Get your prostate checked

Posted by:  :  Category: Medicare

Reality Bites (draft v001) by juhansoninHave you ever put off doing a task or getting a test and later wished you’d just gotten it over with? Now’s the time to talk with your doctor about whether you should get screened for prostate cancer. It’s the most common cancer in men, second only to lung cancer in the number of cancer deaths. The potential benefit of prostate cancer screening is early detection of cancer, which may make treatment more effective.
Source: medicare.gov

Video: medicare.gov

Know Your Medical Benefits Through Medicare.gov

The HMO health care plans are the initial priority when looking out for the most affordable Health Insurance in your city, a lot like guaranteed issue health insurance plans. It offers you a wide medical coverage at cheaper rates with a remarkably high amount of coverage. HMO health plan is a type of health insurance where the insured member visits the hospital, doctor falling in the HMO group. This group of HMO involves a group of doctors and hospitals connected with respective insurance companies for giving health care to the insured members. At Atlanta, vast majority are shifting towards the HSA health insurance plan because of its cheap rates as well as the tax savings it tends to offer. It has the advantage of lower premiums (monthly) as compared to the older health insurance plans.
Source: eurovisionsk.com

Medicare.gov: Medicare @ SEOValidator.Net

Medicare, Medicare Eligibity, Medicare Advantage, Medicare Part D, Medicare Part C, Medicare Part B, Medicare Part A, Medicare heath plans, Medicare drug plans, Medicare supplemental plans, Medicare facilities, Medicare providers, what’s new, parts of Medicare, elder care
Source: seovalidator.net

How To Obtain The Best Offer On Medicare Part D

Posted by:  :  Category: Medicare

Medicare Part D Press Conference (44) by Korean Resource Center 민족학교If you have always had some type of health coverage, the same as Medicare Part D for elderly people, during your working years, then you most probably had a pharmacy or prescription plan already covered in that insurance plan. Having both your healthcare and prescriptions in one plan causes it to become less complicated for you. But, if you turn 65 and you are enrolled for Medicare insurance, then the whole world will change for you. You will have to opt in to a Medicare Part D plan to be able to afford your prescriptions. During 1997, much of the method that individuals connect with Medicare changed and something known as Medicare Part D came about. This is basically Medicares method of giving a prescription plan for people around 65 years of age, however it is usually recognized to be among the most complicated policies around. There are basically thousands of senior citizens who don’t know that they are actually eligible for it and also those that do not know how to go about enrolling. First thing that you must know concerning Medicare Part D is that if you are sixty five and already getting Medicare, then you can certainly apply for the program. This is actually a plan that is obtained from an exclusive company and also there are literally numerous different providers to choose from. There are a few companies, such as Walgreens and / or Walmart, that represent thousands of pharmacies, while there are smaller companies and mail order pharmacies, as well. Medicare Part D plans normally have 4 tiers to them and each and every tier presents a specific type of medication. You have to select which tiers your medications are in in order to get a great value. Naturally, if you’re in the course of changing medications or you have many healthcare needs during the coming year, then you’ll have to make an educated guess. Prior to committing to any provider for your Medicare Part D plan, you have to sit down with your medical doctor and make a full listing of your medicines, along with the amount you are taking. Then, a great way to determine which policy is best for you is to surf to the governments Medicare Part D internet site where you can then input your complete current drugs and see which programs will come out the same. Eventhough you may think that a particular medicine might be the same across the board with regards to cost that is hardly the case. A medicine that might be in Tier 1 in one plan could be in Tier 2 or Tier 3 in another plan, so it is obvious that if you are taking plenty of medicines you can save an awful lot of money by looking around. A lot of Medicare Part D plans have an yearly insurance deductible in addition to a regular monthly premium, so you will have to decide just which one is ideal for you. If you don’t take a lot of medicines, then a large yearly insurance deductible may take care of you, but if you know that you will max out that number quickly, then a higher monthly premium may be best for you. You must also keep in mind that there’s nothing wrong with talking to your physician about switching you to similar medications that could be on a lower tier. This could usually help you to save big money and enable you to take all of the medications that you should be taking rather than by cutting corners.
Source: blogspot.com

Video: Medicare Part D Prescription Drug Plan Basics

InsureBlog: Obamacare, SCOTUS and Medicare Part D

Obamacare 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

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

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

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

AARP Public Policy Institute Reviews Gap in Medicare Part D Coverage

A new report from the AARP Public Policy Institute looks at the potential effects of a provision in the health care law that provides drug subsidies and discounts to Medicare beneficiaries, ultimately eliminating the coverage gap known as the “doughnut hole.” According to the report, “As part of the new health care law, enrollees who reach the doughnut hole in 2011 will receive a 50 percent discount on brand-name and biologic drugs and a 7 percent discount on generic drugs while in the doughnut hole. These discounts will gradually increase until the doughnut hole is eliminated in 2020.” The report includes a table showing “the number and percentage of Part D enrollees by state who are helped by the closing of the doughnut hole.”
Source: kff.org

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

A Democrat reaches across the aisle on Medicare

Private insurers would thus have an incentive to design plans that would offer more generous benefits and lower costs than current Medicare. This kind of market competition has proved effective in the Medicare Part D prescription drug program enacted in 2003. Costs have been lower than government projections and beneficiary satisfaction has been high.
Source: washingtonexaminer.com

