Life Care Centers of America denies massive Medicare fraud charges; judge criticizes feds in secret whistleblower case

Posted by:  :  Category: Medicare

Medicare reimbursed $4.2 billion to Life Care Centers between 2006 and 2011, the newspaper reported. While skilled nursing facilities averaged 35% of treatments for rehab patients at the ultra-high level nationwide in 2008, Life Care Centers had 68% of therapies at the ultra-high level, court records say. Rehab therapy claims have come under increased scrutiny in recent years, with other nursing home chains also have faced accusations of upcoding. 
Source: mcknights.com

Video: Medicare Fraud Whistleblowers

Healthpoint Ltd. to Pay $48 Million for False Claims for Unapproved Drug

Healthpoint Ltd. and DFB Pharmaceuticals will pay up to $48 million to resolve allegations that Healthpoint caused false claims to be submitted to Medicare and Medicaid for an unapproved drug, Xenaderm, which was ineligible for reimbursement by those programs, federal authorities said. Read More.
Source: whistleblowerprotection.com

Florida Hospital group facing a whistle blower lawsuit over Medicare Fraud. (Adventist Health Systems)

The Defendant, Adventist Health Systems recently sought  to have the case dismissed by filing a Motion to Dismiss based on a the government failing to state a claim on which relief can be granted and not pleading the “right elements of fraud”, well they lost this motion and will not be able dodge justice, they will have convince a jury that they have done no wrong.  U.S. Federal District Judge  John Antoon II denied Adventist Health Systems Motion to Dismiss
Source: insurancejusticelawyer.com

Baylor University to pay $900K to settle Medicare fraud claims

As we have mentioned before, some of the country’s largest and most respected medical institutions still make mistakes under the Federal False Claims Act. While this should not be seen as evidence that these organizations have black hearts or are fatally flawed, we think it does indicate that the healthcare industry as a whole could do more to make sure it is complying with all applicable laws.
Source: bostonwhistleblowerlawyerblog.com

Whistleblower Lawsuit Alleging Medicare Fraud Against Blackstone Medical, Inc., Dismissed

administrative complaint Administrative Hearing attorney controlled substances criminal charges dea DEA investigation DEA raid defense attorney defense lawyer department of health Department of Health (DOH) doctor doh DOH investigation drug enforcement administration emergency suspension order false claims act florida fraud prevention health care fraud health law hipaa investigation legal representation licensing and regulatory medicaid medical license medicare medicare audit Medicare fraud Medicare investigation nurse overbilling overprescribing pain clinics pain management pharmacies pharmacist pharmacists pharmacy pharmacy investigation physician physicians prescription drug trafficking
Source: wordpress.com

Whistleblower Alleges Overbilling Of Medicare By Florida Hospice

Douglas Stone was an executive at the Hospice of the Comforter, based in Altamonte Springs, when he learned that the company was overbilling Medicare for patient stays. He filed a whistleblower lawsuit alleging Medicaid/Medicare fraud against the Florida nursing home a year ago; the U.S. Department of Justice recently intervened and will now be pursuing the Medicare fraud claims.
Source: federalwhistleblowerlawyers.com

Hospice Settles Whistleblower Case for $1.86 Million

The federal False Claims Act (FCA) provides incentives for employees to report employers that commit fraud by submitting false claims for federal funds. A recent case involved a company that provides hospice care, which agreed to pay more than $1.86 million to the government to settle a lawsuit brought by two former employees under the whistleblower provisions of the FCA.
Source: wecomply.com

Nursing Home Targeted By Whistleblower Suit For Worthless Care

This is another case brought under the federal False Claims Act. Basically, its point is this: the nursing home received payment of Medicare and Medicaid funds based on it providing an adequate and minimum standard of care.  The suit claims that it did not provide this minimum standard of care, but received payment for doing so and therefore defrauded the federal government of Medicare and Medicaid monies. The False Claims Act allows whistleblowers to retain 15-25% of the monies ultimately recovered.
Source: robertabelllaw.com

Ambulatory Surgery Centers: A Positive Trend in Health Care

Posted by:  :  Category: Medicare

Today physicians continue to provide the impetus for the development of new ASCs. By operating in ASCs instead of hospitals, physicians gain increased control over their surgical practices. In the ASC setting, physicians are able to schedule procedures more conveniently, assemble teams of specially trained and highly skilled staff, ensure that the equipment and supplies being used are best suited to their techniques, and design facilities tailored to their specialties and to the specific needs of their patients. Simply stated, physicians are striving for, and have found in ASCs, professional autonomy over their work environment and over the quality of care that has not been available to them in hospitals. These benefits explain why physicians who do not have ownership interest in an ASC (and therefore who do not benefit financially from performing procedures in an ASC) choose to work in ASCs in such high numbers.
Source: careplusmp.com

Video: Medicare con Florida Health Care Plus

Foot Care Plus: Medicare approved diabetic shoes and inserts

Did you know that Medicare will help pay most of the cost of diabetic shoes with or without inserts per calendar year?  The goal is to help prevent limb loss due to diabetes.  With diabetes, your body’s defense is not up to par like it used to be.  If you or somebody you know has diabetes, tell them about this program set up by Medicare.  As a foot specialist, Foot Care Plus, LLC can help.  Call us at (816) 434-5906.
Source: blogspot.com

workinflorida: CarePlus Medicare Enrollment Specialist

As a CarePlus Medicare Enrollment Specialist you will: be responsible for researching, documenting, evaluating and executing all requested member enrollment… From Humana – 21 Mar 2012 23:35:07 GMT – View all Tampa jobs Tampa, FL Jobs
Source: blogspot.com

