In Swing States, Obama Leads on Handling of Medicare

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyMr. Romney and Mr. Ryan have called for curbing the growing costs of Medicare by making major changes to the program. Their plan would change Medicare for people who are now under 55 so that when they are eligible for coverage they would no longer receive a government-guaranteed, fee-for-service health plan but rather a fixed amount of money each year that they would use to purchase private health insurance or buy into a version of the existing Medicare program. But they have not provided enough details of their plan to assess how much it might increase out-of-pocket costs for future beneficiaries. Mr. Obama has pledged to preserve Medicare in its current form, but has spoken less about its rising costs.
Source: nytimes.com

Video: Vice President Joe Biden on Medicare – Blacksburg, VA

Virginia Senate Candidates Face Tough Issues Beyond Medicare, While Key California House Races Are Shaped By It

Politico (Video): Baldwin Raises $4.6M In Third Quarter, Attacks Thompson For HHS Role Wisconsin Senate candidate Tammy Baldwin took in just under $4.6 million for her campaign during the third quarter of 2012, a campaign source tells POLITICO… Baldwin’s Republican opponent, former Wisconsin Gov. Tommy Thompson, hasn’t yet released his most recent fundraising information, though his campaign told the Milwaukee Journal Sentinel that he has raised between $2 million and $3 million since the primary. Balwin is putting some of her cash toward attacking the Republican on the airwaves for his role in the Bush-era Medicare Part D law. In an ad set for release today, Baldwin says that as secretary of health and human services, Thompson “cut a sweetheart deal with drug companies while working for George Bush, making it illegal for Medicare to negotiate lower prices. Then Tommy made millions at a DC lobbying firm working for drug companies.” That’s of a piece with the messaging Democrats have used to tear down Thompson since he entered the general election as a perceived front-runner over the summer (Burns, 10/15).
Source: kaiserhealthnews.org

Romney University 103: What Mitt Romney’s Medicare changes mean for Virginia

In Virginia more than 559,753 seniors who rely on their Medicare benefits receive one or more preventive services–such as cancer screenings, diabetes testing, and bone density scans–free of charge through their Medicare plan. This is saving Virginia seniors money each year and also providing them with the care needed to protect their health.
Source: progressva.org

Workers can’t be silent about the “fiscal showdown”

For the Dec. 10 Day of Action, we sang holiday carols with lyrics changed to be about our “Jobs, Not Cuts” message. It was hard for us to walk and sing at first — we were like the seven dwarfs at the beginning of “Snow White” when they’re falling all over each other. Eventually we got the hang of it and I think people enjoyed watching and listening to us.
Source: seiu.org

Hospitals facing financial hit

Ashleigh Dye Caroline County Celebrate Virginia Live City Council Civil War courthouse crime Culpeper County Daniel Harmon–Wright derecho earthquake election fatal Fredericksburg Fredericksburg City Council Fredericksburg Va. Getting There Health Care Hurricane Sandy Interstate 95 july 4 King George King George County Michelle Obama Natatia Bledsoe Orange County outage Patricia Cook power outage power outages Rappahannock River robbery Spotsylvania Spotsylvania County Spotsylvania schools Stafford Stafford County storm UMW University of Mary Washington VDOT Virginia State Police VRE weather Westmoreland County
Source: fredericksburg.com

Obama Would Better Handle Medicare, Swing State Voters Say in Polls

According to “The Caucus,” the challenge for Obama is that Medicare is a stronger motivator for older voters than for younger voters. Medicare was chosen as the top campaign issue by 20% of Florida voters over age 65, compared with just 3% of voters under age 55 (Cooper/Kopicki, “The Caucus,” New York Times, 11/1).
Source: californiahealthline.org

Medicare Eligibility Switch Could Cost W.Va. Dearly

“Absolutely … it would impact the plan, and we would have to do something to offset that cost,” Cheatham said of delaying Medicare eligibility. Cheatham said any such increase would have to be offset in one of three ways, or some combination of them: increased funding from the Legislature; higher premiums for beneficiaries; and/or a decrease in benefits in the form of higher deductibles, co-pays and out-of-pocket maximums.
Source: theintelligencer.net

Aging & Law in West Virginia: Medicare Premiums and Deductibles 2013

Part A generally pays inpatient hospital, skilled nursing facility, and some home health. Most beneficiaries do not pay a premium for Part A since they have at least 40 quarters of Medicare-covered employment. Part B generally pays a portion of the cost of physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items. Here below are the premiums, deductibles, and copays for Medicare Parts A and B for 2013:
Source: blogspot.com

Chip Cravaack for Congress

Democrat Plan Means An “Immediate 17-Percent Reduction” In Benefits Or “Immediate 24-Percent Increase” In Taxes: “The long-range financial imbalance could be addressed in several different ways. In theory, the standard 2.90-percent payroll tax and the additional tax 0.9-percent tax on high-income earners could be immediately increased by the amount of the actuarial deficit to 3.69 percent, or expenditures could be reduced by a corresponding amount. Note, however, that these changes would require an immediate 24-percent increase in the tax rate or an immediate 17-percent reduction in expenditures.” (pp. 28-29, “2011 Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds,” The Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, 5/13/2011)
Source: chipcravaack.com

Kaiser Permanente Selects Silver&Fit(R) Senior Fitness Program for More Than 50,000 KP Senior Advantage (HMO) Members in Oregon and Washington

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524Silver&Fit was developed to assist seniors in beginning or continuing a regular exercise program. Regular exercise has shown to be an important element in preventing some medical conditions, including high blood pressure and heart and lung disease. Cardiovascular and strength training can also help seniors improve their balance and become more flexible, preventing common slips and falls and speeding up the recovery period from such injuries. Access to the network of exercise facilities is provided through ASH subsidiary American Specialty Health Networks, Inc.
Source: globenewswire.com

Video: Senior Advantage Medicare

PacifiCare’s massive Medicare Advantage fraud

It has long been recognized that the private Medicare Advantage plans (offered as an option to the traditional Medicare program) have been cheating the taxpayers, initially by selectively enrolling the healthy while being paid at rates that include a mix of the sick, and, more recently, by gaming the process of risk adjustment (which seeks to correct for the health status of the beneficiaries actually enrolled by the private plans). This new report from the HHS Office of Inspector General is helpful because it provides a perspective of the enormity of the problem.
Source: pnhp.org