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

• Part D enrollment is significantly below projected levels – Enrollment is 73 percent in 2012 which is below the projected enrollment of 87 percent. (Note – this includes RDS enrollees). 10 percent of beneficiaries have no equivalent coverage and are assumed to have made a decision not to enroll or are not aware of their drug coverage options. • Benefit costs are lower than projected – Part D spending is 68 percent of the projected costs. This is due to a variety of factors including the shift to generics, lower overall drug pricing trends, slower drug pipelines, lower enrollment, impact of competition and informed consumer shopping. • Generic drugs – Generic drug use increased from 60 percent to 75 percent thus significantly impacting lower program costs. • MA-PD enrollment is higher and premiums are lower than PDPs – MA-PD premiums are lower than PDPs even after taking into account the use of savings from the medical side. • Average utilization has increased however this is consistent with projections. • Rebates have been higher than expectations but there is no publicly available information on the trends. • There is evidence that competition has influenced Part D spending – The Part D market is robust (national average of 31 plans although there has been some consolidation) and bidding has affected premiums and availability of low income subsidies. However over half of enrollment is concentrated in a five plans and. Consumer tools have improved over the course of the program and have influenced plan selection, however only six percent of beneficiaries switch plans from year to year.
Source: gormanhealthgroup.com

Medicare Drug Discounts At Risk If Court Strikes Health Law

Posted by:  :  Category: Medicare

Medicare Part D Press Conference 10-25-06 (16) by Korean Resource Center 민족학교Voluntary 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

Video: Guide to Medicare Part A and Part B

Will You Spend Less With Medicare Part D?

Although the United States government has invested millions and millions of dollars attempting to explain to older people what the Medicare Part D plan is centered on, it seems as if a lot of people more questions than before. In case you are new to Medicare insurance, that you are just turning 65, or you are just now starting to take regular prescriptions for your health, then you certainly need to spend some time to study about Medicare Part D as well as what it could do for you. If you have always had your health insurance plan by your company, then you probably had some sort of prescription plan. This meant that if you went to a pharmacy, the drugstore ran your prescriptions using your plan and you received a reduced rate. Should you have had a very good plan, you only paid a little one-time fee for every prescription, however, if you were like many individuals you still ended up paying quite a lot. Medicare Part D works much the same way except that most of the drugs are put into what is known as a formulary, which is a list of all medicines that is kept by every insurance agency. They then take that listing and divide it into 4 single tiers, according to the cost of the drug and also the type that it is. It goes without saying that every provider has their own individual formulary and that is certainly where you can actually save money. The great news is that you can enroll in Medicare Part D for a small amount if you do your own shopping. You might find that it just costs you $20 or $30 every month if ever you choose perfectly and that the protection gives you significant discount rates on your medications. The main restriction that you’ll need to bear in mind is that you can’t switch companies anytime you want. The whole country is given a little window of time in the fall during which they can switch companies, and that is called the open enrollment period. In case you are trying to know which Medicare Part D to consider, you might think that selecting one of the larger prescription or pharmacy companies could be a smart option, but that is not always the case. This is usually a decision that is broadly personal and something that will be best considered by you taking a look at your whole medications and then selecting a provider based on that. The most effective way to determine what company will be most economical for you would be to go to the governments Medicare site and look up everyone of your medications. The site will show you which company could help you save the most money. You do not have to enroll in Medicare Part D and if you are absolutely in good shape and take no prescriptions whatsoever, then it could be a complete waste of money for you. However, nobody knows what the future will bring and the truth is that you never know when you may need a medication, and it’s more likely that medication will be costly. A lot of people believe that through signing up for Medicare Part D that they are able to recoup the prices of their premiums in just one prescription alone, so although this is a monthly payment that you might not want to make, it is one that could end up helping you save an awful lot of money down the road.
Source: blogspot.com

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

InsureBlog: Obamacare, SCOTUS and Medicare Part D

Obamacare 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

What Is Medicare Part C And What Does It Cover

Second, make a note of the rules the plan specifies such as the time when you can join or opt out of the plan, the rights you have under the plan and the services covered by the plan. Pay special attention to the conditions regarding visiting a specialist doctor and receiving authorization for particular procedures or you may find out too late that you have to bear these expenses on your own.
Source: online-business-expert.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

COBRA and Medicare, Part II 

[1] See, e.g., 42 CFR §423.56; also see CMS website at: http://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/index.html?redirect=/CreditableCoverage/. [2] See 29 USC §1162(2)(D)(ii). [3] See Treas Reg §54.4980B-7, Q&A 3, available at: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=47126146b0c56fbbab9b6b6ebfb7db7d&rgn=div8&view=text&node=26:17.0.1.1.5.0.1.25&idno=26 [4] See Geissal v Moore Med. Corp. (1998) 524 US 74, 141 L Ed 2d 64, 118 S Ct 1869. [5] Note that for individuals who qualify for Medicare because of ESRD and are also entitled to health coverage under an employer plan, the group plan will be the primary payer for a 30-month coordination of benefits period. See 42 USC §1395y(b)(1)(C); 42 CFR §411.162.  This rule applies regardless of whether the individual is a current or former employee and regardless of whether the individual has coverage through COBRA.  Also note that if an individual enrolls in Medicare after electing COBRA coverage, the employer can elect to terminate the COBRA coverage.  [6]  Section 1882(s)(3)(B)(ii) of the Social Security Act; see also “Your Rights to Buy a Medigap Policy” at http://cahealthadvocates.org/medigap/guaranteed-issue.html (site visited May 31, 2012) [7] For a discussion of these plans, see  http://cahealthadvocates.org/medigap/overview.html (site visited May 31, 2012)
Source: medicareadvocacy.org

Practical Insights: Dealing with Medicare Part B and COBRA Coverage

Generally, the Socal Security Act provides that individuals may enroll in Medicare Part B (which covers doctors visits and other outpatient services) when they reach age 65. If they fail to do so during a seven-month initial enrollment period surrounding their 65th birthday, they can enroll during an annual “general enrollment” period that occurs each January 1- March 31, with coverage becoming effective the following July1, though they will incur a penalty in the form of permanently higher Part B premiums (10% increase for each year of available coverage that is foregone). However, actively employed individuals who have employer-provided health coverage can postpone signing up for Medicare Part B until after age 65. When they lose the employer-provided coverage or terminate employment, whichever happens first, they are then provided an eight-month “special enrollment period” (“SEP”) during which they can sign up for Medicare effective immediately and without penalty.
Source: fordharrison.com