CarePlus Medicare Enrollment Specialist

As a CarePlus Medicare Enrollment Specialist you will: be responsible for researching, documenting, evaluating and executing all requested member enrollment… From Humana – 21 Mar 2012 23:35:07 GMT – View all Tampa jobs Tampa, FL Jobs
Source: typepad.com

Are you ready for 2013? 4 questions to ask yourself

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Source: medicare.gov

Video: Medicare Advantage | Questions about Medicare Advantage Plans

Questions for Medicare in outbreak

In response, a department spokesman says Congress needs to provide the FDA with stronger powers. The meningitis outbreak has called attention to the role of compounding pharmacies in supplying medications routinely used by hospitals and doctors to treat patients. Regulated primarily by states, the pharmacies specialize in customizing doses for individual patients who have allergies to ingredients in an FDA-approved drug, or who might need a smaller dosage than what’s available commercially. But some pharmacies have pushed into full-scale manufacturing. Medicare has long been aware of the risks. “By compounding drugs on a large scale, a company may be operating as a drug manufacturer within the meaning of (federal law), without complying with requirements of that law,” Medicare’s coverage manual, a reference for contractors that handle payments, says in a section dealing with compounded drugs. That situation, adds the manual, fails Medicare’s basic standard, that treatments must be “reasonable and necessary” in order to be covered. “This means, in the case of drugs, the FDA must approve them for marketing,” says the manual. It goes on to say that billing contractors should wait for instructions from Medicare before cutting off payment in specific cases where the FDA has determined that a company is producing compounded drugs in violation of the law. “Medicare indicates in its own policy documents that it can cut off payments for compounded drugs produced under manufacturing-like conditions,” said Sen. Charles Grassley, R-Iowa, who over the years has pushed for stronger government oversight of the pharmaceutical industry. “Medicare should explain whether it uses this step, and if not, why not. Every avenue for explaining how this health crisis occurred and preventing others like it needs exploration,” he added. Joyce Lovelace of Albany, Ky., says she doesn’t understand how the outbreak could have happened. Eddie Lovelace, her husband of 55 years, died of a stroke after receiving injections of the steroid implicated in the outbreak as a treatment for pain from an auto accident. “I’m 100 percent behind not paying … whether it’s Medicare, Blue Cross, or whatever,” she said. “Somebody dropped the ball and as a result my husband is gone.” Eddie Lovelace, 78, a long-serving judge, was still working at the time of his death and Medicare was not his primary insurance. Medicare officials are looking into whether the program paid for drugs that have sickened patients. “If the FDA determines a company is producing compounded drugs in violation of (federal law), Medicare will not reimburse for drugs produced in that facility,” said HHS spokesman Tait Sye. “The FDA’s regulatory authority over compounding pharmacies is more limited by statute than it is for typical drug manufacturers. We urge Congress to strengthen the FDA’s authority.” FDA records show that in 2006 the agency issued a warning letter to the New England Compounding Center for producing anesthetic creams, but officials were unable to say if Medicare was alerted. In a separate case, Medicare seems to have taken sweeping action on its own without much prodding from the FDA. In 2007, Medicare stopped coverage for compounded inhalation drugs used to treat lung disease. “Compounded drugs are not considered interchangeable with FDA-approved products,” said an information bulletin at the time from Noridian, a major Medicare payment contractor. “The absence of testing for safety and effectiveness has the potential of putting a patient at increased risk of injury, illness or death.” Michael Carome, deputy director of Public Citizen’s health research group, says Medicare’s policy on compounded drugs seems “internally contradictory.” “They do appear to have a policy for which the default setting is that Medicare does not cover drugs that have not been approved by the FDA,” said Carome. “That essentially applies to many, if not all, drugs made by compounding pharmacies.” Medicare’s defenders say the agency may be reluctant to act for a number of reasons. Cutting off compounding pharmacies could aggravate drug shortages. Also it could open Medicare to a political counterattack from industry, even charges of rationing. But Carome, a kidney specialist who once served in an HHS regulatory office, says the alternative is that compounding will continue with little federal oversight and recurring outbreaks. If Medicare had expanded its compounding crackdown beyond just lung disease medications, “that might have prevented the widespread use of these drugs,” Carome said. “Without coverage, things don’t get used.”
Source: modernhealthcare.com

Questions for Medicare in meningitis outbreak

The health insurance program for seniors long ago flagged compounded drugs manufactured without Food and Drug Administration oversight as safety risks. The outbreak that has sickened more than 250 people nationally has been linked to an injectable steroid from a Massachusetts compounding pharmacy.
Source: thedailyrecord.com

Many Years Young: Questions For Medicare In Meningitis Outbreak

The giant health insurance program for seniors long ago flagged compounded drugs produced for the mass market without oversight from the Food and Drug Administration as safety risks. In 2007, Medicare revoked coverage of compounded inhaler drugs for lung disease. But Medicare doesn’t seem to have consistently used its own legal power to deny payment, and critics say that has enabled the compounding business to flourish 
Source: manyyearsyoung.com

When Can I Get Out of My Medicare Advantage Plan?

