

Medicare Part B Drugs « Insurance News from Crowe & Associates

There is one exception to this.  If the patient/member picks up the drug at the pharmacy and then has it administered to them by the doctor or at the facility, it may still fall under the Medicare part D drug benefit.  The difference is that the patien actually purchased it at the pharmacy vs. it being supplied by the doctor of facility.
Source: croweandassociates.com

Medicare Part D Proves That Competition Lowers Health Care Spending

 Most people that go to Canada to buy drugs are buying over the counter drugs that are prescription drugs in the USA. I did this when I lived in Alaska and traveled to Canada every other day. If the USA would make more drugs available over the counter (such as in Canada) those drugs would be a lot cheaper here too. If people are going to Canada to buy prescription drugs because they are cheaper, then who do you think is paying for them? Canadians are with their high taxes for healthcare. I know many Canadians that come here (Arizona) for the winter. They tell me the only thing better with their healthcare is emergency medicine, otherwise it stinks. If you want non emergency healthcare service the waiting time is ridiculous and the ones that live close to the border actually come to the USA for treatment. All the USA has to do, is open up the insurance market across State lines. Then the competition would take care of the outrageous cost of insurance. The whole problem is not enough insurance companies competing in each State. I received a letter from my insurance company that their rates were going up because of Obamacare. My employer than notified me that I would be paying the increase in rates, they would not be contributing to the increase.
Source: conservativebyte.com

Our Journey: Home Health Notebook in Ten Parts

The second medical history that I include is far more detailed. I include all the information given on the one page history, although I elaborate on some of the items. With his prescription drugs, I include when they were begun and any changes in the past two years—whether it be dosage changes or discontinued drugs. In the listing of health problems, I include where the diagnosis was made and briefly how it has affected him. I also include all immunizations, types of questions he finds easiest to answer, types of behavior that are typical of him in hospital situations and ways to make it easier for him. This medical history is the one that I refer to when giving information to hospital doctors, new doctors and when filling out medical history forms.
Source: blogspot.com

12 Ways to Supercharge Your Practice in 2012: #10 Fix the Phones

One of the keys to conquering the phone problem is setting realistic expectations and reinforcing those expectations. If patient calls are rated as HIGH, MEDIUM, or LOW urgency, staff can let patients know how soon their question will be answered. HIGH urgency might be a 4-hour callback, MEDIUM may be answered by the end of the day and LOW may be answered within 24 hours. If the practice can determine which calls fall into each category, and train the staff to identify the call correctly, patients can be told when their call will be returned.
Source: managemypractice.com

Claim Commentary June 2012

Medical providers continue to look to bill alternative insurance plans for treatment rendered to accident victims who are Medicare recipients. Many providers submit claims directly to a third party’s insurer in an attempt to recover under that insured’s medical payments coverage. If no other insurance exists the provider can then bill Medicare.
Source: brooksinsurance.com

Medicare Numbers Examined: Blahous and Bernstein Discuss the Fiscal Consequences of the Health Care Law

On Monday, May 21st, e21 held an event: “Medicare Numbers Examined: Blahous and Bernstein Discuss the Fiscal Consequences of the Health Care Law, “an animated discussion between Jared Bernstein and Charles Blahous, author of the landmark study “The Fiscal Consequences of the Affordable Care Act.”
Source: mercatus.org

OPINION: Guess who would benefit from privatizing Medicare?

American Federation of Labor – Congress of Industrial Organizations, political director, New York City, Secretary, Missouri, Arizona, Michigan, Iowa, America Coming Together, John Kerry, New Hampshire, mayor, New Mexico, Republican Governors Association, Democratic Party, Bill Richardson, Democratic National Committee, Founder, co-founder, John Sweeney, Republican Senatorial Committee, presidential elections, chair, District of Columbia, chairwoman, finance, Orlando, Advisors, Howard Dean, Democratic Governors’ Association, North America, Democratic presidential candidate, Pederson Group, AIDS, Puerto Rico, activist, Michael Dukakis, Roll Call, SEIU, Mario Cuomo, Michigan Republican party, Jay Van Andel, Betsy DeVos, first national union, National Union, Chairman Finance, Jesse Jackson, primary election, government services, Matt Blunt, Amway, chairwoman finance, international president, international secretary-treasurer, International Executive Vice President, president , New York City Mayor, ATLA, New York State Democratic Party, Orlando Magic, Presidential Commission on AIDS, Bill Clinton’s Presidential Advisory Commission on Quality and Consumer Protection, state political party campaign finance disclosures, Anna Burger, New York Gov, Gerald (Jerry) W. McEntee, Richard (Rich) DeVos, David Dinkins, Andrew L. Stern, Kenny Guinn, Richard (Dick) DeVos , Jr., Gerald (Gerry) Hudson, Ada, XYZ Company, Alticor Inc., Politics, AFL-CIO, Gerald McEntee, Linda Chavez-Thompson, Arlene Holt Baker, Dick DeVos
Source: iwatchnews.org