Brad Hunter, CPA: Medicare Part B

This is the part you pay for each month which is withheld from your social security payment. If your income is less than $85,000 and you file a single return, or if your income is less than $170,000 and you file a joint return, then the monthly premium is $99.90. If you make over those amounts, then your monthly premium increases from $139.90 to a maximum of $319.70 for 2012. It is like a little mini tax return.
Source: bradhuntercpa.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

Information On Medicare Part C And What All It Insures

Second, make a note of the rules the plan specifies such as the time when you can join or opt out of the plan, the rights you have under the plan and the services covered by the plan. Pay special attention to the conditions regarding visiting a specialist doctor and receiving authorization for particular procedures or you may find out too late that you have to bear these expenses on your own.
Source: internet-millionaire-articles.com

ABOUT MEDICARE: Medicare covers kidney disease

ESRD is treated by dialysis, a process which cleans your blood when your kidneys don’t work. It gets rid of harmful waste, extra salt and fluids that build up in your body. It also helps control blood pressure and helps your body keep the right amount of fluids.
Source: times-standard.com

Medicare Part D Spending Trends: Understanding Key Drivers and the Role of Competition

This brief commissioned by the Foundation examines factors that contributed to Medicare’s lower-than-expected spending on prescription drugs under the Medicare Part D drug benefit that started in 2006. Since its launch, Medicare has spent about 30 percent less on Part D benefits than the Congressional Budget Office originally projected. Some cite the program’s design, with private plans competing for enrollment, as the driving factor in lower spending; others point to factors in the overall market for prescription drugs as more influential. Author Jack Hoadley of Georgetown University examines the evidence on both sides of this debate. In addition to a discussion of the role of plan competition, the report cites a number of other factors that contributed to lower spending, including the growth in generic alternatives for popular-but-expensive brand-name drugs and a reduction in new brand-name drugs entering the market – trends that dampened prescription drug spending outside of Medicare as well.
Source: kff.org

AARP Public Policy Institute Reviews Gap in Medicare Part D Coverage

A new report from the AARP Public Policy Institute looks at the potential effects of a provision in the health care law that provides drug subsidies and discounts to Medicare beneficiaries, ultimately eliminating the coverage gap known as the “doughnut hole.” According to the report, “As part of the new health care law, enrollees who reach the doughnut hole in 2011 will receive a 50 percent discount on brand-name and biologic drugs and a 7 percent discount on generic drugs while in the doughnut hole. These discounts will gradually increase until the doughnut hole is eliminated in 2020.” The report includes a table showing “the number and percentage of Part D enrollees by state who are helped by the closing of the doughnut hole.”
Source: kff.org

CMS extends directory of health professionals has launched the first phase of the physician to compare site

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! .....item 1..Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552In addition to information on the practice of the physician, physician Compare also shows consumers whether the practice of some data reported to CMS through the system reports on the quality of doctors, formerly known as the Physician Quality Reporting Initiative . Currently, the system of reporting PQRI is a voluntary reporting program that rewards physicians and other health professionals suitable for the transmission of data on measures for the quality of services provided to Medicare beneficiaries. In 2009, more than 200,000 professionals reported data to CMS through the system reports on the quality of doctors.
Source: mezorex.com

Video: Weekly Address: Medicare Officially Safer After Health Reform

Daily Kos: Mitt Romney: Let’s make it easier to commit Medicare fraud than to register to vote

who will point this out? We do it all the time here, because we are among tens-hundreds?-of thousands of careful, literate readers who want to know the truth. The mainstream media? Not so much. Politicians will not call each other out, apparently, given their use of the terms “misspoke” and “misrepresented” instead of “lied” when discussing even their opponents. The sheer number of them from Republicans makes it nearly impossible for us make any of them “stick” in the voters minds–and of course, most get hit with the “both sides do it anyway” stance by everyone–so there is little to no downside to lying when slandering one’s opponent, other than to one’s conscience. And this is where most Dems (well, most liberals, at any rate) get hurt; we have consciences, so we feel bad if we lie, we try to avoid it, and we apologize or atone for misdeeds when caught, at the very latest. Paradoxically, that makes us weaker in the eyes of the voting public, instead of more reliable and honest.
Source: dailykos.com

Further Action Needed to Address Vulnerabilities in Medicaid and Medicare Programs

CMS 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

Today’s news update

the solicitor then goes on to steal money from the beneficiary’s bank account. The caller initially explains that the beneficiary will be receiving updated Medicare cards within the “next three to five days”, but first, the beneficiary must verify over the phone, personal information, such as name, address and other information. As a lure to get the banking account number, the caller then reads the root number of the person’s bank (the first series of numbers on a check), then asks the beneficiary to complete the sequence by providing the numbers of their actual banking account. The caller’s tone is particularly authoritative, and if the beneficiary does not readily comply, an alleged “supervisor” is put on the line to exert additional pressure.
Source: kymnradio.net

H.R.5994: To provide a demonstration project under which Medicare and Medicaid beneficiaries are provided the… OpenCongress

Hmmmm, no news coverage found for this bill at this time. This means that this this bill has not yet been mentioned on a publicly-searchable news website by either its official number (for example, “H.R. 3200″) or title (for example, “America’s Affordable Health Choices Act of 2009″). As soon as that changes, our daily automated search across the Web will catch it and include it here. If this bill is of interest to you, you can write a letter to the editor referring to this bill by name, and if your letter is published on the Web, a link back your letter will appear here within about one day. Or, if you know of a news article about this bill to display here, email us the web address of this page and the web address of your suggested news article: Our editorial team will post relevant links as quickly as possible. Thanks for helping to build public knowledge about Congress.
Source: opencongress.org

Defense, HHS Secretaries Address Conference on Suicide Prevention

With suicides on the rise among veterans, the Defense and Veterans Affairs Departments are stepping up their efforts to address the problem.  Top enlisted military leaders took part and discussed some of the improvements that have been made to the detection and treatment of mental health problems in veterans. In the first session, attendants heard from the son of a football player who committed suicide after suffering from brain trauma, and the head of Mental Health America.  The second session, the head of the Substance Abuse and Mental Health Services Administration and HHS Secretary Kathleen Sebelius addressed the crowd. Defense Secretary Leon Panetta spoke in the third session on veterans suicide prevention.  The Defense Department confirmed recently that suicides among veterans are on the rise.
Source: c-span.org

Update All of Your Addresses with Medicare Immediately!