First and foremost, you should apply for the supplement plan with either a February 1 or March 1 effective date. Approval on a Medigap policy can take 2-3 weeks to complete underwriting. So it is important to do this well in advance of when you want the plan to start. For example, if you want to make the changeover effective 2/1/13, apply early in January for the supplement (or even during the last couple weeks of December). Once your Medigap plan is approved, you can proceed with returning to Medicare with a Part D plan. The easiest way to do this is to call Medicare (1-800-MEDICARE) and select a Part D plan, while at the same time disenrolling from your Medicare Advantage plan. You cannot have both a Part D plan and a Medicare Advantage plan, so this changeover can be done within the same phone call. Make the changeover effective either 2/1/13 (if doing it in January) or 3/1/13 (if doing it between 2/1 and 2/14).
Source: medicare-supplement.us

Common health insurance questions answered: What is medicare advantage?

Private companies, such as Blue Cross Blue Shield Michigan and Blue Care Network, contract with Medicare to offer these plans to individuals who purchase their own coverage and through employer and union groups. Medicare beneficiaries who buy their own coverage have many plan options to consider. Insurers often offer several different benefit plans with various benefit levels and monthly premiums. They include extras to make their plans more attractive to prospective members. Some enhancements to look for are:
Source: ahealthiermichigan.org

Losing your Group Medicare coverage? Is your Medicare plan being terminated? December 7 may not be your enrollment deadline.

Health Alliance Plan (HAP) is a Michigan-based, nonprofit health plan that serves more than 50,000 Medicare beneficiaries enrolled in HAP Senior Plus HMO, HAP Senior Plus HMO-POS, Alliance Medicare PPO, Medicare Supplement and Prescription Drug Plans. HAP partners with leading physicians and hospitals, employers and community organizations to improve the quality of health care and enhance the health and well-being of the lives we touch. HAP offers award-winning preventive services, disease management, wellness programs and customer service.
Source: healthcareinmichigan.com

Medicare open enrollment: How can I find a better plan?

What about doctor availability? On the Medicare site you can directly compare up to three plans, and when I selected your current plan and these other two plans, I saw that your current plan says it has 1001-1500 “physicians and providers,” compared to 4001-5000 for the other two plans. For each plan you can click on “View provider and physician network website,” which takes you away from Medicare.gov and onto the plan’s own website, where you can search its provider directory to judge for yourself whether it has enough doctors to meet your needs.
Source: consumerreports.org

How The ‘Fiscal Cliff’ Affects Health Care: Six Questions

A: It depends on how large a role Medicare plays in a broader deal.  Some of the proposals include raising Medicare’s eligibility age to 67, asking wealthier Medicare beneficiaries to pay more for their coverage and paying Medicare providers less. All are complicated and many Democrats have said that they do not want to make changes that harm beneficiaries or shift costs from the government onto seniors.  Republicans are insisting that entitlement savings play a large role in any deficit reduction deal.
Source: kaiserhealthnews.org

What’s New for Medicare Recipients for 2013

This article by a political dem hack is nothing but lies and deceipt. Which is how the dems won the electon Lies. Affordable act will make it worst it did not strenthen anything. Preventive care, little late at 65. We know hospitals being sanctioned for readmits, we know 30 % cut backs for providers now going forward. Yes 716 billion was taken out of medicare fro Obamacare. Did you listen to paul ryan u cannot count that money twice. I have billed for mediare for 30 years. The dems pretend they care they could care less. They only care about votes.
Source: patch.com

Can You Appeal a Denied Medicare Claim?

Posted by:  :  Category: Medicare

In 2010, 40 percent of Part A appeals and 53 percent of Part B appeals were granted, according to the Centers for Medicare & Medicaid Services, which administers Medicare (CMS). Even in the case of big ticket durable medical equipment appeals, 44 percent of appeals were successful. More than half of appeals to Medicare Advantage and prescription drug plans are successful, too.
Source: hunterestategroup.com

Video: You Can Help Fight Medicare Fraud

Medicare Billing Housekeeping during the Holidays

The holiday season is coming with food, fun and family time ahead. However, billing must continue and claims must be sent as part of supporting the overall health of home health organizations.  The general decrease in workload due to lighter patient loads and absences from the office provides a little extra time to catch up on “housekeeping.”  Now is a good time to review old claims that have not been sent and adjustments that have not been completed or any other claim problems that have not been resolved. Clearing these problems up as well as continuing with current billing are enough to keep one busy, and keep everything current. Keep in mind to review claims for timely filing deadlines and get those claims completed and sent. The timely filing deadline for all claims is one year from the end of episode date for each claim.
Source: axxessweb.com

Seniors Need To Be Tenacious In Appeals To Medicare

Medicare officials say appeals are rare, though they would not provide statistics on how many appeals came from beneficiaries rather than from health-care providers, such as hospitals, doctors and nursing homes.  The inspector general’s office in the Department of Health and Human Services reported last month, however, that 85 percent of appeals in 2010 that reached the third level of review, which are decided by an administrative law judge, were filed by health care providers.  And for those who persevere and do appeal a third a third time, the OIG found that the judges reversed 56 percent of all unfavorable decisions in 2010.
Source: kaiserhealthnews.org

Rep. Allen West “Another False Obama Medicare Claim: The $6,400 Myth”

That structure ensures that seniors would have at least two choices (and likely far more) that they are guaranteed to do better than they do now. The amount of the premium-support subsidy would also be tied to underlying health-care costs, so it would not shift costs to beneficiaries, as Democrats also falsely claim. The very reasonable Romney-Ryan policy bet is that costs could nonetheless fall over time because seniors would have the incentive to switch to the most competitively priced Medicare plan.
Source: allenwestrepublic.com

Medicare Cuts to Provider Payments or Actual Medicare Reform?