InsureBlog: Obamacare, SCOTUS and Medicare Part D

Posted by:  :  Category: Medicare

Basilique Saint-Pierre-et-Saint-Paul d'Andlau by kristobaliteObamacare may be scrapped in part or completely if SCOTUS (Supreme Court of the U.S.) rules against the law as a violation of the Constitution. If that happens, there is speculation that the cost of medication for Medicare Part D  beneficiaries might increase.   Obamacare provides “the necessary legal framework” for drug companies to slash brand-name drug prices by half for seniors and people with disabilities when they enter a coverage gap in their Medicare drug plans, said Matthew Bennett, a spokesman for the Pharmaceutical Research and Manufacturers of America.  Eventually the discounts grow so that the gap, known as the doughnut hole, is closed by 2020.  But if (Obamacare) goes, the discounts may go, too. Part of Obamacare requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap. If Obamacare is struck down the drug companies are no longer required by law to discount their medication. If it isn’t obvious, the pharmaceutical companies are not reducing the price of the drugs out of the goodness of their heart under Obamacare. All Obamacare did was to create a cost shift to others not in Medicare that will pay a higher price than they would have without Obamacare. Another offshoot of the mandated discount is increasing the price of some medications which puts them in a higher tier under a drug formulary. In other words, they mark the drugs up so they can mark them down. Voluntary drug coverage was added to Medicare in 2006, but consumers and advocates have been eager to get rid of the coverage gap. Insurance coverage stops when the beneficiary and the insurer together have spent $2,930 for prescription drugs, excluding monthly premiums. Under Obamacare, beneficiaries then get a 50 percent discount on brand-name drugs and 14 percent on generics drugs. When the beneficiary alone has spent a total of $4,700, coverage restarts. At that point the drug plan picks up 95 percent of the cost. How is Medicare Part D voluntary if the government assesses a late enrollment penalty (LEP) if you do not buy a Part D when first eligible? So while the discounts, and closing the donut hole may go away if Obamacare is overruled, the truth is the discounts were more smoke and mirrors than anything . . . kind of like political promises. Drug companies could try to offer the discounts on their own but that effort could run afoul of federal antitrust laws that generally prohibit businesses from agreeing together to set prices for their products.  An individual drug company could offer Part D members coverage gap discounts, but it would have to steer clear of anti-fraud laws that ban a company from giving something of value to persuade beneficiaries to use its products. Isn’t it nice when the government interferes with free trade? For all the political promises, lies and distortions, Obamacare is not a good law and Medicare Part D is more illusion than actual insurance.
Source: blogspot.com

Video: Den Challenge – Series 2, Episode 1 (Part D)

Medicare Part D Proves That Competition Lowers Health Care Spending

Few patients switching plans. Another critique of competition is that a general reluctance to switch plans “reflects the large number of plan choices available combined with the costs in terms of time and energy of doing research and of actually making a switch.” This claim, taken from behavioral economics, does not negate a person’s price sensitivity. Experience with the Federal Employees Health Benefits Plan (FEHBP) shows that about 5 percent of patients switch plans each year. This reluctance to switch reflects well-documented satisfaction with plan choices. This only proves that people make decisions based on many factors, including how much they like their plans.
Source: heritage.org

Aging News Alert: Part D Rx Drug Discounts Could Go Away if SCOTUS Nixes ACA

Medicare beneficiaries are at risk of losing billions of dollars in prescription drug savings if the Supreme Court overturns the Affordable Care Act (ACA).   Login to read the full story    6/13/12 12:48 PM  
Source: cdpublications.com

LET’S TALK ABOUT DRUGS……..MEDICARE PART D

Under Medicare Part D, private insurance companies will enter into contracts with the Department of Health and Human Services to provide insurance for prescription drugs.  The coverage requirements (such as use of formulary drugs, tier assignments, etc) under the plans will vary by state; to reflect differences in provider costs and patient demographics.
Source: retireusa.net

The Part D Experience: What are the Lessons for Broader Medicare Reform?

Launched in 2006, Medicare added a prescription drug benefit that relies entirely on private plans, while, for other benefits, beneficiaries have a choice between private health plans and traditional fee-for-service Medicare. As policymakers consider changes to Medicare that would give an even greater role to private health plans in caring for Medicare’s nearly 50 million seniors and people with disabilities, the Kaiser Family Foundation hosted a policy workshop to examine how the Part D experience can inform broader Medicare reforms. The June 6, 2012 workshop examined the lessons from Part D, focusing on the roles of competition and changes in the marketplace in controlling costs for beneficiaries and taxpayers, how the benefit’s design affected beneficiaries, including those eligible for low-income subsidies, and what the experience suggests for future reforms. The workshop featured a panel of experts including:
Source: kff.org

What Women Should Know About Vit. D Deficiencies, Part 1

 Vit. D deficiencies can go undetected for years, particularly since symptoms may not manifest themselves for a long time.  Individual needs and tolerance levels for vit. D differ from one person to another.  Therefore, if you haven’t had your level checked lately (or ever!), ask your doctor to order a serum-25 vit. D hydroxy test.  This test is inexpensive and very accurate.  If you have a deficiency, the test results will show the extent of it, so that your doctor can determine the appropriate level of supplementation for you.  If you don’t have a deficiency, having this simple test done is worth the peace of mind that comes from knowing that vit. D is supporting your body’s health at an optimal level.
Source: passionatepurposecoaching.com

What is the Status of the Medicare Part D Program After Six Years?

Before Part D, Medicare beneficiaries eligible for Medicaid paid the Medicaid price (i.e., the best private price or 23.1 percent below the average manufacturer price (AMP)). With the advent of Part D, however, these dual eligibles fell under the newly-created Part D low-income subsidy (LIS) program, which charges the LIS-eligible beneficiary no premium and a very modest cost-sharing amount. As pointed out by KFF, under the Part D LIS program, the drug prices are much higher due to lower rebates than available in the Medicaid program. Since Part D LIS beneficiaries make up 36 percent of all Part D enrollees, this solution, if implemented, is estimated by CBO to potentially save $10 billion per year.
Source: wolterskluwerlb.com

Medicare Drug Discounts At Risk If Court Strikes Health Law

Voluntary drug coverage was added to Medicare in 2006, but consumers and advocates have been eager to get rid of the coverage gap. Insurance coverage stops when the beneficiary and the insurer together have spent $2,930 for prescription drugs, excluding monthly premiums. Under the health law, beneficiaries then get a 50 percent discount on brand-name drugs and 14 percent on generics drugs. When the beneficiary alone has spent a total of $4,700, coverage restarts. At that point, the beneficiary picks up 5 percent of the costs.
Source: kaiserhealthnews.org

MORPHOSIS: F/O/D #2 (part 2)