Texas Medicare Advantage Disenrollment : Learn Your Options

If saving money is a goal, you may want to consider a Medicare Supplement Plan. In Texas, there are several different plans to choose from, all with different combinations of benefits and coverage options.  High deductible plan F may be a good solution for reducing out-of-pocket expenses and the monthly cost may be significantly lower than you might expect. With great benefits, no network restrictions and lower costs, a Medicare Supplement plan may be a good alternative to your Texas Medicare Advantage plan.  Remember, if you choose to disenroll in your Medicare Advantage plan, you will still need to qualify for a Medicare supplement plan and you will be enrolled in Original Medicare.
Source: texasmedicarehealth.com

Medicare Advantage Future

It appears that the Advantage plans eventually will be limited to lower incomes where it will be based on people on medicaid or dual eligible. It simply can’t go to the way of having one area in the country offer it and not in others. Can this be unconstitutional? Insert from the congress blog:The candidates’ positions on Medicare Advantage – The Hill’s Congress Blog "Medicare Advantage plans are paid based on a legislative formula, and any payments they receive above what is necessary to provide the basic Medicare benefit must be provided to the beneficiaries of the plans in the form of expanded benefits, such as lower deductibles and copayments for services. Once the election is over and the artificial and temporary bump-up in payments is terminated, as it inevitably will be, the Medicare Advantage plans will be forced to pare back benefits, and enrollment in the plans will drop." "This should not be surprising. The traditional Medicare fee-for-service insurance is an extremely inefficient model. There is no incentive for either the providers or the enrollees (most of whom have supplemental coverage beyond Medicare) to control the use of services. Thus, the volume and intensity of service use rises dramatically each year. Moreover, there is no coordination among those providing medical services to the patients, which leads to fragmented and low-quality care in too many instances." Since traditional med sups are considered inefficient in controlling costs and the fact the president wants to cut spending on advantage plans it leaves a big gap of uncertainty of which way we go with medicare. I would hope we get rid of the political animal and try to come up with the most efficient way to run medicare for future generations to come as the country ages. What is your take?
Source: insurance-forums.net

Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality

The program is one of several Medicare is launching to make hospitals and doctors accountable for quality and more careful stewards of public money. In October, Medicare also began reducing payments to 2,217 hospitals because too many of their patients ended up back in their care within a month. Medicare already gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
Source: kaiserhealthnews.org

Medicare expansion may help reduce bankruptcy rates

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524While the governor supports the measure, Republican state legislatures are hesitant. They cite concerns about the costs of implementing such a measure. Some health policy experts have tried to put this worry to rest, stating how much of the cost will be saved by the state’s not having to pay to provide emergency care for those without insurance. And expanding coverage in Missouri could provide health care to as many as 300,000 underprivileged people.
Source: stlouisbankruptcylawattorney.com

Video: Medicare vs Medicaid 612-309-9184 Minnesota Medical Assistance Minneapolis Elder Law Attorney

Texas Attorney General Missing the Mark on Medicare

True, so many people have been trapped into dependence upon government intentionally to win votes; nevertheless, a means must be provided for protecting those already ensnared into the system or close to falling into it. Still, playing games under the fraudulently ratified and unconstitutional 16th Amendment should end asap with the elimination of the Gestapo IRS and a despotic, unaccountable private central banker-controlled Federal Reserve, both egregious tyrannies upon a free people.  A free people should never have to beg for their own money back from an oppressive, unconstitutional, wasteful, malfunctioning and bureaucracy-unaccountable federal government so far removed from the people and even now teetering on complete absorption into a One World Government.
Source: wetexans.com

Clinical Director for Miami

According to the evidence at trial, the defendants and their co-conspirators caused the submission of over $50 million dollars in false and fraudulent claims to Medicare through Biscayne Milieu, which purportedly operated a partial hospitalization program (PHP) – a form of intensive treatment for severe mental illness.  Instead, the defendants devised a scheme in which they paid patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were never provided.  Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.  The evidence at trial showed that once these ineligible patients were admitted to Biscayne Milieu, Alalu and others concealed the fraud by falsifying patients’ group therapy notes to reflect legitimate PHP treatment that was never provided, and directed others to do so.
Source: enewspf.com

SSA Announces COLA, Hike in Medicare Premiums

Many are concerned that their Social Security will not be sufficient to support them let alone finance the type of retirement that they would like to enjoy.  Social Security payments are minimal, with the average monthly benefit being less than $1240 as of this writing.  Someone who retired this year having paid the maximum amount into the program over 35 years would receive $2513 per month.  Even this maximum benefit is relatively modest when you consider the cost-of-living.
Source: wealth-counselors.com

Personal Injury Attorney Fees

In virtually every personal injury case, there is a claim (often called a lien) by a third party to be repaid out of the case settlement.  Most frequently this lien is for the amount of medical benefits paid because of the injury.  How this lien for repayment relates to the attorney’s contingent fee usual in a personal injury case is important to the net amount that the injured victim actually receives from a settlement.  Clients often express the concern that after health insurance or other third parties are repaid and after the percentage is paid for attorney’s fees, there will be little left to compensate them as injured victims.  This concern is well-founded where the settlement in a personal injury claim has to be discounted for reasons such as insufficient insurance, inability of the guilty party to pay or disputed liability.
Source: bostoninjurylawyer-blog.com

The “Appellate Gourmet (c)”: Attorney’s fees, injunctions, repeat violence and Medicare fraud, with arugula and Manchego cheese galettes

(Reuters) — Enrollment in Medicare Advantage, the private insurance segment of the popular U.S. health care program for the elderly, is expected to grow 11 percent next year while premiums remain steady, government health officials said Sept. 19. The U.S. Centers for Medicare and Medicaid Services estimated that 14.5 million people will enroll in Medicare Advantage plans in 2013, based on insurance industry expectations. That is up from 13.1 million people this year.
Source: blogspot.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

Changes to Medicaid, Medicare could create more financial woes

Organizations working against such changes include the AARP. Recently, the group sent a letter to the President and members of Congress so that its members’ voices could be heard. More than 37 million people over the age of 50 years old are part of AARP and they are worried that proposed changes to Medicaid and Medicare – including raising the eligibility age – may have severe effects on the financial ability of the elderly. According to estimates, as much as 20 percent of a senior’s income goes toward health care costs.
Source: bostonelderlawfirm.com

Settlement helps to keep Medicare coverage for chronically ill

This change will affect Texas residents as they make long term care planning decisions and other types of estate planning decisions. A comprehensive retirement and estate plan includes money set aside to cover medical expenses, and that means figuring out one’s likely needs and making sure that private insurance is available if government programs like Medicare and Medicaid aren’t available for all necessary treatments.
Source: wrightabshire.com