Comments are subject to approval and moderation. We remind everyone that The Heritage Foundation promotes a civil society where ideas and debate flourish. Please be respectful of each other and the subjects of any criticism. While we may not always agree on policy, we should all agree that being appropriately informed is everyone’s intention visiting this site. Profanity, lewdness, personal attacks, and other forms of incivility will not be tolerated. Please keep your thoughts brief and avoid ALL CAPS. While we respect your first amendment rights, we are obligated to our readers to maintain these standards. Thanks for joining the conversation.
Source: heritage.org

Senate and House Dems Oppose Medicare Eligibility Change

Posted by:  :  Category: Medicare

20090418jb_EFCAcanvassingPA_27 by SEIU InternationalCan you see a coal miner, with multiple work-related disabilities, forced to work past the age of retirement, just to keep his or her health care coverage. Unless his employer declares bankruptcy, just to avoid paying the health coverage costs of its older workers. As happened to my dad back in the 70s.
Source: keystonepolitics.com

Video: State Takeover of Harrisburg, Medicare/Medicaid Funding [Pennsylvania Newsmakers]

Health care union members accuse Pa. chamber of “Scrooging” the middle class

SEIU Healthcare Pennsylvania members and leaders rally outside the Pennsylvania Chamber of Business and Industry in Harrisburg to demand the chamber stop lobbying efforts supporting the extension of tax cuts to the wealthiest two percent of Americans and restructuring of programs such as Medicaid, Medicare and Social Security. Danell Fuller, a nursing home worker from Philadelphia, takes part in the rally. 12/13/2012 DAN GLEITER, The Patriot-News
Source: pennlive.com

MarketingHire.com: jobs, Horsham jobs, Pennsylvania jobs, Medicare Marketing Communications Specialist

Previous experience with ECM, Merrill, and/or SalesForce fulfillment tools UnitedHealthcare Medicare & Retirement is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. Imagine joining a group of professionals and clinicians who are working to improve health care for people over 50. Consider the influence you can have on the quality of care for millions of people. Now, enhance that success with enthusiasm you can really feel. That’s how it is at UnitedHealthcare Medicare & Retirement. Everyday, we’re collaborating to improve the health and well being of the fastest growing segment of our nation’s population. And we’re doing it with an intense amount of dedication. Here, you will discover a culture that grows through challenge. That evolves by being flexible. That succeeds by staying true to our mission to make health care work effectively and efficiently for seniors. Put your best to work for us, and discover extraordinary opportunities for growth. Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing. Job Family: Communications Business Segment: Medicare and Retirement Shift: Day Job Travel: Yes, 25 % of the Time Overtime Status: Exempt
Source: marketinghire.com

Ryan Takes to Pennsylvania to Push Medicare Message

Mr. Ryan was extrapolating from a 2010 report from Medicare’s Office of the Actuary. It analyzed the potential impact of lower premium supports paid to private companies that issue Medicare Advantage plans, popular alternatives to traditional Medicare with extra benefits such as gym memberships. To slow the growth of Medicare spending, the Affordable Care Act reduces support for the private plans, which Democrats consider inefficient. Beneficiaries would still be covered under traditional Medicare.
Source: nytimes.com

Medicare Takes Center Stage In Close Pennsylvania Races

The campaign jockeying over Medicare comes at a time when the program represents a huge fiscal challenge to both parties. With almost 50 million beneficiaries — and growing at the rate of 10,000 baby boomers every day — the entitlement program is one of the fastest-growing portions of the federal budget. Both parties acknowledge the need to curb its growth; both have also used the issue for political gain, casting themselves as the program’s protectors against what they portray as rivals’ threats.
Source: kaiserhealthnews.org

Medicare to End Practice of Requiring Patients to Show Progress to Receive Nursing Coverage

For decades, home health agencies and nursing homes that contract with Medicare have routinely terminated the Medicare coverage of a beneficiary who has stopped improving, even though nothing in the Medicare statute or its regulations says improvement is required for continued skilled care. Advocates charged that Medicare contractors have instead used a “covert rule of thumb” known as the “Improvement Standard” to illegally deny coverage to such patients. Once beneficiaries failed to show progress, contractors claimed they could deliver only custodial care, which Medicare does not cover.
Source: pennsylvaniatrustsandestates.com

Pennsylvania providers already feeling Medicare cuts, worrying about more to come