This entry was posted in Medicare and tagged administrative law judge(ALJ), Centers for Medicare & Medicaid Services (CMS), clinic, corrective action plan (CAP), durable medical equipment (DME) suppliers, fraud prevention, home health agencies, investigators, Medicaid Fraud Control Unit (MFCU), medical groups, medical practices, medicare, Medicare Administrative Contractors (MAC), Medicare administrative hearing, Medicare audits, Medicare number revocation, Medicare Provider Enrollment Chain and Ownership System (PECOS), Medicare site visits, Medicare termination, National Plan & Provider Enumeration System (NPPES), NPI Registry, nursing homes and other healthcare providers, OIG special agents, pharmacies, physicians, request for reconsideration, termination of Medicare billing privileges, Zone Program Integrity Contractors (ZPIC), zpic audit, ZPIC site visit. Bookmark the permalink.
Source: wordpress.com

Protect Yourself from Medicare Fraud

Guard personal information: To commit Medicare fraud, a person must have access to Medicare and Social Security numbers. Seniors shouldn’t share this information with anyone who is offering free goods or services in exchange for a Medicare number. If your Medicare card is lost or stolen, immediately contact Social Security at 1-800-772-1213.
Source: sequoiaseniorsolutionsblog.com

ICSI and Nine Health Care Partners Receive 3

Posted by:  :  Category: Medicare

Advancing Integrated Mental Health Solutions Center, as an integral part of the Department of Psychiatry & Behavioral Sciences at the University of Washington, is a leading center of research, training and innovation in integrated mental health programs. The department has nearly 200 full-time faculty engaged in a wide variety of clinical and research programs, plus training programs for health professionals in urban and rural sites in a five state region in the Pacific Northwest. A primary area of research interest is the development of programs in which mental health professionals collaborate effectively with primary care physicians and other health care providers to care for children, adults, and older adults with common mental disorders.
Source: ahier.net

Video: How it Works – Tufts Medicare Preferred

Tufts Medicare Preferred 2012 Step Therapy Criteria

Clinical Trial Process Diabetes Diet Medical Dictionary Aplastic Anemia Bone Cancer Azt AIDS in Africa Sickle Cell Anemia AIDS Lung Cancer Nevirapine Normal Cd4 T Cell Count Tay sachs Disease Helper T Cells Pregnancy Week by Week Hepatitis B Vaccine Famous People with AIDS Chlamydia Squamous Cell Carcinoma Herpes Breast Cancer Clinical Trials for Pay Phases Clinical Trials Society for Clinical Trials Graves Disease HIV Types of T Cells AIDS Statistics History of AIDS HPV
Source: starhi.com

Somerville Harvard Vanguard Medical Associates Promotes Bike Safety For Children

About Harvard Vanguard Medical Associates Harvard Vanguard Medical Associates is a nonprofit multi-specialty medical group providing care to 495,000 adult and pediatric patients at more than 21 offices across eastern Massachusetts. As an affiliate of Harvard Medical School, Harvard Vanguard physicians are on the staff of Boston’s academic medical centers and community hospitals. Harvard Vanguard’s 4,100 employees, including more than 630 physicians and 1,000 healthcare professionals, are committed to making it easier for patients to be and stay healthy. Harvard Vanguard practices are among the highest rated in the state for clinical quality and accept insurance from most major health plans, including Aetna, Blue Cross Blue Shield of MA, Fallon Community Health Plan, Harvard Pilgrim Health Care, Neighborhood Health Plan, Tufts Health Plan, and Tufts Health Plan Medicare Preferred. Harvard Vanguard is an affiliate of Atrius Health (http://www.atriushealth.org), an alliance of six non-profit community-based medical groups in Massachusetts.
Source: patch.com

Harvard Vanguard Medical Associates Earns Highest NCQA Recognition For Patient

http://www.harvardvanguard.org Harvard Vanguard Medical Associates is a nonprofit multi-specialty medical group providing care to 495,000 adult and pediatric patients at more than 21 offices across eastern Massachusetts. As an affiliate of Harvard Medical School, Harvard Vanguard physicians are on the staff of Boston’s academic medical centers and community hospitals. Harvard Vanguard’s 4,100 employees, including more than 600 physicians and 1,000 healthcare professionals, are committed to making it easier for patients to be and stay healthy. Harvard Vanguard practices are among the highest rated in the state for clinical quality and accept insurance from most major health plans, including Aetna, Blue Cross Blue Shield of MA, Fallon Community Health Plan, Harvard Pilgrim Health Care, Neighborhood Health Plan, Tufts Health Plan, and Tufts Health Plan Medicare Preferred. Harvard Vanguard is an affiliate of Atrius Health (http://www.atriushealth.org), an alliance of six non-profit community-based medical groups in Massachusetts.
Source: patch.com

Medicare Requirements – What You Need

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSAs long as you meet the requirements for Medicare plan A, you are eligible to receive Medicare plan B. However, if you are 65 or older, you don’t need to receive social security benefits or have government work credits to receive this part of Medicare benefits. Citizens who have Medicare parts A and B can sign up for Medicare part C, the Medicare Advantage plan. There might however, be extra premiums required for some plans. The requirements for part Dof Medicare is the same as for parts B and C. Anyone who has enrolled in Medicare parts A and B or have Medicare part C is eligible for Medicare part D. the only stipulation is that because part D is optional, you have to sign up for it when you first become eligible or face a penalty.
Source: medicarerequirements.org