Ad mortem festinamus peccare desistamus. Scribere proposui de contemptu mundano ut degentes seculi non mulcentur in vano. Iam est hora surgere a sompno mortis pravo. Vita brevis breviter in brevi finietur mors venit velociter quae neminem veretur. Omnia mors perimit et nulli miseretur. Ni conversus fueris et sicut puer factus et vitam mutaveris in meliores actus intrare non poteris regnum Dei beatus. Tuba cum sonuerit dies erit extrema et iudex advenerit vocabit sempiterna electos in patria prescitos ad inferna. Quam felices fuerint qui cum Christo regnabunt facie ad faciem sic eum adspectabunt Sanctus Dominus Sabaoth conclamabunt. Et quam tristes fuerint qui eterne peribunt pene non deficient nec propter has obibunt. Heu heu miseri numquam inde exibunt. Cuncti reges seculi et in mundo magnates advertant et clerici omnesque potestates fiant velut parvuli dimitant vanitates. Heu fratres karissimi si digne contemplemus passionem Domini amara et si flemus ut pupillam oculi servabit ne peccemus. Alma Virgo virginum in celis coronata apud tuum filium sis nobis advocata et post hoc exilium occurens mediata. Vila cadaver eris cur non peccare vereris. Cur intumescere quearis. Ut quid peccuniam quearis. Quid vestes pomposas geris. Ut quid honores quearis. Cur non paenitens confiteris. Contra proximum non laeteris. (in Llibre Vermell de Montserrat, 1399)
Source: blogspot.com

Find Aetna Medicare, Illinois Plans Affordably

Medicare is a health insurance plan specifically created by the United States government to help our seniors, aged 65 and over pay for needed medical care. Unfortunately times change and the Original Medicare plans are no longer enough for most of our seniors. In particular the rising cost of prescription medications has made it almost impossible for many people to afford the care that they need. In the late 1980s Medicare changed and a new Part was added to the mix specifically to meet this growing need. This article will help you understand a little about Part D and how to choose the best Medicare drug plan from a company you can trust like Aetna Medicare, Illinois.
Source: abchealthplans.com

OIG Concludes Part D Plans Include Drugs Used by Dual Eligibles : Health Industry Washington Watch

As mandated by the ACA, the OIG has issued its annual report ("Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2012") assessing the extent to which Medicare Part D formularies include drugs commonly used by full-benefit, Medicare/Medicaid dual-eligible individuals. Based on a review of the 3,107 Part D plans operating in 2012, the OIG determined that 96% of the plans cover 191 drugs commonly used by dual eligibles, and 61% of these drugs are included by all Part D plan formularies. On average, 24% of the unique drugs were subjected to utilization management restrictions (i.e., prior authorization, step edits, or quantity limits) on Part D plan formularies, up from 19% in 2011; most of this increase is attributable to an increase in the use of quantity limits.
Source: healthindustrywashingtonwatch.com

Shari W Husband Lost Job, Now I Need Medicare Prescription Coverage

Posted by:  :  Category: Medicare

Rogue Magazine - October 1964 - Volume 9 Number 5 - Water Balloons .....item 1..routinely use devious devices -- wears us down like rabid trial lawyers until we give in (August 15, 2011 / 15 Av 5771) ... by marsmet542Scrubbs, Maybe this will help you out a little more: 1. I never have gone to an infusion center for my IVIG. 2. I have always had my infusion administered at home by a home nurse through a Home Healthcare Agency and it was fully covered under my Private Insurance carrier. Medicare has never paid anything toward my infusions because at the time of my first infusion in 2005 I was not approved for SSDI yet and I did not have Medicare at all. The home healthcare company worked out something with my private insurance carrier and I never had to pay anything for IVIG, I have continued to have my infusions at home to date. 3. When I was finally approved for SSDI in 2009 I went ahead and enrolled in Medicare Part A and B but my Private Insurance was still Primary. Medicare has always been secondary coverage for me and neither A nor B has been involved in paying for any part of my IVIG. 4. At my last visit with my Neurologist this past Tuesday we discussed the fact that as of June 30th, 2012 I will no longer have Private Insurance and so Medicare A and B will be my primary coverage along with D if I purchase it (which I know I will if I choose to go with Medicare only). Thus Medicare will be my Primary and responsible for my IVIG as of July 1st. Since they do not approve IG infusions at home for MG I will more than likely go to my Neuro’s office for it because he administers infusions there. The Neuro and staff informed me that Medicare will not pay 100% for infusions, they will only pay for 80% even if I have Part A and Part B. That is they way it is according to them and there are no negotiations with Medicare. 5. The only way I could get the 20% paid for (according to my Neuro) is if I purchase a Medigap policy. My Neuro has two other Medicare patients that receive IVIG and they both have a Medigap Policy. In my case there is only one company that will issue a Medigap policy to me since I am under the age of 65 and that policy will cost $480 per month which is almost the amount I would pay for single coverage with my Primary Insurance Carriers COBRA policy effective July 1st. Paying more than $600 per month whether it will be with a Cobra Policy or Medigap policy is going to be difficult since my husband is unemployed and paying 20% without the Medigap policy for each IVIG will be even harder to do. 6. When you say Part B Supplement, do you mean Medigap Policy or is there something else out there that I’m not aware of? 7. I have a massive headache over all of this and it seems like nobody except fellow MG’ers get why I’m concerned and becoming stressed. I hope this has helped you understand a little bit better. If not, please let me know and I’ll be more than happy to explain anything that you don’t understand. I look forward to your reply and appreciate you taking the time to help me. Any and all information is greatly appreciated. Shari
Source: psychcentral.com

Video: You Can Help Fight Medicare Fraud

Federal government supports identity theft

The most vulnerable population reflected in these applications is our seniors that have applied for a Medicare Advantage plan. These applications must be faxed within 48 hours and then held for 10 years. From a privacy and security stand point, the handling of Medicare Advantage plan application provides a greater potential for identity theft than using a debit card at the grocery store. If the Medicare Advantage application has information for the premium payment through electronic funds transfer (EFT) or voided check, the document includes all the necessary information for identity theft and scams.
Source: insuremekevin.com

Medicare health insurance Is Already In Fiscal Trouble; Let’s Stop The Deception

Nearly all Healthcare companies are legitimate and honest. Unfortunately, there are those that are not truthful! Medicare is certainly a large government agency that it becomes a fairly easy target for scams. A number of government agencies are combating against Medicare scams. Precisely what are these people doing to pull the particular fraud off? The unethical healthcare professional basically charge for services which were never given. Generally the consumer has no clue that which was done and they do not question their medical providers. Naturally with Medicare getting funded by tax payers along with the Medicare system is in jeopardy of survival caused by a shortage of funding. The scams eventually ends up costing the Medicare receiver additional money in premiums.
Source: bertram2011.com