Among several examples: Hospitals now may lose Medicare money if too many patients are readmitted within 30 days of discharge — for any reason. The Centers for Medicare and Medicaid Services cut home health payment rates by 3.79 percent in 2011 and 2012, and will cut home health by another 1.32 percent in 2013, said Jennifer E. Battista, communications director of the Pennsylvania Homecare Association. Another Medicare program for rural hospitals that serve a high number of seniors also was left unfunded. At Wayne Memorial Hospital in Honesdale, Wayne County, that will cost $1.7 million.
Source: medcitynews.com

Importance Of Understanding Medicare Benefits

Posted by:  :  Category: Medicare

'tis I by McBethaddiction addiction treatment program alternative medicine anti-aging beauty care chiropractor cosmetics cosmetic surgery dental Diet disease doctors drug abuse drug addiction treatment drugs and alcohol exercise family fitness food general health Health health and fitness health issues home illness lifestyle living medical Medication medicine nutrition prevention rehab treatment program Self Help self improvement Skin skin care specialist sunless tanning surgery tanning therapy treatment Weight Loss
Source: nchopecoalition.org

Video: How to Understand Medicare Plans

Middlesex YMCA: Medicare Made Clear

Determining which insurance coverage is best for you can be confusing, and its even more so when you add in all of the Medicare options. To help you sort through all of the information and get answers to your questions, the Middelsex YMCA is proud to host two FREE information sessions called “Medicare Made Clear”. Choose the one session that is most convenient for you. And please invite a friend. Session A- Wednesday, November 10th 11:00 am in the Hazen Room of the YMCA Session B- Friday, November 12th 9:30 am in the Hazen Room of the YMCA Each session will be approx 1 hour and we will provide coffee. To reserve your seat please stop by the Front Desk of the YMCA or contact Helen at (860) 343-6230 or hpeaslee@midymca.org
Source: blogspot.com

Trolling for Insurance Prospects on Twitter

The similarities between insurance company and drug marketing were striking when I clicked a button directing me to sign up for United’s “Medicare Made Clear Newsletter” which promised I could “keep current with news and information from Medicare Made Clear.” Of course, signing up would do more than that. It would give the insurer my contact details, including zip code, for its great database of future customers. In the insurance biz, that’s called lead generation, and getting sales leads this way is a snap. I recalled a similar newsletter a few years ago from a disease awareness group that was really promoting drugs for restless legs syndrome.
Source: preparedpatientforum.org

ICYMI: Health Affairs Article: Medicare Advantage Provides Higher

Posted by:  :  Category: Medicare

A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare.  Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare.  This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Source: ahipcoverage.com

Video: Differences between Medicare PPO & HMO Plans

What’s the Right Medicare Plan for You, Part 2

At HealthPlus, there are two types of Medicare plans: HMO-POS and PPO. In an HMO, or Health Maintenance Organization, your primary care physician (PCP) acts as your health advocate, coordinating all of your medical care. With an HMO plan, you are required to obtain a referral from your PCP to see a specialist. Don’t worry, the referral process is simple and managed by your PCP. In many cases, if you see a specialist routinely you can get a referral good for a year so you don’t have to get a new one each time you visit that specialist. A PPO plan, or Preferred Provider Organization, has no referral requirements and allows you to see whichever doctor you choose within our network or outside our network. However, keep in mind your copays or coinsurance will usually be higher if you see a doctor outside the HealthPlus PPO network.
Source: healthplusdifference.org

Research Roundup: Medicare Advantage Plan Beneficiaries May Get More Appropriate Services; CHIP Participation Grows

Urban Institute/Robert Wood Johnson Foundation: Medicaid/CHIP Participation Among Children And Parents – “Despite the economic downturn, most states have maintained or expanded Medicaid and CHIP for children, by expanding eligibility to higher income and immigrant children, undertaking enrollment and retention simplifications, and implementing new policy options,” the authors wrote about coverage rates between 2008 and 2010. The rate of eligible children participating in Medicaid or CHIP grew to 86 percent nationwide and the number of eligible children who were not insured fell by 500,000 in that time, the study found. Participation rates for eligible parents were lower, however. The authors conclude that the 2009 law designed to improve participation of children in the program “may have contributed to increased take-up for Medicaid/CHIP among children, but that additional efforts will be needed, particularly among parents, to achieve high levels of Medicaid enrollment under the Affordable Care Act ACA” (Kenney et al., 12/3).
Source: kaiserhealthnews.org

United Healthcare Medicare Plans

United Healthcare is a popular choice and based on the company, one record five Medicare beneficiaries in their health plans. They also provide coverage through SecureHorizons, AmeriChoice, and Evercare. You may want to consider United Healthcare Medicare plan if you recently turned 65 and are just becoming eligible for Medicare. You may currently be enrolled in a health plan Medicare but not happy and want to change providers. You may be a situation where you move to a new location and can not receive coverage under your old plan. You might be interested in Medicare health plan if you are worried about getting coverage for your prescription drugs.United Healthcare Medicare plans are offered in a number of options including HMO plans, insurance plans supplement, special needs plans, and Medicare Part D prescription drug plans. These plans offer different types of coverage and the best one for you will depend on your individual health condition.For example, United Healthcare Medicare HMO plans are simple to use and understand. You simply pay a set amount anytime you need medical services. You know in advance what your costs will be and not surprised by bill huge doctor. HMO plan charges you a set fee for an office visit, visit the emergency room, and hospital stay. The fees are lower than you would pay in traditional Medicare coverage. The only potential drawback only HMO plan is that you must use doctors within the network if you need emergency care. If you use a doctor outside the network, you must pay full out-of-pocket costs.United Healthcare Medicare plans also include supplement insurance. This insurance helps cover the costs incurred in Medicare part BA and party costs. The special needs programs are only for those with certain medical conditions and life situations and not open to general enrollment.United Healthcare Medicare drug prescription coverage can be vital for you if you want to take drugs on an ongoing basis. With this coverage, you pay a flat fee for drugs or get them for free. Coverage is extended to include the most commonly prescribed drugs for seniors.
Source: startupzz.com