Video: Gastric bypass surgery:Medicare requirement in Texas ,and things you need to know….wmv

The Complication of Kaiser Permanente Medicare Eligibility

With State Farm homeowners insurance, you can rest assured that your beloved house and valuable items are well protected. If disaster strikes, the company will give funds for you to repair or rebuild the house. Besides, State Farm can recommend a list of participating contractors for the repair/rebuilding and guarantee their work for 5 years. Other additional costs incurred during the process are also covered. Read more
Source: insurance-how-to.com

PA: Medicaid expansion would cost $2B through 2019

Dr. Dennis Gingrich, board chairman of the Pennsylvania Academy of Family Physicians, a primary care and health policy nonprofit, said if ACA is shot down in its entirety, the country will be “back to square one” for health-care reform, which means around 32 million Americans will continue to go without health care who otherwise would have a plan. It’s also unclear what would happen to ACA-recommended changes that have been rolled out by states and insurance companies.
Source: watchdog.org

Research Roundup: Helping The Homeless Transition Out Of The Hospital

Urban Institute/Robert Wood Johnson Foundation: Churning Under The ACA And State Policy Options For Mitigation Concerns have been raised that when the health law’s expansion of insurance coverage takes effect in 2014, people will frequently involuntarily transition between eligibility for Medicaid, private insurance subsidies, and other coverage options — what is referred to as “churning.” In this brief, analysts estimate that 29.4 million people under age 65 will see a change in eligibility status from one year to the next. To combat churning, the authors recommend several state-based options, including the integration of Medicaid with plans available on insurance exchanges, as well as the use of premium supports to supplement the Medicaid programs. States can reduce churning by several million people through these strategies, but the authors also conclude “churning will be a fact of life under the ACA” (Buettgens, Nichols and Dorn, 6/14). The following series of briefs by the Kaiser Family Foundation looks at oral health care coverage and access among three critical populations.
Source: kaiserhealthnews.org

Changes Ahead for "Dual Eligibles"

Posted by:  :  Category: Medicare

Improving care for patients with “dual eligibility” has become a priority for federal and state policy makers. In 2008 these folks made up 20% of the Medicare population but accounted for 31% of Medicare spending. Likewise, they comprised 15% of Medicaid beneficiaries, yet accounted for 39% of Medicaid costs. People in this group are among the sickest, frailest, and poorest Americans.  They often have multiple chronic conditions and a high demand for both mental health and long-term care services.
Source: hickman-lowder.com

Video: Mitt Romney Embraces Privatizing Medicare and Social Security and Raising Eligibility Ages

Research Roundup: Raising Medicare’s Eligibility Age

Journal Of The American College Of Radiology: Imaging And Insurance: Do The Uninsured Get Less Imaging In Emergency Departments? – Using data from the 2004 National Hospital Ambulatory Medical Care Survey, researchers compared treatment among patients who were uninsured, those covered by Medicaid and those with other types of insurance and found that the uninsured patients received 8 percent fewer imaging tests than patients with non-Medicaid insurance and that Medicaid enrollees received 10 percent fewer than those with other insurance. They conclude: “Further research is needed to understand whether insured patients receive unnecessary imaging or if uninsured and Medicaid patients receive too little imaging” (Moser and Applegate, January 2012). Archives Of Pediatrics And Adolescent Medicine: The Interplay Of Outpatient Services And Psychiatric Hospitalization Among Medicaid-Enrolled Children With Autism Spectrum Disorders — For children with Austism Spectrum Disorders (ASD), barriers to care — such as lack of qualified practitioners and poor insurance coverage — increase the chances that they will be hospitalized for psychiatric reasons. The researchers looked at a large national sample of Medicaid-covered children with ASD to see if “increasing outpatient services results in reduced use of costly and restrictive service.” The researchers found that each $1,000 increase in spending on outpatient services like respite care over 60 days “resulted in an 8% decrease in the odds of hospitalization” (Mandell et. al., 1/2) New England Journal Of Medicine:  Fitness Memberships And Favorable Selection In Medicare Advantage Plans — Researchers used national figures from the Centers for Medicare and Medicaid Services to see what kind of changes occurred when 11 Medicare Advantage plans incorporated a gym membership as a part of their covered benefits: “Persons enrolling in plans after the addition of a fitness-membership benefit reported significantly better general health, fewer limitations in moderate activities, less difficulty walking.” The authors noted that creating an insurance risk pool for Medicare Advantage plans, as well as  for small business and individual plans, violates the 2010 health law. However, a benefits package that caters to a healthier subset of seniors may have the same effect as creating a risk pool (Cooper and Trivedi, 1/11).
Source: kaiserhealthnews.org

Daily Kos: Old Waitress says, “Don’t Raise Medicare Eligibility Age!”

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Source: dailykos.com

Daily Kos: Why is Raising Medicare Eligibility to Age 67 a Bad Idea? Here’s Why.

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Source: dailykos.com

Brad DeLong: Raising the Medicare Eligibility Age Is a Really Bad Idea Blogging: Is This a Problem with the Media or with the Congressional Budget Office?