Medicare Is Already In Economic Trouble; Let’s Stop The Fraudulence activity

The vast majority of Healthcare companies are trustworthy and honest. Nonetheless, as with anything else some are not. Medicare is certainly a large government organization that it becomes a simple target for fraud. Numerous government agencies are battling against Medicare fraudulence. How does fraud generally happen? Its actually easy to do and only requires that the Healthcare provider bills Medicare for services which have not been supplied. In most cases the individual has no clue what was done and they will not question their medical providers. This costs Medicare a tremendous amount of cash and as you know Medicare is under a lots of financial pressure. The fraud leads to higher rates for everyone.
Source: desirsdavenirvosges.com

April 12, 2012 Column 558 “Medicare Fraud 2″

            We recently completed taping our April radio show and this is exactly what we were talking about—fraud. And, for your information and amusement, the radio show is entitled “A Senior Moment”, and is done on KMUN public radio. If you miss these spots when aired, you can access them at http://www.coastradio.org/index7.html. End of ad.
Source: wordpress.com

Medicare insurance Is Undoubtedly In Fiscal Trouble; Let’s End The Deception

The vast majority of Healthcare suppliers are legitimate and honest. Regrettably, you will find those that are not truthful! Medicare is unquestionably a large government agency that it becomes an easy target for scams. A number of government agencies are fighting against Medicare scams. How does fraud normally happen? Its basically easy to do and merely requires that the Healthcare provider bills Medicare for services that have never been given. Not surprisingly most of us have no idea precisely what services were carried out anyway. This costs Medicare an enormous amount of money and as you know Medicare is under a good deal of financial pressure. The scams ends up costing the Medicare beneficiary more money in premiums.
Source: russellsabode.com

Update on Medicare Number Terminations You Can Check the Status of a Corrective Action Plan CAP Online

Note that the date that will be listed as being received will probably be days, if not weeks after you sent it. That is why it is extremely important to send such documents in by U.S. express mail, return receipt requested, and track it to ensure you know it was received and when it was actually received. As with any important document, you should always retain a good, legible, hard photocopy with copies of all airbills, postal mailing documents and return receipts.
Source: thehealthlawfirm.com

Medicare insurance Is Presently In Economic Trouble; Let’s Eliminate The Fraud

Most healthcare providers are honest and also trustworthy. Regrettably, there are those that are not trustworthy! Medicare is particularly a great target for deceitful activity. Many Government agencies will work with Medicare to halt these fraudulent activities. How does fraud normally happen? Its actually super easy to do and merely requires that the Healthcare provider bills Medicare for services which have not been supplied. After all many of us have no idea just what services were performed anyway. Naturally with Medicare getting funded by tax payers along with the Medicare system is at risk of survival due to a shortage of funds. The deception eventually ends up costing the Medicare recipient additional money in premiums.
Source: misterfatty.com

Halt Fraud As A Medicare Consumer And Watchdog

Nearly all Healthcare vendors are trustworthy and honest. Even so, as with other things a few are not. Medicare is especially a great target for deceitful activity. Many Government agencies work with Medicare to halt these fraudulent activities. How does fraud normally happen? Its actually super easy to do and only requires that the Healthcare provider charges Medicare for products and services that have never been given. Naturally many of us have no clue exactly what services were completed anyway. Naturally with Medicare being financed by tax payers along with the Medicare system is in jeopardy of survival caused by a shortage of funds. The scams leads to higher monthly premiums for everyone.
Source: muratabenov.com

Health Law’s Birth Control Mandate, Medicare’s Doughtnut Hole Draw Headlines

Posted by:  :  Category: Medicare

Stella Johnson On The Impact Of Health Insurance Reform by Leader Nancy PelosiReligion News Service/The Washington Post: Religious Leaders Ask HHS To Broaden Birth Control Exemption A coalition of nearly 150 religious leaders, led by conservative Protestants, have petitioned the Obama administration to broaden the exemption that allows churches and some religious organizations to avoid a controversial new mandate that all health care insurers provide free contraception coverage (Gibson, 6/12).
Source: kaiserhealthnews.org

Video: Affordable Care Act: Closing the Medicare Doughnut Hole

Drug Makers Say If Court Strikes Health Law, Medicare Discounts Could End

Voluntary drug coverage was added to Medicare in 2006, but consumers and advocates have been eager to get rid of the coverage gap. Insurance coverage stops when the beneficiary and the insurer together have spent $2,930 for prescription drugs, excluding monthly premiums. Under the health law, beneficiaries then get a 50 percent discount on brand-name drugs and- percent on generics drugs. When the beneficiary alone has spent a total of $4,700, coverage restarts. At that point the drug plan picks up 95 percent of the cost.
Source: gantdaily.com

InsureBlog: Obamacare Saves Medicare

Sec. Sebelius also fails to mention the $450 billion in cuts to Medicare funding that are built in to Obamacare. These cuts will result in higher costs to you and fewer Medicare Advantage choices. Obamacare will use money intended for seniors on Medicare to pay for “free” health care for the poor under age 65.
Source: blogspot.com

Doughnut Hole Rebate Checks Fuel Medicare Fraud & Insurance Scams

Missouri Attorney General Chris Koster (also the name of the website) comments on the types of Medicare scams taking place across the nation. The article can be found in the Attorney General’s News Release titled, "Attorney General Koster Warns Seniors About Medicare Rebate Fraud Schemes" (June, 2010). According to the author (name not given), "[Koster] said a common scam related to the $250 donut hole checks was for individuals to convince seniors that the rebate check needed to be transferred to a third party or used to cover specific prescription drug payments."
Source: suite101.com

Some On Medicare Stop Taking Medications During Donut Hole

In the meantime, people on Medicare should remember to choose their Medicare coverage wisely. If you’re looking at a Medicare plan, be sure the medications you take are covered, that you’re still able to visit any “must-have” doctors and that you take into consideration not only your health but also your finances. Your wallet and your body will thank you.
Source: allsup.com