Owner of Brooklyn Clinic Pleads Guilty in Connection with $71 Million Medicare Fraud Scheme

Shelikhova was an owner and manager of a clinic in Brooklyn that operated under three corporate names: Bay Medical Care PC, SVS Wellcare Medical PLLC, and SZS Medical Care PLLC (Bay Medical Clinic). According to court documents, owners, operators, and employees of Bay Medical paid cash kickbacks to Medicare beneficiaries and used the beneficiaries’ names to bill Medicare for more than $71 million in medical services and procedures that were medically unnecessary or never provided, including physician office visits, physical therapy, and diagnostic tests.
Source: brooklynews.com

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

OIG Study: Medicare Overpaid Nursing Homes $1.5B in 2009

The study was based on a random sample of SNF claims from 2009 and were reviewed by three registered nurses, a physical therapist, an occupational therapist, and a speech therapist. The purpose of the study was to assess the “appropriateness of Medicare payments” to SNFs, which the federal government has long been suspected as among the most common recipients of Medicare overpayments. 
Source: dbllaw.com

California: No Blanket Rule Precludes Award of Attorney’s Fees Based on a Medicare Set

Attorney’s Fees; Calculation; C&R Agreements. WCAB, rescinding WCJ’s award of $66,860.30 fee to applicant’s attorney, held that attorney was entitled to full $90,000 fee requested pursuant to LC 4903(a), 8 CCR 10775 and WCAB Policy and Procedural Manual § 1.140, when WCAB found that, in calculating attorney’s fee at reduced rate, WCJ improperly determined that pursuant to Pratt v. Wells Fargo Bank, 2010 Cal. Wrk. Comp. P.D. LEXIS 499 applicant’s counsel was not entitled to any fee based upon settlement monies used to fund Medicare Set Aside account in applicant’s C&R Agreement, that panel’s holding in Pratt was not intended to set a blanket rule precluding an award of attorney’s fees based on an MSA when there has been a prior award of medical treatment, that WCAB was not bound by holding in Pratt to extent decision prohibits award of attorney’s fees based on MSA, that although disregard of MSA funds may be appropriate in setting a reasonable attorney’s fee in proper case, given results obtained, disregard of those funds would not be reasonable in instant case, and that WCJ in this case incorrectly found that applicant did not benefit by MSA for purposes of attorney’s fee award.
Source: lexisnexis.com

Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality

Posted by:  :  Category: Medicare

Old people read alone... by Ed YourdonThe program is one of several Medicare is launching to make hospitals and doctors accountable for quality and more careful stewards of public money. In October, Medicare also began reducing payments to 2,217 hospitals because too many of their patients ended up back in their care within a month. Medicare already gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
Source: kaiserhealthnews.org

Video: Medicare is Battle Cries for Tight House Races in Fla., NY

Do Republicans Want to Cut Medicare?

The Republican positioning on Medicare has set the tone for the current budget impasse. Obama is asking for $1.6 trillion in higher tax revenue. Republicans are demanding more spending cuts, but they won’t say how much they want, let alone what specifically they will cut. The current party thinking on Medicare, sanctified by Romney and Ryan, has defined itself as matching or even outspending Obama on Medicare for anybody aged 55 and up. That would lock out any budget savings at all for the next decade, and make any savings roll in extremely slowly afterward.
Source: nymag.com

Medicare Loosens the Purse Strings

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.com

Daily Report: Medicare Is Faulted on Shift to Electronic Records

The report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.
Source: nytimes.com

Prominent Queens Doctor Pleads Guilty To Medicare Fraud

(TM and Copyright 2012 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2012 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)
Source: cbslocal.com

ObamaCare and Medicaid: More Pre

Michael S. Greve is a professor at George Mason University School of Law. From 2000 to August, 2012, Professor Greve was the John G. Searle Scholar at the American Enterprise Institute, where he remains a visiting scholar. Before coming to AEI, Professor Greve cofounded and, from 1989 to 2000, directed the Center for Individual Rights, a public interest law firm. He holds a Ph.D. and M.A. in government from Cornell University, and completed his undergraduate studies at the University of Hamburg. Currently, Professor Greve also chairs the board of the Competitive Enterprise Institute and is a frequent contributor to the Liberty Law Blog. Professor Greve has written extensively on many aspects of the American legal system. His publications include numerous law review articles and books, including most recently The Upside-Down Constitution (Harvard University Press, 2012). He has also written The Demise of Environmentalism in American Law (1996); Real Federalism: Why It Matters, How It Could Happen (1999); and Harm-less Lawsuits? What’s Wrong With Consumer Class Actions (2005). He is the coeditor, with Richard A. Epstein, of Competition Laws in Conflict: Antitrust Jurisdiction in the Global Economy (2004) and Federal Preemption: States’ Powers, National Interests (2007); and, with Michael Zoeller, of Citizenship in America and Europe: Beyond the Nation-State? (2009).
Source: libertylawsite.org

20 States With Highest & Lowest Medicaid Physician Pay Increases in 2013

Under the Patient Protection and Affordable Care Act, states will have the option to expand Medicaid coverage to more people. Because of this, the PPACA also included a rule that would increase Medicaid payments for certain primary care physicians to Medicare rates over the next two years, starting this January. In November, CMS released a final rule indicating that all primary care physicians in specialties of family medicine, general internal medicine or pediatric medicine (and related subspecialties) will be paid Medicare rates for Medicaid primary care services for calendar years 2013 and 2014. In the Kaiser Commission’s report, analysts looked at which physicians would benefit the most from the final rule based on their state’s Medicaid-to-Medicare fee ratio. For example, across the entire United States, Medicaid payments to primary care physicians are 58 percent of comparable Medicare payments. Primary care physicians are paid the least for Medicaid services in Rhode Island, New York, California, Michigan, New Jersey and Florida. Physicians in Rhode Island are expected to see a 198 percent raise in Medicaid payments in 2013 — the most of any state. Here are the states with the largest and smallest estimated Medicaid fee increases to primary care physicians in 2013, based on the Kaiser Commission’s report. 10 largest increases in 2013 Rhode Island: 198 percent New York: 156 percent California: 136 percent Michigan: 125 percent New Jersey: 109 percent Florida: 105 percent Pennsylvania: 96 percent Illinois: 93 percent Indiana: 87 percent Hawaii: 79 percent 10 smallest increases in 2013 North Dakota: 0 percent Alaska: 0 percent Delaware: 2 percent Oklahoma: 3 percent Wyoming: 4 percent Montana: 7 percent Mississippi: 11 percent Idaho: 13 percent North Carolina: 18 percent Vermont: 22 percent
Source: beckersspine.com