Director’s Blog: Raising the Ages of Eligibility for Medicare and Social Security: If the eligibility age was raised above 65, fewer people would be eligible for Medicare, and outlays for the program would decline relative to those projected under current law. CBO expects that most people affected by the change would obtain health insurance from other sources, primarily employers or other government programs, although some would have no health insurance. Federal spending on those other programs would increase, partially offsetting the Medicare savings. Many of the people who would otherwise have enrolled in Medicare would face higher premiums for health insurance, higher out-of-pocket costs for health care, or both.
Source: typepad.com

Romney Proposes Raising Medicare Eligibility Age in 2022

A cogent example is the value of colonoscopies. The NE Journal of Medicine study shows that the procedure reduces the incidence of colorectal cancer and saves lives, cutting the death rate in half.   The procedure can cost thousands of dollars. The GAO found that only a quarter of all Medicare beneficiaries ages 65 to 75 had been so screened, and about 59 percent of men and women between the ages of 50 and 74  were tested.  While not the most pleasant procedure, it is important for all over 50.  Implementation would not be without new cost, certainly in the shorter term.
Source: talkleft.com

Romney Offers Proposal To Gradually Increase Medicare Eligibility Age

Romney said that his proposal would begin in 2022. Under the proposals, the Medicare eligibility age would increase by one month annually. “In the long run, the eligibility ages for [Medicare and Social Security] will be indexed to longevity so they increase only as fast as life expectancy,” Romney said (Espo, AP/Contra Costa Times, 2/24).
Source: californiahealthline.org

Gerber Medicare Supplement Insurance

Posted by:  :  Category: Medicare

Social Media Marketing plan: If you’ve heard it once, you’ve heard it ten times: Your business, no matter how small, needs to take advantage of social media marketing plan. You need to use the platforms that are available, and meet your customers and potential clients on their own turf. Here are ten steps you can take to get your small business noticed. Here are related links/video for social media marketing plan 1. http://www.youtube.com/watch?v=y7p4KOBGi0U 2. http://www.youtube.com/watch?v=k2daaSuJxAE 3. http://www.youtube.com/watch?v=gCYhKOqT7DU http://tabithanaylor.com/
Source: scoop.it

Video: Gerber Life Medicare Supplement

Gerber Life Medicare Supplement

I hope you obtain new knowledge about Medicare Supplement. Where you may put to easy use in your life. And most of all. View Related articles related to Medicare Supplement. I Roll below. I even have suggested my friends to help share the Facebook Twitter Like Tweet. Can you share Gerber Life Medicare Supplement.
Source: blogspot.com

What to Expect on a Gerber Medicare Supplement Plan

However, Medicare has its own gaps, resulting to a need for Medicare supplement plans. These supplement plans can be obtained by individuals who are currently members of the Medicare plan by the government. To be able to deal with several supplement plans, the Center for Medicare and the Medicare Services make sure that these plans are standardized for each Medicare holder. It is also helpful that Medicare supplement plans are available for view online, individuals can take a look and review which of these plans suit their needs the most.
Source: ezinemark.com

Gerber life medicare supplement

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Source: fluxfeatures.com

Gerber Medicare Supplement Reviews

(Plans from Mutual of Omaha, Humana, Gerber, AARP, Anthem Blue Cross and Sentinel) step 2 of 2 Compare Plans in ZIP Code Fields marked in red are required. Please make sure phone number is 10 digits. First Name:Last Name:Email:Phone:Coverage For: Me I am helping someone else. Zip Code:Age: 65 or older Will be 65 within 3 months Younger than the above Medicare A&B: Enrolled Not Enrolled Medicare Health plan Currently need a plan or hoping to enroll within the next 90 days I don t need a plan YES – By submitting this information, I authorize BestofMedicare. com, its partner companies or affiliates to contact me by phone or email about my Medicare needs only. No purchase is necessary to see if you qualify for plan coverage under Medicare. YES – By summiting this information, you are stating that you have read and agree to our Privacy Policy and Site Terms of Use. ? Official Government Information Sites Medicare. gov The official U. S Government site for MedicareCMS. gov Centers for Medicare & Medicaid services Stopmedicarefraud. gov CMS Program Integrity Objective – Stop Medicare Fraud & AbuseDisclaimer This website is a private website and is not associated, endorsed or authorized by the Social Security Administration, the Centers for Medicare and Medicaid Services, or the Department of Health and Human Services nor do we claim to be. Medicare has neither reviewed nor endorsed this information. This site contains basic information about Medicare, services related to Medicare and services for people with Medicare and is not connected with any Government. If you would like to find more information about the US Government Medicare program please visit the Official US Government Site for People with Medicare located at medicare. gov. ? Home
Source: posterous.com

Medicare Supplement Companies in San Jose

Your Medicare Supplement resource. Looking for a new plan, want to compare rates, you’ve come to the right place. Please use this website to search and review information. Compare rates, apply, find a doctor or hospital, you can do it all right here. Or better yet simply contact me anytime, I’ll be happy to answer all of your questions. Thanks … John
Source: wordpress.com

Gerber Medicare Supplement Rate Increase for NH

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Source: srbenefit.com

Kan. firm to pay $6.1 million Medicare settlement

Posted by:  :  Category: Medicare

Kinky For Governor by Big Grey MareWICHITA, Kan. (AP) – The U.S. Justice Department says a Kansas hospice care provider and its Texas-based parent company have agreed to pay $6.1 million to settle allegations they submitted false claims to the Medicare program.
Source: kltv.com

Video: Grandma and the Big Bad SGR!

Texas firm to pay millions in Medicare fraud case

“Orthofix is very pleased that it has reached formal agreements to resolve all issues associated with the government’s investigation of sales of its bone growth stimulator devices. The company has been in a lengthy period of full cooperation with the federal government and now can move forward in pursuit of its mission to serve patients,” Brien T. O’Connor, a Boston attorney for Orthofix said Thursday in a statement.
Source: columbiamissourian.com

Texas Drifter: How To Report Social Security Apartheid

… Eliminate American apartheid by public bureaucrats issuing SSI disability benefits based on race, ethnic background, and or political affiliation. The process is managed to delay application process for entitled benefits until person legally entitled to benefits dies. Example Black liberal unemployed Obama supporter receives benefits for mental stress issues; while Anglo American documented by physical tests to have congenital heart defect (CHD) issues are denied, re-denied, and delayed SSI benefits by government bureaucrats until patent hopefully dies. Since bureaucrats engaging in these practices seem to be soulless creatures serving their prejudices and hatreds, remember their denials are self serving lies. Since public subsidies are limited resources they should be distributed on documented physical needs; not race, ethnic heritage, gender choice, political affiliation. It seems ironic that those most opposed to South African apartheid are now defending its use in America. (End of excerpt)
Source: allrightmagazine.com