GOP Enablers of Obamacare

GOP Sen. Roy Blunt of Missouri, vice chair of the Senate GOP Conference, told a St. Louis radio station two weeks ago that he supports keeping at least three Obamacare regulatory pillars: federally imposed coverage of “children” up to age 26 on their parents’ health insurance policies (the infamous, unfunded “slacker mandate”), federally mandated coverage regardless of pre-existing conditions (“guaranteed issue,” which leads to an adverse-selection death spiral) and closure of the coverage gap in the massive Bush-backed Medicare drug entitlement (the “donut hole fix” that will obliterate the program’s cost-controls).
Source: westernjournalism.com

Surviving the Medicare Part D Coverage Gap: The Shrinking Donut Hole in the Prescription Drug Plan

The coverage gap in the Medicare Part D prescription drug plan, known popularly as the Medicare "donut hole" or "doughnut hole," is expected to affect over one million seniors in 2010, according to a House of Representatives press release. The good news is, this coverage gap, inside which enrollees must pay for prescription medications fully out of pocket, is slated to be reduced and even, by the year 2020, completely eliminated due to the passing of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (otherwise known as the "health reform bill.") Meanwhile, seniors participating in this prescription drug plan (PDP) who fall into the donut hole must weather the storm.
Source: suite101.com

Choosing Plans Of Travel Health Insurance

Posted by:  :  Category: Medicare

Health Insurance Does Not Insure Health by SavaTheAggieTravel health insurance typically comes bundled up with trip interruption/cancellation insurance, travel accident insurance coverage, baggage loss, emergency evacuation and also healthcare expenditures coverage. The normal premium is about 200$ every year. Unfortunately the premium depends a lot in your age, price of trip (for unmarried trip insurance coverage), the distance of trip, the nation to which the trip is being made, any preexisting health conditions and others. Some travel wellness insurance coverage plans also cover accidental deaths as well as flight accidental death.
Source: worldofcurrency.com

Video: Essential Things To Know About Individual Health Insurance Plan

Ask The Experts: Retirement

Q. I am a retired FERS employee. I elected to continue my federal health insurance (family plan) as the supplemental insurance for Medicare. I did not take the supplemental (Part B) insurance that Medicare offered. If I die, can my wife continue the federal health insurance? For how long? Can she keep the federal health insurance for the rest of her life? Can she have the “single” rate on the insurance?
Source: federaltimes.com

College Students and Recent Grads Conflicted about Health Care Reform, according to eHealthInsurance Survey / eHealth

eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website, www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through the company’s eHealthTechnology solution (www.eHealthTechnology.com), eHealth is also a leading provider of health insurance exchange technology. eHealthTechnology’s exchange platform provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides powerful online and pharmacy-based tools to help seniors navigate Medicare health insurance options, choose the right plan and enroll in select plans online through its wholly-owned subsidiary, PlanPrescriber.com (www.planprescriber.com) and through its Medicare website www.eHealthMedicare.com.   
Source: ehealthinsurance.com

Insurance quotes for your pet

Rather, cats prefer sitting back to assess before they commit anything by themselves. Then again, cats happen to be wanderers, while dogs end up committing themselves wholeheartedly into adventure which thrusts forward all the way down the rabbit hole and there is hardly any thought of any exit strategy. That explains why, among the searches for pet insurance quotes, the search for dog health insurance quotes is so high. Dogs really are much more exposed to injuries than cats. If you are a wise dog owner, you will acknowledge that fact and should get prepared for that through getting adequate and proper insurance coverage for your dog.
Source: gokakeya.com

Landscape for health care is changing

Officials have reported in recent months that they won’t be able to simply set prices without considering the actual costs to health providers – shocking, I know. To some extent, they had actually assumed they could just “pick” an affordable price and provide coverage. The fact that this realization is occurring tells me that while the state exchange will provide some people some form of value, it is not the proverbial silver bullet to making insurance coverage affordable.
Source: wordpress.com

Can you stay on your ex’s health insurance after divorce?

With all of the current ambiguity and uncertainty surrounding the health care laws in the United States, it is no wonder that many Ohio residents are confused about their available health insurance offerings. And insurance becomes even more confusing during and after a divorce, especially when all members of the family had previously been covered under one spouse’s health insurance policy.
Source: columbusfamilylawyerblog.com

Medical Care Insurance in Hawaii

With the great deal of medical insurance providers in Hawaii, you can absolutely make the best out of emphasizing one that would help you. It is recommended that regular students are able to acquire a more affordable fee with the health care insurance quote. Part time pupils could get discounts given by such. For all those young adults who are differently-abled or cannot complete their education, they can be hampered with student loan debts but they can still avail of the medical care insurance plan. They just need to sign up and the firm will measure the degree and the degree of the disability.
Source: theboardmagazine.com

Further Action Needed to Address Vulnerabilities in Medicaid and Medicare Programs

Posted by:  :  Category: Medicare

GIMME SOME OF THAT GOOD 'OLE OBAMA DOUBLESPEAK by SS&SSCMS noted vulnerabilities in the prepayment reviews of claims in five states and effective practices in seven others. In anticipation of new analytic tools to predict vulnerabilities before claims are paid, the agency has initiated discussions with and provided guidance to states.
Source: medicareindex.com

Video: Senator Harkin Addresses False Claims That Health Reform Will Hurt Medicare Recipients

How to Avoid Common Version 5010 Claims Rejections

For additional help with your Version 5010 upgrade and Medicare claims, you can contact your Medicare Administrative Contractor (MAC). The MACs work closely with clearinghouses, billing vendors, and health care providers who require assistance in submitting and receiving Version 5010 compliant transactions. If you experience difficulty reaching a MAC, you should send a message describing your issue to ProviderFeedback@cms.hhs.gov with “5010 Extension” in the subject line.
Source: chirotexas.org

Online Medicare Forms: Appeal, Payment, Disclosure, Application

Medicare insurance forms for parts A, B, C and D are accessible online for electronic filings and mail in. Online forms include an application for Medicare, claim forms for patients requesting payments and Medicare appeal forms. Older Americans can apply for Medicare even if not planning to retire, as long as the person is close to 65 years old. Even when a person has been denied Medicare, appeal forms can be submitted online requesting a hearing or case review.
Source: suite101.com