NY Medical Society Calls for Resolution of Deep Medicare Cuts

These cuts are driven by a flawed formula called the Sustainable Growth Rate (SGR) which penalizes physicians by lowering their payments when growth in the use of medical care exceeds the Gross Domestic Product. This is done despite the fact that service use is driven by factors outside physician control such as patient health needs, emerging technology and public policy changes. When factoring in cuts to the Medicare conversion factor in 2002 along with some very minor increases in the conversion factor since then, Medicare payments are, on average, level with what they were 10 years ago. In fact, many physicians have experienced significant cuts. Yet, at the same time, liability insurance costs and other overhead costs for physicians have risen rapidly in New York while reimbursement from health insurers has been constrained.
Source: readmedia.com

Navigating Medicare's Open Enrollment Period

Medicare beneficiaries who are happy with their plans do not need to do anything, if they don’t want to change. But it is still a good idea to check options, Ms. Metcalf advises, to make sure a version of Medicare is the best one in terms of cost and coverage. If, for instance, you have the original version of Medicare and pay extra for prescription drug coverage (so-called Part D coverage), you may want to make sure important medications you need are still covered under your plan, to avoid having to pay more for them.
Source: nytimes.com

Grappling With Details of Medicare Proposals

Still, it’s clear the proposed changes would shift costs from the federal government to retirees. An early version of a Republican plan would have more than doubled out-of-pocket health expenses for older adults, to $12,500 in 2022, the Congressional Budget Office estimated. “All scenarios will require seniors to pay more,” said Robert Moffit, senior fellow at the Heritage Foundation, a conservative research organization in Washington. To think otherwise, he said, “is a fantasy.”
Source: nytimes.com

9 Recent Medicare, Medicaid Issues

1. CMS released its annual report on the quality of healthcare and coverage for the 43.5 million children enrolled in Medicaid and CHIP in fiscal year 2011. 2. For 10 states, Medicaid and other healthcare programs were over budget as they planned for 2013 — more states than last year. 3. Primary care physicians who treat Medicaid patients in Rhode Island, New York, California, Michigan, New Jersey and Florida may be able to breathe a little easier next year: A report found their Medicaid pay rates are estimated to increase more than 100 percent. 4. Maine’s 39 hospitals put pressure on state lawmakers to pay the $484 million owed them for treating Medicaid patients. 5. An OIG report discovered Medicare paid an average of $919 for beneficiaries’ back braces between 2010 and 2011 — four times greater than the average $191 cost to suppliers. 6. Out of seven major payors, providers ranked Medicare Part B first in terms of overall satisfaction. 7. In a letter to lawmakers, the Alliance of Specialty Medicine called for a permanent fix to Medicare’s formula for annual payment increases to physicians. 8. U.S. Sen. Bob Corker (R-Tenn.) proposed a halt on hospital provider fees across the nation, calling the funding measure a “massive bed tax gimmick.” 9. The U.S. Court of Appeals for the Ninth Circuit ruled California may chop Medicaid reimbursements rates to providers by 10 percent next year.
Source: beckershospitalreview.com

Owner of Brooklyn Clinic Pleads Guilty in Connection with $71 Million Medicare Fraud Scheme

Shelikhova was an owner and manager of a clinic in Brooklyn that operated under three corporate names: Bay Medical Care PC, SVS Wellcare Medical PLLC, and SZS Medical Care PLLC (Bay Medical Clinic). According to court documents, owners, operators, and employees of Bay Medical paid cash kickbacks to Medicare beneficiaries and used the beneficiaries’ names to bill Medicare for more than $71 million in medical services and procedures that were medically unnecessary or never provided, including physician office visits, physical therapy, and diagnostic tests.
Source: brooklynews.com

N.Y. doctor pleads guilty to $11.7M Medicare fraud scheme

Prosecutors said Ho Yon Kim, 86, of Flushing, N.Y., while president of URI Medical Service PC and Sarang Medical PC, both in Flushing, purportedly provided physical therapy and electric stimulation treatment. Kim admitted he exchanged spa servces to Medicare beneficiaries that allowed their numbers to be billed for services never provided, or not needed.
Source: ifawebnews.com

REPORT: NY House GOP Protecting Tiny Minority from Taxes While Aiming Cuts at Social Security & Medicare

“Many members of Congress are sitting on the fence as the fiscal cliff debate rages on. As our report clearly illustrates, the needs of the many outweigh the needs of the few,” said Ron Deutsch, Executive Director of New Yorkers for Fiscal Fairness.  “It’s time for members to jump off the fence and support asking the favored few to contribute just a little more so we can ensure that our seniors and the most vulnerable members of our society get the services our shared social contract has promised them.  Poll after poll shows that the public completely supports rescinding the Bush tax cuts for people making over $250,000 and protecting Social Security and Medicare.  It’s time to listen to the public, not wealthy contributors.”
Source: strongforall.org

AHA, Hospitals Sue HHS Over Medicare Audit Practices

Posted by:  :  Category: Medicare

Racism by elycefelizDespite being overturned 75 percent of the time, CMS follows RAC findings and requires hospitals to repay an entire Part A payment upon a RAC determination that the inpatient care should have been provided as outpatient care under Part B.  Furthermore, CMS takes the position that Part B payment is not permitted after a Part A payment denial.  In the end, this can result in millions of dollars in uncompensated care.  For example, Michigan-based plaintiff Munson Medical Center has repaid $6.485 million as a result of RAC payment denials since 2007. 
Source: dbllaw.com

Video: Rand Paul In The ’90s: Medicare Is Socialism And Social Security Is A Ponzi Scheme

Hartford woman meets with members of Congress regarding AARP, ‘fiscal cliff’

Last week, AARP Kentucky staff and volunteer Charlotte Whittaker met with Senators McConnell and Paul, Representatives Guthrie, Massie, Yarmuth, Whitfield (or their staff) and other key members of Congress involved in the lame duck discussions to avert a so-called “fiscal cliff.”  The AARP volunteers and staff urged the members of Congress not to reduce Social Security or Medicare benefits in any end of year deal. With regard to both Medicare and Medicaid they told members of Congress that simply reducing government expenditures by shifting costs does not lower the cost of health care—it merely shifts the cost to beneficiaries and other payers.
Source: ocmonitor.com