Medicare Advantage HMO Plans in Texas

Now, with the good you have to take into account the bad. Medicare Advantage HMO plans require you to only use doctors and providers in the plan network unless its and emergency and sometimes those networks can get rather restrictive so check to be sure you can live with who is and is not in network. If you are someone that demands to preserve your choice of medical providers this plan probably won’t work for you, stick with a Medigap supplement plan. Another drawback is these plans are specific to certain counties and geographic locations. For example, one plan may operate in the four county DFW metroplex but that same plan wont be available in then very next county unlike supplements that are available everywhere.
Source: medicareinsurancetexas.com

Are you ready for 2013? 4 questions to ask yourself

Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Source: medicare.gov

Medicare HMOs, now with less cream skimming

We analyzed utilization patterns of enrollees in Medicare Advantage health maintenance organization (HMO) plans compared to matched samples of people in traditional Medicare during 2003–09, to ascertain whether the HMO enrollees demonstrated different levels of use of services, which can be a hallmark of more integrated care. We found that utilization rates in some major categories, including emergency departments and ambulatory surgery or procedures, generally were 20–30 percent lower in Medicare Advantage HMOs in all years. Medicare Advantage HMO enrollees initially had lower rates of ambulatory visits and hospitalizations, although these rates converged by 2008; they also received about 10 percent fewer hip or knee replacements. In contrast, HMO enrollees underwent more coronary bypass surgery than patients in traditional Medicare. These findings suggest that overall, Medicare Advantage HMO enrollees might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.
Source: theincidentaleconomist.com

do people like medicare advantage?

Flexible benefit structures: Medicare Advantage plans were traditionally HMO plans, with all services being provided through a designated provider network of physicians and hospitals. But, in the last few years more and more Medicare Advantage plans are being offered as Preferred Provider Organizations (PPOs), which give customers more choices when it comes to providers. Some are also Private Fee-for-Service (PFFS) plans that don’t typically have networks, however, providers must accept plan payment and rules; and Special Needs Plans (SNPs) specifically designed for people with lower incomes and/or specific diseases or conditions.
Source: ehealthinsurance.com

Looking Into Different Aspects Of Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSOne issue that is near and dear to our hearts when considering health insurance is prescription drug coverage.  It is notable to understand that any Medicare Supplemental Policy you currently purchase will not come with prescription drug coverage.  This is something that needs to be purchased through separately and is referred to as Medicare Part D prescription drug coverage.
Source: seniorhealthdirect.com

Video: Medicare Advantage vs. Medicare Supplement Insurance

AFLAC Medicare Supplement Insurance Plans Now Available for Sale in 27 States

All states except NY and FL are now available for recruiting. The final states recently added are WI, MN and MA. If you plan to recruit in these states make sure you are appointed. If you are not currently set up for any of these states and would like to be, please forward the State License you would like to be set up in and we will get you set up as quickly as possible.
Source: ihealthbrokers.com

Comparing Medicare Supplemental Insurance Benefits

These plans, called “Medigap” plans, each have different medical care coverage. Variable benefits of coverage to be considered are: • Coinsurance plus coverage that last 365 days after medicare benefits end (Medicare Part A) • Coinsurance/Copayment for medicare part B. • Pints of blood (transfusions, first three pints) • Hospice care copayments or coinsurance • Coinsurance for Skilled Nursing Facilities • Part A medicare deductible • Part B medicare deductible • Part B excess charges • Emergencies during foreign travel • Preventative care coinsurance, per Medicare Part B If any of these are important for you to have covered, comparing medicare supplemental plans that include benefits is the only way to ensure they are included.
Source: seniorcorps.org

Choosing The Most Effective Medicare Supplement Insurance Texas

An aging population needs more health care attention so as to remain in good health. What this implies is that the veterans are bound to spend more of their retirement savings on the medical expenses. Turning to insurance companies for health insurance can prove very decisive. There are quite a number of health insurers who offer supplements, and at times it can be a challenge to pick the one that suits your interest. It is imperative that before choosing the right medicare supplement insurance Texas people do research to have enough knowledge of the types that are available in the market.
Source: submititr.com

How To Know If You Need Medicare Supplemental Insurance

If you require a lot of medical attention, getting the most coverage you can afford makes sense. Whether you have cancer, chronic illnesses, a major health condition, or regular visits to hospitals and specialists, supplemental insurance will help ensure that everything you need is covered and affordable. Getting Medicare supplemental insurance is also a good idea if your regular Medicare policy does not cover something specific that you need, such as a prescription medication, a certain type of service, or additional medical care that you need. Talk to your doctors and healthcare providers about your current health and the steps you will need to take in order to stay healthy. This will give you a good idea of what you need, and whether Medicare will cover it. If not, seek out a supplemental insurance plan.
Source: dzida.org

Medicare Supplement Ins question?