Nursing Center Error Page

site map. You can also click one of the Helpful Links below, use the navigation bar on the left to go to another NursingCenter section, or click the Back button on your browser to return to the previous page. After you’ve found the page you want, be sure to update your bookmark so you can find it again later! We apologize for any inconvenience and we thank you for visiting the all-new NursingCenter.  
Source: nursingcenter.com

Medicare This Week: June 8th, 2012, 4010 Ends July 1st, ePrescribing Hardship Exemptions, Improvements to PECOS

Effective July 1, 2012 only ASC X12 Version 5010 (Version 5010) or NCPDP Telecom D.0 (NCPDP D.0) formats will be accepted by Medicare Fee-For-Service (FFS). Providers that are still conducting one or more of the Version 4010 transactions electronically, such as submitting a claim or checking claim status, or rely on a software vendor, billing service or clearinghouse to do this on their behalf, are affected by this change. Now is the time to contact your software vendor, billing service or clearinghouse, when applicable, if you have not done so already to ensure you are ready. Transactions conducted by Medicare Administrative Contractor (MAC), fiscal intermediary (FI) or carrier telephone interactive voice response (IVR) systems, Direct Data Entry (DDE) and Internet Portals, for those contractors with Internet Portals, are not impacted.
Source: managemypractice.com

New Carriers for Medicare DME Claims

The seven states are Connecticut, Idaho, Indiana, Montana, Rhode Island, South Carolina and Washington. With this action, effective Nov. 1, HCFA begins a national changeover to four regional carriers to handle DME claims. All other states will be phased into the new setup on a schedule that begins Dec. 1, and extends through March 1. The extended schedule is designed to provide assistance to the other states overtime to avoid any complications along the way. The scope of this project prevents all states from being transferred all at once. Previous projects have revealed the need to work on transitions in stages for the highest success rating.
Source: wordpress.com

On Filing and Filling out a Medicare Claim Form

Once you already filed your claim form along with the itemized bill, provide extra copies of it. This will purge any glitches made during the filing process and will make it more convenient for you upon re-filing your lost health insurance claims. * Review your claim form thoroughly before sending. To make sure that everything else is accurate, don’t forget to double-check your claim form before sending them to Medicare. Also, don’t forget to include the paperwork used during the filing process. Ask your health insurance company how long will you wait for your claim form to be paid by Medicare. The main purpose of buying health insurance claims is to get its sufficient coverage unless it’s not required. There are terms and conditions you need to follow upon qualifying for Medicare’s insurance policy claims. Otherwise, you won’t be able to claim any Medicare coverage that is debarred from a particular policy you chose – This is where the filling out process comes in. Here are few steps: 1. Make sure that you already claimed your coverage before obtaining a Medicare claim form. Why is this very important? Simply because your coverage will serve as your basis during contact with Medicare or any health insurance company. 2. Since specific health insurance claim forms varies from one company to the other, you’re usually required to fill out the following information: * Your personal details – It’s the most important part of every claim form. You need to write down the personal details provided including your name, address and contact number. * Your policy number – Don’t forget to write your policy number since this will be used by the company to identify your insurance policy claim. * Reasons for filing – Another important information you need to fill out in your claim form. 3. Attached any documents that will serve as your proof for eligibility for Medicare’s benefits. Note: You can attach the itemized bills provided.  
Source: ezinemark.com

HIT Exchange: Health 2.0 Announces Winners of the Medicare Claims Data Challenge

Health 2.0 announced today that teams from Zenithech LLC, Avanade Inc. and Big Yellow Star won the Medicare Claims Data Developer Challenge sponsored by IMPAQ International LLC and the National Opinion Research Center (NORC) at the University of Chicago. IMPAQ, a social research and consulting services company, and NORC, a not-for-profit, academic research organization, created the competition to spur development of interactive Internet-based tools to make Medicare claims data more accessible and usable for clinicians, health researchers, consumers, policy-makers, entrepreneurs and others.   Teams comprised of software developers, entrepreneurs, and technologists participated in the national event, which required contestants to create online tools allowing users to access at least one of the eight public use files (PUFs) covering eight types of 2008 Medicare claims data released last year: inpatient, durable medical equipment, hospice, carrier line, home health, Medicare Part D, outpatient and skilled nursing facility. Applications were judged on the potential to help address Medicare claims data challenges, usability, and the potential for integration with existing claims systems or other health technology platforms.   “The ingenuity, innovation and creativity the participants demonstrated were exceptional,” said Indu Subaiya, Co-Chair and CEO of Health 2.0, which collaborated with IMPAQ and NORC. “The tools they created will facilitate and foster exciting research that will drive new ideas and approaches to improve quality of care, lower costs and shape health policy. It was a tough competition, and we congratulate the winners.”   The first place winner was Zenithech, a Fairfax, Va.-based developer of web and mobile applications. The company won $7,500 and two passes to the Health 2.0 Spring Fling Matchpoint Boston conference for developing MEDZ, a dashboard that displays and lets users conduct in-depth analysis of all eight PUFs for comparative research and in-depth analysis.   Avanade, a business technology solutions and managed services provider, captured second place with a business intelligence reporting tool called DataGnosis that enables researchers to perform canned and ad-hoc reporting on all eight PUFs. Users also can tie those claims with U.S. Census data, positioning them to identify trends and patterns across each state. Avanade was awarded $2,000.   Big Yellow Star, a Philadelphia company focused on health informatics, public health and health literacy projects, was awarded third place. It received $500 for a dashboard that makes hospice and outpatient PUFs accessible to users.
Source: hitexchangemedia.com

Connolly issues automatic edit for RAP with no CMS Issue Number

401.9 2012 codes case-mix cdc cms CMS OASIS comprehensive assessment diabetes HHA HHPPS HHS home health home health diagnosis coding htn ICD-9 Home Health Coding ICD-10 icd-10 delay Lisa Selman-Holman m0090 M1012 M1020 M1022 M1024 m1306 m1307 M1308 m1310 m1312 m1314 M1320 M1324 M1340 medicare nahc new codes OASIS oct. 1 physical therapy POC pressure ulcers selmanholmanblog.com soc surgical wound V Codes WOCN
Source: selmanholmanblog.com

Centene Surges on Receipt of Ohio Medicaid Contract (CNC)