Lifeline Direct Insurance Introduces Kentucky Medicare Supplement Insurance

“Regardless of what part of Kentucky you reside in, you have more important things to use your funds on when compared with costly supplement Medicare insurance policies. For this reason, you should seek out Kentucky Medicare supplement insurance plans online. Through online shopping, you will be furnished with many no cost quotes with regard to insurance coverage from several firms. Simply evaluate these types of estimates before you purchase the one that is most fitting to your situation,” stated by Matthew Loughran, from Lifeline Direct Insurance Services.
Source: virtual-strategy.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Access Denied / User Login

This login area is for Library Staff Only all other accounts will be denied. If you are trying to access your Library Account please visit here or click "Access Library Account" at the top of the page.
Source: lexpublib.org

Kentucky Court Finds Insurer Did Not Commit Bad Faith in Delaying UM Benefit Payment Until Medicare Lien Was Determined

The insurer attempted to determine the value of Medicare’s lien and asked for permission to discuss the lien with Medicare. The claimant refused the request and instead asked the insurer to deposit the full policy limits into an escrow account from which the Medicare lien would be paid. The claimant agreed to hold the insurer harmless from any claim by Medicare; however, Medicare was not involved in and not bound by this agreement. As an alternative, the insurer suggested including Medicare as a payee on the settlement check. Claimant also rejected this request. Finally, the insurer decided to await Medicare’s determination of the value of the lien and then issue separate checks to Medicare and plaintiff.
Source: badfaithblog.net

Managed Care Lawsuit Watch

The Third Circuit upheld the District Court’s dismissal of the complaint, finding that Plaintiffs failed to allege any facts to demonstrate that “MUA procedures were ‘medically necessary’ for the particular patients who received them.” It also rejected Plaintiffs’ argument that the AMA’s assignment of a CPT code to MAU procedures automatically rendered them medically necessary and not experimental. The Court cited the introduction to the CPT Codebook, which indicated that inclusion of a procedure did not represent an endorsement of the procedure or that the procedure would be covered under any health insurance policy. But even if the CPT Codebook suggested that the MUA treatment was consistent with national standards, the Court held that Plaintiffs still could not demonstrate that MUA treatments would be considered safe and effective for treating the individual patients at issue in the suit—something the relevant plans required for the procedures to be considered “medically necessary.” As such, if the MUA treatments were not medically necessary or were experimental under the terms of the relevant plans, “routinely denying coverage for such procedures would have been consistent with the terms of those plans.” Consequently, UnitedHealth did not abuse its discretion in denying reimbursement to Plaintiffs.
Source: crowell.com

blue cross medicare florida

Posted by:  :  Category: Medicare

First Coast Service Options Inc. (FCSO) is the Medicare administrative contractor for jurisdiction 9, which includes Florida, Puerto Rico, and Related links: etymology of word football free witchcraft spells computers guitar hero 2 youtube top 100 hip hop downloads letter people using twitter that 70s show tv guide clock samples for windows vista
Source: posterous.com

Video: Florida Blue Medicare

Florida Blue Is New Name for BCBS of Florida

They are also trying to decrease or hold steady their Medicare supplement rates while competitor AARP is increasing their supplement rates by 5%.  This new approach is a welcome change from the old BCBS of Florida who seemed to rely on their name recognition and less on robust benefits or a value based approach.  In less than a week the new benefit information for 2013 will be released.  Starting on October 15th you will be able to enroll into one of the Florida Blue plans if you want.  I will have updated information on this site so check back regularly.  If you have not already, sign up for my free mini-course in the upper right hand corner!
Source: medicare-plans.net

Florida Blue Partners with Healthways to Offer SilverSneakers® Fitness Program Through 2015

Healthways (NASDAQ: HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: insidesouthflorida.com

State Roundup: Colo. Gov. Wants $18.5M For Expanded Mental Health Care

Stateline: Connecticut Health Agency Fights Desperation Among The Uninsured At 68, Maureen Smith has short, blonde hair, fashionable dark-framed glasses, and a soft, measured way of speaking that is the aural equivalent of comfort food The last is a particularly valuable trait because Smith frequently finds herself on the opposite end of the telephone with someone at the edge of desperation, if not a good deal beyond it. It might be a mother distraught after her teenage son has been rushed to an emergency room following a suicide attempt and her insurance carrier balks at paying for his hospital admission. It might be an elderly man enraged over a $75,000 hospital bill for a hip procedure that his insurer says it will not cover because it regards the operation as “experimental.” Or it might be a young woman in tears because her insurance company will not pay $8,000 for a “safety bed” for her five-year old son whose cerebral palsy causes him to thrash about at night, keeping his parents sleepless and watchful out of fear that he will hurt himself (Ollove, 12/18).
Source: kaiserhealthnews.org