USDOJ: Hospice Care of Kansas and Texas

Hospice Care of Kansas LLC and its parent company, Ft. Worth, Texas-based Voyager HospiceCare Inc ., have agreed to pay $6.1 million to resolve allegations that they violated the False Claims Act by submitting claims to the Medicare program for ineligible hospice services, the Justice Department announced today.   Hospice Care of Kansas currently provides hospice services throughout the state of Kansas.   Hospice Care of Kansas, which is based in Wichita, Kan ., was purchased by Voyager in 2004. The Medicare hospice benefit is available for patients who elect palliative treatment ( medical care focused on providing patients with relief from the symptoms, pain and stress of a serious illness) for a terminal illness, and have a life expectancy of six months or less if their disease runs its normal course.   Today’s settlement resolves allegations that Hospice Care of Kansas and Voyager submitted or caused the submission of false Medicare claims between January 2004 and December 2008 for beneficiaries that did not have a terminal prognosis of six months or less.   The government alleged that Hospice Care of Kansas and Voyager engaged in certain practices that resulted in the submission of false claims, including the provision of compensation to clinical employees based on patient census and admissions, delaying discharges of patients determined not to have a six month or less prognosis, instructions to staff to document patient conditions in a misleading manner, and implementation of an inadequate compliance program. “The Medicare hospice benefit is intended to provide comfort and care to terminally ill persons in the final stages of their disease,” said Stuart F. Delery, Acting Assistant Attorney General for the Department of Justice’s Civil Division.   “This settlement shows that the Department of Justice will not tolerate hospice providers that attempt to maximize their profits at the expense of their legal and ethical obligations to the Medicare program, taxpayers, and beneficiaries.”   “Our goals are to protect taxpayer dollars, ensure the viability of government health care programs and strengthen our national health care system,” said Barry Grissom, United States Attorney for the District of Kansas. “This case is a step in that direction.” “We expect providers of Medicare services to operate with the utmost integrity and with the best interests of our beneficiaries in mind.   Working with our partners at the Department of Justice, we will hold those accountable who do not operate in this manner,” said Gerald Roy, Special Agent in Charge, United States Department of Health and Human Services, Office of Inspector General. The allegations that are the subject of today’s settlement were originally raised in a lawsuit filed by a former Hospice Care of Kansas nurse, Beverly Landis, under the qui tam, or whistleblower, provisions of the False Claims Act.   The act allows private citizens with knowledge of fraud to bring an action on behalf of the United States and share in any recovery.   As a part of today’s resolution, Ms Landis will receive payments totaling $1.342 million.   This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $7.7 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $11.3 billion. The investigation was jointly handled by the Justice Department’s Civil Division, the FBI, the Office of the Inspector General of the Department of Health and Human Services and the United States Attorney’s Office for the District of Kansas.   The claims settled by this agreement are allegations only, and there has been no determination of liability. Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

Texas Hospital Group Pays $5 Million to Settle Medicare Fraud Case

Christus Spohn Health System Corporation in Texas has paid the United States more than $5 million to settle allegations regarding violations of the False Claims Act, federal authorities in Houston announced. The allegations against the hospital group involved upcoding Medicare claims to charge inpatient rates for outpatient services. A whistleblower in the case will receive more than $1 million of the settlement. Read More.
Source: whistleblowerprotection.com

Study Shows Tort Reform Doesn’t Work

Besides resulting in inadequate compensation for deserving victims, tort reform actually prevents most of these victims from receiving any recovery whatsoever.  Why?  Because most attorneys cannot afford to take on a case where the most they can recover is an attorneys’ fee of 40% of $250,000 ($100,000), especially when the out-of-pocket costs of trying such a case can easily exceed $100,000.  What rationale lawyer would risk $100,000 of their own money for the chance of a $100,000 fee?  What client would want to endure the emotional trauma of a trial for the possibility of recovering paltry $50,000 for the death of their loved one after paying attorneys’ fees and expenses?  What tort reform has done has kept thousands of deserving victims of medical negligence out of court, thereby lowering the costs of litigation to doctors and insurance companies.  And what have these doctors and insurance companies done with their windfall?  Lined their pockets.
Source: hop-law.com

Texas Firm To Pay Millions In Medicare Fraud Case

McKINNEY (AP) – The Justice Department says a Dallas-area medical manufacturer has agreed to pay $42 million in penalties to settle civil and criminal cases related to fraudulent claims it made to Medicare and other federal health care programs through the sale of its bone growth stimulator devices.
Source: cbslocal.com

Texas Health Insurance Companies & Rates: Locate your Best Options

A search on the internet for “health insurance in Texas” will return so many results, you couldn’t possibly begin to read about each and every company. Do yourself the favor of making the job easier and more successful by staying with the names you know and recognize for health insurance. With the major carriers, you are guaranteed to receive quality benefits and in many cases, the rates between the big names are relatively competitive. There’s a reason why Blue Cross Blue Shield is the most trusted name in health insurance. They are a household name because they have been providing quality coverage to Texans for generations and will continue to do so. Save yourself time and aggravation by dealing with insurance professionals.
Source: texasmedicarehealth.com

Camden Shoe Store Charged With Medicaid Fraud

Posted by:  :  Category: Medicare

ADAPT Medicaid Rally by SEIU International“I do not wear orthopedic shoes. I can’t go into this store say ‘I want to buy a pair of shoes’ because it’s not a shoe store. They don’t have shoes,” says Paul Melletz, an attorney for the store.
Source: cbslocal.com

Video: What is medicaid?