Posted by:  :  Category: Medicare

Attorney General Richard Cordray Announces Candidacy for Re-election by ProgressOhioEd Liston is a senior contributing editor at TheStockMarketWatch.com. An active market watcher and investor, Ed guides an independent team of experienced analysts and writes for multiple stock trader publications. He is widely quoted in various financial publications on the Internet. When Ed is not writing about stocks, investing in stocks, talking about stocks, or otherwise doing something stock related, he likes to go sailing and fishing in his yacht.
Source: thestockmarketwatch.com

Video: Ohio Medicaid Russian Drug Smuggling Investigation

Georgia Chapter, American Academy of Pediatrics: Ohio drops 2 for Medicaid contracts, adds 2 others

Among other changes, state officials are raising performance expectations in the contracts by linking part of each Medicaid managed care plan’s payment to standards aimed at making people healthier. The plans also will have to develop financial incentives for hospitals, doctors and other providers that are tied to improving quality and patients’ health.
Source: blogspot.com

Ohio Launches Initiative to Expand and Improve Medicaid Presumptive Eligibility for Pregnant Women and Children

“Nationwide Children’s Hospital is honored to be a test site for enhanced Medicaid presumptive eligibility for children and adolescents,” said Kelly J. Kelleher, MD, vice president for health services research at Nationwide Children’s Hospital. “This program will allow preventive and treatment services to begin immediately for children and adolescents who might otherwise delay prescriptions or other therapies after an initial visit without insurance. It will also provide greater choices for a family that is seeking a medical home for their child or teen by offering immediate coverage. We look forward to working with the state of Ohio and other partners to increase access, improve outcomes and reduce health-care costs for Ohio’s children through this program.”
Source: asiainc-ohio.org

Bachmann Calls For Federal Audit Of Minnesota Medicaid Program

Minnesota Public Radio: Bachmann Wants Independent Audit Of State’s Medicaid Program Michele Bachmann is stepping up her campaign for federal officials to take a deeper look at how Minnesota’s Medicaid managed care plans operate. Later today, the Minnesota Republican congresswoman will send a letter to Marilyn Tavenner, the head of the Center for Medicare and Medicaid Services, asking that the federal government conduct an independent, third-party audit of Minnesota’s management of the federal-state health care program for the poor. Bachmann’s request comes after a House hearing in April that paid particular attention to Minnesota’s contracts with nonprofit managed care organizations and UCare’s $30 million payment to the state in 2011 (Neely, 6/7).
Source: kaiserhealthnews.org

Ohio Medicaid Losses Wreck Providers (MOH, CNC, AGP, WCG)

The Wall Street Journal also noted that AMERIGROUP Corporation (NYSE: AGP) and WellCare Health Plans, Inc. (NYSE: WCG) are not being awarded new contracts in Ohio but that Centene was planning an effort to appeal the decision that would impact 9% of the 1.8 million members.  WellCare is down 6.6% at $69.35 against a 52-week range of $33.29 to $74.41.  AMERIGROUP shares are down the least with a drop of 4.7% at $64.22 against a 52-week range of $37.57 to $75.74.
Source: 247wallst.com

Duped by Congressional Lies by Walter E. Williams

Posted by:  :  Category: Medicare

Social Security Adminstration building on Edsall Rd - 100-0027 by Rev. Xanatos Satanicos Bombasticos (ClintJCL)Then there’s the fairness issue that we’re so enamored with today. It turns out that half the federal budget is spent on programs primarily serving senior citizens, such as Social Security, Medicare and Medicaid. But let’s look at a few comparisons between younger Americans and older Americans. More than 80 percent of those older than 65 are homeowners, and 66 percent of them have no mortgage. Homeownership is at 40 percent for those younger than 35, and only 12 percent own their home free and clear of a mortgage. The average net worth of people older than 65 is about $230,000, whereas that of those younger than 35 is $10,000. There’s nothing complicated about this; older people have been around longer. But what standard of fairness justifies taxing the earnings of workers who are less wealthy in order to pass them on to retirees who are far wealthier? There’s no justification, but there’s an explanation. Those older than 65 vote in greater numbers and have the ear of congressmen.
Source: lewrockwell.com

Video: US Social Security (Politics in Ecolang.)

Forced to Early Social Security, Unemployed Pay a Steep Price

While many are delaying retirement because of financial concerns, the weak job market has led others to draw social security early, seeing no other way to make ends meet. The Bulletin reported that about 200,000 more people filed initial claims in 2009 and 2010 than the agency had predicted before the recession, and that those trends seemed likely to continue, most likely because of unemployment.
Source: inquisitr.com

Social Security News: Many Listings Extended Without Change, Including Mental Disorders

     Social Security Commissioner Michael Astrue has twice tried to amend the mental disorders listings. Not long before the 2008 election, Astrue received approval from the Bush Administration to publish a proposed new Listing. Astrue did not promptly send the proposal to the Federal Register for publication as is normally the case. I think it would have been published if McCain had won that election. With Obama winning, the 2008 proposal was shelved.  There is no way of knowing what was in the 2008 proposal but I doubt that I would have liked it. In 2010, Astrue received Obama Administration approval for new proposed mental impairment listings. The proposal was controversial and Social Security had to issue a “clarification.” In theory, despite the notice in today’s Federal Register, Social Security could attempt to get Office of Management and Budget (OMB) approval for the mental impairment listings proposal made in 2010. Due to the length of time that has passed and the proximity to the election, I doubt that will happen. If it were submitted to OMB today, it probably wouldn’t be acted upon until September. It’s just too late to do before the election, considering that it would be controversial.
Source: blogspot.com

Average number of contributors to Spanish Social Security System stands at 16,996,510 in May

Accountants amendments bankruptcy proceedings bureaucratic procedures business contracts Costa del Sol costa del sol accountants criminal law marbella duties Economists embassy emigration financial fiscal advisor fiscal advisors marbella IMF Inheritance inheritance marbella justice law lawyer lawyers costa del sol lawyers in marbella legal advice legal advice costa del sol marbella economist Monetary fund NIE NIE number certification property property lawyer property lawyer in marbella purchase registration of mark Residency self-employed workers tax advice marbella tax advisor Tax Advisors taxation Tax Resident Trade mark unemployment wills in marbella
Source: arcos-lamersasociados.com