Daily Kos: Romney and Bain profited from massive Medicare Fraud

Meteor Blades, grytpype, OkieByAccident, JWC, buffalo soldier, Sylv, TXdem, zane, CJB, Sean Robertson, Chi, MadRuth, murphy, grollen, askew, BigOkie, Outsourcing Is Treason, greenbird, bosdcla14, karlpk, sara seattle, Shockwave, Psyche, jazzizbest, Sherri in TX, donna in evanston, Wintermute, Andrew C White, SanJoseLady, hyperstation, jdld, mslat27, Mnemosyne, movie buff, TX Unmuzzled, saluda, frisco, SallyCat, MarkInSanFran, hubcap, Creosote, davelf2, dweb8231, TexasDemocrat, Bugsby, Paulie200, concernedamerican, bronte17, 88kathy, TracieLynn, sponson, indybend, howd, susakinovember, ellefarr, highacidity, sayitaintso, stevej, themank, Minerva, Jeffersonian, mkfarkus, barath, Aquarius40, farmerhunt, chimpy, Frederick Clarkson, pollbuster, ivote2004, itskevin, oceanview, kitebro, Cedwyn, jted, antirove, Chrisfs, revsue, Lilyvt, kharma, dejavu, psnyder, TexDem, Miss Jones, roseeriter, duncanidaho, wdrath, Jujuree, manwithlantern, Steveningen, RuralLiberal, Tillie630, papercut, rlharry, 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Pickering, realwischeese, sfarkash, 57andFemale, Tortmaster, jfromga, jan0080, Livvy5, schnecke21, Leftcandid, Larsstephens, Lefty Ladig, ruscle, cassandraX, Clyde the Cat, Amber6541, hotdamn, smileycreek, just like that, icemilkcoffee, roadbear, The Jester, NJpeach, eXtina, estreya, drainflake77, gramofsam1, Susan from 29, Observerinvancouver, blueyescryinintherain, vixenflem, secret38b, fidellio, Anima, Crabby Abbey, LOrion, mjbleo, Garfnobl, RJP9999, Eddie L, gulfgal98, pixxer, ItsSimpleSimon, Kristina40, itswhatson, elengul, MsGrin, BlueFranco, ericlewis0, Floande, eclecta, USHomeopath, debk, Anne was here, whatever66, Actbriniel, slice, Quantumlogic, Mike08, Maximilien Robespierre, spindr27, TAH from SLC, kerflooey, surfermom, muzzleofbees, mama jo, I love OCD, Dretutz, ozsea1, sfcouple, afisher, Mr MadAsHell, freesia, BPARTR, anyname, FarWestGirl, pbgv23, skip945, KelleyRN2, Alice Olson, trumpeter, mrsgoo, Haf2Read, marleycat, PorridgeGun, zukesgirl64, Kokomo for Obama, Cinnamon, sethtriggs, Cinnamon Rollover, thomask, BarackStarObama, muddy boots, rk2, Grandma Susie, createpeace, DeviousPie, antooo, peregrine kate, VTCC73, Caddis Fly, Jamie Sanderson, Andrew F Cockburn, SNFinVA, randomfacts, Vatexia, Pope Buck I, MattYellingAtTheMoon, Sunspots, thejoshuablog, DRo, Mentatmark, CoyoteMarti, Auriandra, DEMonrat ankle biter, ParkRanger, Nashville fan, ArtemisBSG, No one gets out alive, johnnr2, bearette, AnnetteK, Only Needs a Beat, jacey, ridemybike, gnostradamus, Liberal Granny, JTinDC, RhodaA, OldDragon, TheLizardKing, HotAsMaPacman, Siri, IndieGuy, James Renruojos, OneVoice IN 4th, S F Hippie, orangecurtainlib, barkingcat, a2nite, Deep Texan, rukidingme, HoofheartedBC, congenitalefty, Horace Boothroyd III, This old man, Mike RinRI, Karelin, Spirit Dancer, TBug, My Name Isnt Earl, Arahahex, MartyM, marking time, wxorknot, redstella, Vote4Obamain2012, arizonablue, Victim of Circumstance, Kinak, ItsaMathJoke, dotdash2u, wasatch, databob, Melanie in IA, Robynhood too, Ron Ebest, Near Miss, Lily O Lady, Blue Bell Bookworm, DamselleFly, ebailey, The grouch, Herodotus Prime, Late Again, dear occupant, patchmo13, parsonsbeach, howabout, Icicle68, bob152, ET3117, tngirl, blue91, ChristineM
Source: dailykos.com

Increasing Medicare Age Increases American Health Care Spending

Posted by:  :  Category: Medicare

Lots of those 65 and 66-year-olds will need Medicaid. That will cost the federal government about $8.9 billion. Lots of those seniors will go to the exchanges for insurance. That will cost the federal government about $9.4 billion in subsidies. Oh, that Medicaid will cost states too, about $700 million. The 65 and 66 year olds getting insurance from their employers will cost them about $4.5 billion (they’re expensive). As I’ve reported before, Medicare premiums will go up ($1.8 billion), and exchange premiums will go up ($700 million). And, there will be increased out-of-pocket spending by the 65 and 66-year-olds themselves for premiums, deductibles, co-pays, etc. Add it all up. To save the federal government $24.1 billion, we need to spend $29.8 billion.
Source: keystonepolitics.com

Video: Keystone 65 BlueCross

Medicare Open Enrollment Information Session

Independence Blue Cross is hosting a community meeting for residents 65 years or older to discuss Medicare’s Annual Open Enrollment period. From October 15 through December 7, residents with Medicare can make changes to their plan and adjust coverage to ensure they are receiving the benefits they need at the cost they can afford from the doctors and hospitals of their choice. This information session will review Medicare options for Bucks County residents, including IBC’s new $0 premium Keystone 65 Select Medicare Advantage HMO plan. The meeting is free but registration is required because space is limited.
Source: patch.com

Access towards the finest health services in the lowest charges with Blue Cross Keystone 65

Capabilities of Blue Cross Keystone 65: Blue cross keystone 65 is one of the best medicare plans that are accessible to us at an cost-effective price tag. So that you can enroll one’s name in this plan, one particular have to need to only fill within the request form. The essential function of a blue cross keystone 65 program includes: Important and cash saving extra are offered Members obtain remedy and care from a network of main care physicians, specialists and so on. Demand only a small copayment to go to the physician or physician An added coverage is becoming provided for routine vision, preventive care and hearing care.
Source: healthinsuranceconsult.com

Blue Cross Keystone 65 is best for the aged people

For those who desire to apply for plans with prescriptions, this has also been covered by Keystone 65 Choose HMO. For Keystone 65 Select HMO the price which includes the prescription is $42.10 per month. There are covered various preventive solutions by this new Keystone 65 Pick HMO strategy that too without having any co-pay. Silver Sneakers, which is fairly well-liked, has also been included in this new strategy. This service makes it possible for the members to join a major health club membership with no the must make any payment. Within the regions of greater Philadelphia there are over 200 gyms that are participating in this plan.
Source: co.uk

Medicare Open Enrollment Information Session

Independence Blue Cross is hosting a community meeting for residents 65 years or older to discuss Medicare’s Annual Open Enrollment period. From October 15 through December 7, residents with Medicare can make changes to their plan and adjust coverage to ensure they are receiving the benefits they need at the cost they can afford from the doctors and hospitals of their choice. This information session will review Medicare options for Delaware County residents, including IBC’s new $0 premium Keystone 65 Select Medicare Advantage HMO plan. The meeting is free but registration is required because space is limited.
Source: patch.com

Medicare Open Enrollment Information Session

Independence Blue Cross is hosting a community meeting for residents 65 years or older to discuss Medicare’s Annual Open Enrollment period. From October 15 through December 7, residents with Medicare can make changes to their plan and adjust coverage to ensure they are receiving the benefits they need at the cost they can afford from the doctors and hospitals of their choice. This information session will review Medicare options for Montgomery County residents, including IBC’s new $0 premium Keystone 65 Select Medicare Advantage HMO plan. The meeting is free but registration is required because space is limited.
Source: patch.com

Healthways Extends Partnership with Independence Blue Cross

 Fitness Program to eligible Independence Blue Cross (IBC) members. SilverSneakers will continue to be offered to eligible IBC members in Bucks, Chester, Delaware, Montgomery and Philadelphia counties in Pennsylvania, and members of IBC affiliate AmeriHealth HMO in Burlington, Camden, Cumberland, Gloucester and Salem counties in New Jersey. In Pennsylvania, SilverSneakers will be available to IBC Medicare eligible members enrolled in Personal Choice 65 PPO, Keystone 65 Preferred HMO, and Keystone 65 Select HMO. In New Jersey, AmeriHealth 65 Preferred HMO plans will offer SilverSneakers.
Source: distilnfo.com