Your issue is probably not with the Supplement but is with your drug plan. Are you sure that the drug plan you have is the best one for you? Also, if your only income is Social Security it is possible that you may qualify for LIS (Low Income Subsidy) which will bring your drug costs down to no more than $6.50 for each drug each month. Ask your agent for assistance. You can cancel a med sup at any time but also there may be another med sup that is less expensive. Be aware that you may not qualify to get back on one in the future because of your health. There may be Medicare Advantage plans in your area but unless you qualify for a special election period you will not be able to sign up for one until this fall. In the same way you will not be able to change drug plans even if there is one better suited for you.
Source: z-answers.com

Anthem Blue Cross Blue Shield Medicare Supplement Plans Are Affordable…

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

Tricare Help – How does Tricare work with our temporary travel insurance?

Posted by:  :  Category: Medicare

You correctly note that by law, Tricare must be last payer to all other health insurance. But there is one exception to that rule: Tricare is first payer to supplemental insurance coverage, a category into which your short-term travel policy falls. Supplemental insurance pays after Tricare pays its portion of the bill, reimbursing beneficiaries for out-of-pocket medical expenses that you paid to civilian providers based on the plan’s policies. All supplemental insurance policies have their own fine print, so you should read your travel insurance policy carefully to make sure you know what it will and will not cover.
Source: militarytimes.com

Video: (Part 1) Using TRICARE and Medicare

Ask The Experts: Retirement

A: As you’ve concluded, there aren’t any easy answers. Such decisions are personal. However, a few generalizations can be made. First, each of you will be first eligible for Medicare parts A and B at age 65. Second, if you choose to be covered by Tricare, you must be enrolled in parts A and B. Third, if your choose Tricare, you can suspend FEHB coverage and, if things with Tricare don’t work out, reactivate that enrollment. Finally, any decision you make needs to balance cost with current and expected need. If you can’t project your needs far enough, think about the worst things that could happen to you and see which combination of benefits would give you the best protection at the lowest cost.
Source: federaltimes.com

How Does Medicare Affect TRICARE?

Effective October 2009, TRICARE beneficiaries who are awarded retroactive benefits based on disability or permanent kidney failure do not have to pay for Part B for those months in the past in order to keep TRICARE. You should, however, contact the Department of Defense to find out whether you would now need to enroll in Medicare Part B in order to keep your TRICARE.
Source: specialneedsplanning.net

Episode #21: TRICARE and MEDICARE 09/18 by Dot Mil Docs

The growing number of medically retired wounded, ill and injured servicemembers need to know about becoming eligible for Medicare and how it effects their TRICARE benefits. Anne Breslin, Senior Health Program Analyst for the TRICARE Management Activity will answer critical questions about the TRICARE/Medicare relationship for beneficiaries under age 65. The appearance of advertising on this Web site, does not constitute endorsement by the DOD, of the products or services advertised on this site.
Source: blogtalkradio.com

TRICARE Moving to Medicare Type Methodology for SCHs

Medicare reimburses SCHs for inpatient care at the greater of the Medicare DRG for all Medicare discharges, or the amount the SCH would have been paid if it were paid the average cost per discharge at that SCH in fiscal years 1982, 1987, 1992, 1996 or 2006, updated to the current year, for all Medicare discharges. DOD noted, however, that establishing a methodology exactly like Medicare is not practical. While the aggregate DRG reimbursement for all TRICARE discharges can be calculated, using the Medicare cost per discharge would not be appropriate for TRICARE because of differences in the TRICARE and Medicare beneficiary case mix. Also, applying an annual update to a TRICARE base-year average doesn’t make sense because of the relatively low number of TRICARE discharges in any given year—fewer than 20 at nearly half of SCHs. The average cost per discharge in any one year may not be a good measure of the average cost in future years.
Source: healthcarereforminsights.com

Myrtle Beach area doctor settles Medicare, Tricare billing fraud case

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Source: myrtlebeachonline.com

TRICARE to MEDICARE Transition

On 8-31-2008 Friar 1610 posting in a separate thread, wrote: "What worries me about TRICARE Standard (and also about MEDICARE as I get within spittin’ distance of it) is this: It seems like every year there’s a drill to reduce the fees paid to providers. At the eleventh hour they always seem to restore (or slightly increase) the fees and kick the decision into the next FY when even deeper reductions are proposed. The potential – and in some cases actual – problem: fewer and fewer civilian providers wanting to accept new patients under TRICARE/MEDICARE." Friar, do you have an update on this? I have had Medicare/Tricare for Life for some time and have not one complaint about it. As far as I know, it is currently the best senior medical insurance available. (But – we earned it, didn’t we?!) I’d be concerned if I thought it would be hard to be accepted though. One thing to be aware of – not a big deal – Medicare premiums are now means tested to a top level of around $250/month that will kick in if you sell highly appreciated assets and have a big capital gain – at least for that year.
Source: early-retirement.org