Social Security, Medicare: Focus of June 12 Maui Debate

AARP is a membership organization for people age 50 and older with nearly 150,000 members in Hawaii. The group champions access to affordable, quality health care , provides the tools needed to save for retirement, and serves as an information source on issues critical to older Americans.
Source: mauinow.com

Seven DON’TS for Social Security Disability in 2012

DON’T Be in Denial About your Disabilities- Most people we help with SSD are honest, hardworking people who have experienced a misfortunate illness or accident.  Many times we find that these individuals are in denial about the depth of their symptoms.  People in denial have a difficult time letting their medical and legal professionals know the depth of the symptoms they are experiencing.  In a strange way they believe that admitting to the magnitude of the problem is a sign of weakness.  To the contrary, if you can break through your denial, we find it to be a courageous thing for an individual to completely own his/her problems.  Then, and only then, will his/her medical and legal professionals be in a position to help him/her the most. It is SO important to not let your pride get in the way of winning your case.  You need to be completely honest about ANY and ALL medical problems you may have. Your doctors won’t judge you and we certainly will not judge you.
Source: brookslawgroup.com

Workers India Federation resolves to entitle Social Security of Unorganized Workers :Religiousindia

In the inaugural address Bishop Oswald Lewis, chairman of CBCI Office for Labour said the concern for others entails desiring what is good for them from every point of view : physical, moral and spiritual. He quoted the Letter to the Heb 10:24 “Let us be concerned for each other, to stir up response in love and good work.” He added that the concern for others is being aware of their needs. Upholding the call for ‘concern for other’ WIF AGM resolved to extend the number of workers’ facilitation centers from 48 to 200 and increase subscription of MSY to one lakh from twenty thousand with the help of web enabled facilitation in 2012-13.
Source: religiousindia.org

Health Insurance Medicare

Posted by:  :  Category: Medicare

Grand Bargain Watch - Save Social Security by DonkeyHoteyMedicare provides medical insurance to citizens aged 65 and above and have congenital or acquired health conditions. It has four categoriesA, B, C, and D. Each category covers a certain aspect of health care insurance. Contrary to the misconception that Medicare covers all medical costs of a beneficiary, only 80 percent of the total expenses for health services are shouldered by the policy. The remaining 20 percent is paid either through the patient’s personal funds or a Medicare Supplement. The Medicare Supplement program, more commonly known as Medigap, is an insurance coverage extension program that encompasses other services not subsidized by the original Medicare policy. The supplementary plans are not sponsored by government, but by private insurance companies. Only Medicare Parts A and B subscribers can take advantage of Medigap plans. Because Medigap plans are private, they are flexible and can vary according to the marketing strategy of the insurance provider. It will extend a holder’s insurance coverage to health services not included in his or her existing policy. Acting as add-ons, these insurance supplements allow beneficiaries to make the most out of Medicare setups. Generally, Medigap comes in 10 standardized insurance plans identified by the letters A to L. Extra services that were canceled under the original Medicare program find new life in Plans M and N. Each of these plans differs slightly from the others. So far, the Best Medicare Supplement plans are Plan F and N, because they are the most comprehensive and convenient. The cost of the Best Medicare Supplement plan depends in part on the age of the beneficiary. The initial plans provide limited coverage for older subscribers, since they are highly vulnerable to diseases and injuries. However, the newer policies are more affordable and have excellent coverage for these beneficiaries. Current Medigap policies have no drug coverage. Beneficiaries who had been enjoying prescription compensation under Medicare until 2006 might lose this benefit. Since insurance providers want to iron out the terms of their offers, they improve the plans from time to time. It is better to study the different policies to pinpoint just what plan is called for. This will help people choose the Best Medicare Supplement for their needs.
Source: healthinsurance-medical.com

Video: Insurance Co. ‘Misleads’ Medicare Recipients

Drug Makers Say If Court Strikes Health Law, Medicare Discounts Could End

Voluntary drug coverage was added to Medicare in 2006, but consumers and advocates have been eager to get rid of the coverage gap. Insurance coverage stops when the beneficiary and the insurer together have spent $2,930 for prescription drugs, excluding monthly premiums. Under the health law, beneficiaries then get a 50 percent discount on brand-name drugs and- percent on generics drugs. When the beneficiary alone has spent a total of $4,700, coverage restarts. At that point the drug plan picks up 95 percent of the cost.
Source: gantdaily.com

Medicare Drug Discounts At Risk If Court Strikes Health Law

Voluntary drug coverage was added to Medicare in 2006, but consumers and advocates have been eager to get rid of the coverage gap. Insurance coverage stops when the beneficiary and the insurer together have spent $2,930 for prescription drugs, excluding monthly premiums. Under the health law, beneficiaries then get a 50 percent discount on brand-name drugs and 14 percent on generics drugs. When the beneficiary alone has spent a total of $4,700, coverage restarts. At that point the drug plan picks up 95 percent of the cost.
Source: kaiserhealthnews.org

View and Compare Medicare Supplement Insurance Online

When it comes to taking the leap into gap insurance online advisors will guide you through what is available and help shop the Medigap market to find the best premiums that you qualify for. As rates change each year you will want to contact your online Medicare Supplement Insurance provider to get updates on lower rates from other Medigap Insurance providers. An online advisor is helpful in helping determine exactly what gap insurance program you should enroll in according to prior history and current lifestyle.
Source: online-biz-articles.com

Medicare insurance Is Definitely In Fiscal Trouble; Let us End The Deception

The majority of Healthcare companies are trustworthy and honest. Unfortunately, you can find those that are not truthful! Medicare is certainly a large government organization that it becomes a fairly easy target for fraud. Numerous government agencies are battling against Medicare deception. Exactly what are these people doing to pull the particular fraud off? The dishonest healthcare professional merely charge for services that were never given. Not surprisingly most of us have no idea just what services were completed anyway. Naturally with Medicare being funded by tax payers along with the Medicare system is in danger of survival because of a shortage of money. The deception winds up costing the Medicare recipient more money in premiums.
Source: gazettevideos.com