Owner of Brooklyn Clinic Pleads Guilty in Connection with $71 Million Medicare Fraud Scheme

Posted by:  :  Category: Medicare

NYC TO WALL ST.: BUSH / CHENEY: DROP DEAD. by eyewashdesign: A. GoldenShelikhova was an owner and manager of a clinic in Brooklyn that operated under three corporate names: Bay Medical Care PC, SVS Wellcare Medical PLLC, and SZS Medical Care PLLC (Bay Medical Clinic). According to court documents, owners, operators, and employees of Bay Medical paid cash kickbacks to Medicare beneficiaries and used the beneficiaries’ names to bill Medicare for more than $71 million in medical services and procedures that were medically unnecessary or never provided, including physician office visits, physical therapy, and diagnostic tests.
Source: brooklynews.com

Video: New York: Medicare Fraud Summit Closing Remarks

Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality

The program is one of several Medicare is launching to make hospitals and doctors accountable for quality and more careful stewards of public money. In October, Medicare also began reducing payments to 2,217 hospitals because too many of their patients ended up back in their care within a month. Medicare already gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
Source: kaiserhealthnews.org

Grappling With Details of Medicare Proposals

Still, it’s clear the proposed changes would shift costs from the federal government to retirees. An early version of a Republican plan would have more than doubled out-of-pocket health expenses for older adults, to $12,500 in 2022, the Congressional Budget Office estimated. “All scenarios will require seniors to pay more,” said Robert Moffit, senior fellow at the Heritage Foundation, a conservative research organization in Washington. To think otherwise, he said, “is a fantasy.”
Source: nytimes.com

Brooklyn, N.Y., Physician and Clinic President Pleads Guilty to Medicare Fraud Scheme

According to court documents, Ho Yon Kim, 86, of Flushing, N.Y., was the president of URI Medical Service PC and Sarang Medical PC, both doing business in Flushing, and purportedly providing physical therapy and electric stimulation treatment. He was also a rendering physician at both clinics. Kim pleaded guilty in Brooklyn federal court before U.S. Magistrate Judge Marilyn D. Go to a superseding information charging him with conspiracy to commit health care fraud.
Source: jameshoyer.com

Do Republicans Want to Cut Medicare?

The Republican positioning on Medicare has set the tone for the current budget impasse. Obama is asking for $1.6 trillion in higher tax revenue. Republicans are demanding more spending cuts, but they won’t say how much they want, let alone what specifically they will cut. The current party thinking on Medicare, sanctified by Romney and Ryan, has defined itself as matching or even outspending Obama on Medicare for anybody aged 55 and up. That would lock out any budget savings at all for the next decade, and make any savings roll in extremely slowly afterward.
Source: nymag.com

Which States Will Boost Medicaid Physician Pay the Most in 2013?

Primary care physicians who treat Medicaid patients in Rhode Island, New York, California, Michigan, New Jersey and Florida may be able to breathe a little easier next year, as their Medicaid pay rates are estimated to increase more than 100 percent, according to a report from The Kaiser Commission on Medicaid and the Uninsured (pdf). Under the Patient Protection and Affordable Care Act, states will have the option to expand Medicaid coverage to more people. Because of this, the PPACA also included a rule that would increase Medicaid payments for certain primary care physicians to Medicare rates over the next two years, starting this January. In November, CMS released a final rule indicating that all primary care physicians in specialties of family medicine, general internal medicine or pediatric medicine (and related subspecialties) will be paid Medicare rates for Medicaid primary care services for calendar years 2013 and 2014. In the Kaiser Commission’s report, analysts looked at which physicians would benefit the most from the final rule based on their state’s Medicaid-to-Medicare fee ratio. For example, across the entire United States, Medicaid payments to primary care physicians are 58 percent of comparable Medicare payments. Primary care physicians are paid the least for Medicaid services in Rhode Island, New York, California, Michigan, New Jersey and Florida. Physicians in Rhode Island are expected to see a 198 percent raise in Medicaid payments in 2013 — the most of any state. Here are the states with the largest and smallest estimated Medicaid fee increases to primary care physicians in 2013, based on the Kaiser Commission’s report. 10 largest increases in 2013 Rhode Island: 198 percent New York: 156 percent California: 136 percent Michigan: 125 percent New Jersey: 109 percent Florida: 105 percent Pennsylvania: 96 percent Illinois: 93 percent Indiana: 87 percent Hawaii: 79 percent 10 smallest increases in 2013 North Dakota: 0 percent Alaska: 0 percent Delaware: 2 percent Oklahoma: 3 percent Wyoming: 4 percent Montana: 7 percent Mississippi: 11 percent Idaho: 13 percent North Carolina: 18 percent Vermont: 22 percent
Source: beckershospitalreview.com

Daily Report: Medicare Is Faulted on Shift to Electronic Records

The report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.
Source: nytimes.com

Two Brooklyn Clinic Employees Plead Guilty in Connection with $71 Million Medicare Fraud Scheme

Kostiochenko, Shelikhov, and Zheleznyakov were employees of a clinic in Brooklyn that operated under three corporate names: Bay Medical Care PC, SVS Wellcare Medical PLLC, and SZS Medical Care PLLC (Bay Medical clinic). According to court documents, owners, operators, and employees of the Bay Medical clinic paid cash kickbacks to Medicare beneficiaries and used the beneficiaries’ names to bill Medicare for more than $71 million in services that were medically unnecessary or never provided. The defendants billed Medicare for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy, and diagnostic tests.
Source: geyergorey.com

ObamaCare and Medicaid: More Pre

Michael S. Greve is a professor at George Mason University School of Law. From 2000 to August, 2012, Professor Greve was the John G. Searle Scholar at the American Enterprise Institute, where he remains a visiting scholar. Before coming to AEI, Professor Greve cofounded and, from 1989 to 2000, directed the Center for Individual Rights, a public interest law firm. He holds a Ph.D. and M.A. in government from Cornell University, and completed his undergraduate studies at the University of Hamburg. Currently, Professor Greve also chairs the board of the Competitive Enterprise Institute and is a frequent contributor to the Liberty Law Blog. Professor Greve has written extensively on many aspects of the American legal system. His publications include numerous law review articles and books, including most recently The Upside-Down Constitution (Harvard University Press, 2012). He has also written The Demise of Environmentalism in American Law (1996); Real Federalism: Why It Matters, How It Could Happen (1999); and Harm-less Lawsuits? What’s Wrong With Consumer Class Actions (2005). He is the coeditor, with Richard A. Epstein, of Competition Laws in Conflict: Antitrust Jurisdiction in the Global Economy (2004) and Federal Preemption: States’ Powers, National Interests (2007); and, with Michael Zoeller, of Citizenship in America and Europe: Beyond the Nation-State? (2009).
Source: libertylawsite.org