How Tricare, Medicare work in retirement

Yes it’s gen­er­ally a good deal in the states but not so good over­seas where one gets to pay for medicare but gets none of the ben­e­fits. In addi­tion if one lives in the Philip­pines they will find the Tri­care Stan­dard has been reduced to a sec­ond class ben­e­fit with lim­ited access to providers. Very often retirees find they get to pay 100% of the cost of their care. On aver­age for inpa­tient care they can look for­ward to pay­ing 50% or more of the pro­fes­sional fees and even then they have to learn med­ical cod­ing and pro­ce­dures to con­vert local global bills into a form accept­able to TMA. Any­where else in the world they accept the local global bill and pay the full 75% they should. Local providers and hos­pi­tals tend to avoid Tri­care because of its bad rep­u­ta­tion and past actions. So also expect to keep $10,000 plus lay­ing around to pay for your hos­pi­tal­iza­tion up front and then hope to get 50% back.
Source: military.com

State Roundup: Report Finds Racial Gap in Colo. Dental Coverage; Health Cuts Part Of Conn. Budget Plan

Posted by:  :  Category: Medicare

Martin Place 1 by Greens MPsCT Mirror: Malloy Defends His Plan To Collect More Revenue From Businesses Gov. Dannel P. Malloy defended his plan Monday to seek an extra $22 million in revenue from businesses and power plants to help close the current budget deficit, arguing this doesn’t break his pledge not to raise taxes. … Though details were limited, the “road map” — as referred to by the administration — called for $220 million in spending cuts and $22.6 million in new revenue. … Malloy also acknowledged he could face a tough road with his fellow Democrats in the House and Senate majorities. The largest single-reduction proposed Friday involves $122 million aimed at the Department of Social Services, which administers a wide array of health care and other support services for the poor, aged and disabled, most of which are partially supported with federal aid. That proposed $122 million cut is expected to save the state just $63.5 million since the reduction would trigger a $58 million loss in federal assistance (Phaneuf, 12/10).
Source: kaiserhealthnews.org

Video: Dental Insurance Commercial for Folks on Medicare

do people like medicare advantage?

Flexible benefit structures: Medicare Advantage plans were traditionally HMO plans, with all services being provided through a designated provider network of physicians and hospitals. But, in the last few years more and more Medicare Advantage plans are being offered as Preferred Provider Organizations (PPOs), which give customers more choices when it comes to providers. Some are also Private Fee-for-Service (PFFS) plans that don’t typically have networks, however, providers must accept plan payment and rules; and Special Needs Plans (SNPs) specifically designed for people with lower incomes and/or specific diseases or conditions.
Source: ehealthinsurance.com

Medicare open enrollment: How can I find a better plan?

What about doctor availability? On the Medicare site you can directly compare up to three plans, and when I selected your current plan and these other two plans, I saw that your current plan says it has 1001-1500 “physicians and providers,” compared to 4001-5000 for the other two plans. For each plan you can click on “View provider and physician network website,” which takes you away from Medicare.gov and onto the plan’s own website, where you can search its provider directory to judge for yourself whether it has enough doctors to meet your needs.
Source: consumerreports.org

Visit the Dentist Before You Retire

Consider first that most employer based dental insurances are included in your benefits and in most cases you cannot opt out of them. If your employer is one of those contracts that has included dental insurance then use it. It is true that dental insurance does not typically cover at 100% of dental procedures, but it still covers a portion of dental services. This is a drastic change in comparison to not having any dental insurance at all. That is like going up that proverbial creek, and trying to paddle against the current. Once you retire and your dental benefits expire you will have an extremely hard time convincing medicare to cover you. Why? They do not cover dental care. It is that simple, so while you and your spouse are still working, using your dental care benefits is an excellent idea.
Source: danmatthewsdds.com

Florida Medicare 2013 Open Enrollment

For example, suppose after running a search-providing zip code of your county in a southwestern state and you find that your current plan does not cover any vision or dental coverage, and then plans can be changed. There are other two available plans, which cover both the aspects plus limited hearing coverage. This sort of Medicare plans are of high quality ratings such as 4.5 out 5stars. This also means that Medicare is giving them an extra quality bonus which are use to augment benefits like vision-dental coverage or results in overall cost reduction of the plan, to the members.
Source: medicare-supplement-advisor.org

The Disability Information and Resource Centre

Medicare benefits will not be paid for any dental services under the Medicare Chronic Disease Dental Scheme after December 1st 2012. Patients without a GP care plan in place before September 8th 2012 will not be able to access the Medicare Chronic Disease Dental Scheme before it closes on December 1st 2012.
Source: org.au

Researchers find dental coverage pays in the long term for older Americans at The Designated Geek HealthCare Info

In conclusion, the authors say that despite the lack of resources and action on chronic diseases in developing countries, a great hope has emerged following the United Nations General Assembly resolution of non-communicable diseases, which he calls a higher priority high stakes of the state of health, national and global agendas. There will be a high-level meeting of the General Assembly on chronic disease in September 2011.
Source: thedesignatedgeek.com

Proposed legislation would expand dental care and services to Medicare and Medicaid beneficiaries and providers

The bill, which has been hailed by seniors groups such as National Committee to Preserve Social Security and Medicare, would pay for the expanded services by levying a tax on non-consumer financial trading. That tax would raise $288 billion over the next 10 years, according to the bill. Click here to read the Senate bill, and here to read Senate report on the U.S. dental crisis. 
Source: mcknights.com