States need better Medicare data to fight Medicaid fraud

Billing for dual-eligible beneficiaries is vulnerable particularly to fraud and abuse, largely because their care is funded separately. For example, ambulance companies charge Medicaid to transport elders and adults with disabilities to the emergency room, and then Medicare foots their hospital bills. As a result, ambulance company owners and operators can bill Medicare for millions of dollars for ambulance rides that are medically unnecessary or never occur.
Source: fiercehealthcare.com

Using Medicare Data To Curb Medicaid Fraud

Stateline:  States Seek Medicare Data To Keep Fraudulent Providers Out Of Medicaid The federal government says it has ambitious projects underway to make Medicare data more useful to states, and to help states share information about their respective Medicaid programs. The problem, federal officials say, is that Medicare, which provides health coverage for seniors, is organized very differently from Medicaid. And each state organizes its Medicaid program in a different way, making data matches difficult (Vestal, 6/21).
Source: kaiserhealthnews.org

The Case for Medicaid Audits to Prevent Fraud

I got involved in this issue in February, after whistleblowers contacted my office to report details in the Minnesota Medicaid program that just didn’t add up. I was appalled to learn what could be going on in my home state. So I joined with State Senators Sean Nienow (District 17) and Michelle Benson (District 49) for a press conference on these allegations, and I have been involved publically in the issue ever since.
Source: redstate.com

Iowa Republicans Try to Block Medicaid

Perhaps the most ridiculous aspect of this story is that Iowa Republicans are willing to risk losing money for a glancingly small number of abortions. According to the Register “there have been 22 Medicaid-paid abortions in Iowa so far in the fiscal year that ends this month. Fifteen of the 22 were for severe fetal anomalies, five were to save the life of the mother and two involved instances of rape. There have been no reported Medicaid-paid abortions in cases of incest so far this fiscal year.”
Source: nytimes.com

State Computer Backlog Wrongly Bounces Recipients Off Medicaid

Sheldon Toubman, staff attorney with New Haven Legal Assistance, said the Erhardts are among thousands of Connecticut residents who have been bounced off the Medicaid system by the state Department of Social Services’ automated computer system. The reason this happens, Toubman said, is that the department doesn’t have enough staff to keep up with the paperwork, so the computer system interprets their status as having been terminated.
Source: courant.com

WildAlchemist: Medicaid on brink of financial collapse in Illinois and other states

The taxpayer-funded government healthcare disaster known as Medicaid is on the brink of collapse in Illinois and a number of other states, according to reports, and legislators are working feverishly to come up with solutions to keep the welfare program afloat. A recent Reuters report explains that Illinois Governor Pat Quinn, for instance, has signed into law a string of new bills that will supposedly trim roughly $2.7 billion from his state’s Medicaid’s expenditures in order to keep the program going. Representing a whopping 39 percent of the entire state’s general budget, Medicaid in Illinois is currently an enormous drain on the system, especially because hospitals and healthcare providers often, greatly over-bill for services and drugs dispensed under the program. This is one of the issues Gov. Quinn hopes to address with his new legislation, as well as issues of eligibility. Gov. Quinn is also cutting various Medicaid programs, which some say will eliminate health insurance coverage for thousands of Illinoisans. Earlier in the year, the state of Missouri made cuts to its Medicaid program, as did the states of North Carolina and Wisconsin. Texas is currently in the process of making cuts to its Medicaid program as well, and Alabama has established major cuts to its Medicaid program in the 2013 budget. All across the country, in other words, states are cutting benefits, altering eligibility, and restructuring guidelines for the purpose of retaining cash. At the same time, however, many states are once again raising taxes for the stated purpose of eliminating ongoing budget deficits. But many states, including Illinois, continue to tolerate tax loopholes, off-shore tax havens, wasteful spending, and other serious problems that need to be addressed as part of independent audits. Illinois State Rep. Chapin Rose (R-Charleston) put together a step-by-step plan back in 2010 that includes eliminating “fraud and waste in welfare,” which is precisely what Gov. Quinn appears to now be doing. (http://illinoisreview.typepad.com) The bigger problem, though, is the centralized financial debacle that has trickled-down from the federal government to the states. A significant bulk of public funds, both nationally and locally, is spent on wasteful welfare programs like Medicaid that continue to expand their ranks, year after year, with no end in sight. And yet, with these programs on the verge of collapse, the federal government is in the midst of trying to implement Obamacare, which will make Medicaid expenditures look like mere pocket change. Source – www.naturalnews.com
Source: blogspot.com

Who Benefits from the ACA Medicaid Expansion?

The ACA expands Medicaid to a national floor of 138% of poverty ($15,415 for an individual; $26,344 for a family of three). The threshold is 133% FPL, but 5% of an individual’s income is disregarded, effectively raising the limit to 138% FPL. The expansion of coverage will make many low-income adults newly eligible for Medicaid and reduce the current variation in eligibility levels across states. To preserve the current base of coverage, states must also maintain minimum eligibility levels in place as of March 2010, when the law was signed. This requirement remains in effect until 2014 for adults and 2019 for children. Under the ACA, states also have the option to expand coverage early to low-income adults prior to 2014. To date, eight states (CA, CT, CO, DC, MN, MO, NJ and WA) have taken up this option to extend Medicaid to adults. Nearly all of these states previously provided solely state- or county-funded coverage to some low-income adults. By moving these adults to Medicaid and obtaining federal financing, these states were able to maintain and, in some cases, expand coverage. Together these early expansions covered over half a million adults as of April 2012.
Source: kff.org

Medical Ethics and Me: Oregon Studies the Value of Medicaid

We are a Boston-based group of 19 who provide feedback on medical ethics policies to the Harvard teaching hospitals. We are diverse as to socioeconomic status, religious affiliations, cultural and language groups, and educational backgrounds. The need for such a consultative group has been evident for a long time since individuals currently serving as community members on hospital ethics committees are not broadly representative of multiple communities.
Source: medicalethicsandme.org