Prominent Queens Doctor Pleads Guilty To Medicare Fraud

(TM and Copyright 2012 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2012 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)
Source: cbslocal.com

REPORT: NY House GOP Protecting Tiny Minority from Taxes While Aiming Cuts at Social Security & Medicare

“Many members of Congress are sitting on the fence as the fiscal cliff debate rages on. As our report clearly illustrates, the needs of the many outweigh the needs of the few,” said Ron Deutsch, Executive Director of New Yorkers for Fiscal Fairness.  “It’s time for members to jump off the fence and support asking the favored few to contribute just a little more so we can ensure that our seniors and the most vulnerable members of our society get the services our shared social contract has promised them.  Poll after poll shows that the public completely supports rescinding the Bush tax cuts for people making over $250,000 and protecting Social Security and Medicare.  It’s time to listen to the public, not wealthy contributors.”
Source: strongforall.org

Philadelphia Social Security Disability Attorneys

Posted by:  :  Category: Medicare

If you are receiving long-term disability benefits, the Philadelphia Social Security attorneys at Silver & Silver can answer all your questions about the Medicare plans offered and what benefits you are entitled to receive.  Our law offices are located in Ardmore, Pennsylvania, and are easily accessible from communities throughout the Philadelphia area and its surrounding suburbs of Delaware County, Montgomery County, Bucks County, Chester County, and Berks County, as well as in the South Jersey communities of Camden, Burlington, Cherry Hill, Voorhees, Haddonfield, Moorestown, Mt. Laurel, Gloucester, Atlantic County and others. Call us at 1-800-94SILVER (1-800-947-4583) to schedule a free consultation or contact us online.
Source: silverandsilver.com

Video: Social Security Disability Medicare FRAUD

Office of Statewide Benefits provides information on Medicare Parts A, B enrollment

Failure to enroll and maintain enrollment in Medicare Parts A and B upon eligibility may result in the subscriber being held financially responsible for the cost of all claims incurred, including prescription costs. Retirees and spouses enrolled in Medicare Parts A and B must provide a copy of their Medicare Identification Card to be enrolled in the state of Delaware Special Medicfill plan.
Source: udel.edu

The Connecticut Social Security Disability Lawyer Blog: Do I Automatically Get Medicare with SSDI?

…this is definitely one of the questions most often asked by my clients…  Clients also ask me a lot about whether they will get Medicaid.  I will address these questions separately below: MEDICARE: You will receive Medicare after you receive Social Security Disability Benefits for 24 months. When you become eligible for disability benefits, the Social Security Administration will automatically enroll you in Medicare.  It is important to note that Social Security starts counting the 24 months from the month you were entitled to receive disability, not the month when you received your first check.  This two year period starts five months after your disability began.  (This is due to the fact that there is a five month waiting period to receive SSDI.) However, special rules apply to: End-stage renal disease (permanent kidney failure). People with permanent kidney failure get Medicare beginning:
Source: blogspot.com

Pa Work Injury Law: Medicare Posts List of Top Hospitals

In many regions, the hospitals that did the best are not the ones with the most outsized reputations, but regional and community hospitals, according to government records. New York-Presbyterian in Manhattan and Massachusetts General Hospital in Boston, both dominant hospitals in their cities, will have their payments reduced. Other leading names in the hospital industry, including the Cleveland Clinic and Intermountain Medical Center in Utah, will receive bonuses, although not the largest in their regions.
Source: blogspot.com

Tricare Help – I’m on Medicare disability and TFL; do I have to buy Part B?

20/20/20 age appeal catastrophic cap child born out of wedlock claims continued care cost share death DEERS dental dependent disabled divorce doctor doctors FEHBP handbook health care reform hospital ID card marriage maternity care Medicare military treatment facilities other health insurance outside the U.S. parents Part A Part B pharmacy pre-existing condition pregnancy reserves secondary insurance social security spouse supplements surgery Tricare For Life Tricare Prime Tricare Standard Tricare Young Adult Program VA widow
Source: militarytimes.com

Does Medicare or Medicaid Come with Disability?

Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions. Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down. 
Source: disabilitysecrets.com

Settlement Eases Rules for Some Medicare Patients

Neither the Medicare law nor regulations require beneficiaries to show a likelihood of improvement. But some provisions of the Medicare manual and guidelines used by Medicare contractors establish more restrictive standards, which suggest coverage should be denied or terminated if a patient reaches a plateau or is not improving or is stable. In most cases, the contractors’ decisions denying coverage become the final decisions of the federal government.
Source: usbia.org

Adults with Disabilities More Likely to Seek Care in the Emergency Department

“More working age adults have chronic conditions and disabilities,” said Rasch, adding that 53 percent of the U. S. adult population has one or more chronic conditions or diseases. “It’s a cumulative problem as people age and their need for coordinated care becomes greater. We must develop the same, better-coordinated care models for adults that were developed in the late 80s and early 90s for children with special health care needs.”
Source: mylocalhealthguide.com

Medigap: Providing Financial Security and Peace of Mind for Medicare Beneficiaries

Proponents of limiting first-dollar coverage in Medigap often cite the findings from a 1970’s RAND experiment to make the case zero cost-sharing leads to higher health care spending.  AHIP commissioned a white paper to examine the relevance of this study to current Medicare beneficiaries. The white paper found that the RAND study “was set in a reimbursement environment far different from today’s Medicare,” and noted that “a higher proportion of Medicare beneficiaries are low income (and low wealth), and so the impact of higher cost-sharing may be magnified for this population.” The authors conclude that “an across-the-board ban on first-dollar coverage Medigap plans is an overly blunt tool for lowering healthcare expenditures and invites adverse, unintended consequences.”
Source: ahipcoverage.com

Altius Health Plans Altius Advantra Medicare Review

Posted by:  :  Category: Medicare

Altius Health Plans offers Medicare health insurance programs for residence of Utah and a county in Wyoming.  Altius Advantra and Altius Advantra Preference are Medicare Advantage HMO plans available in Box Elder, Cache, Daggett, Davis, Duchesne, Morgan, Rich, Salt Lake, Summitt, Tooele, Wasatch, and Weber counties in Utah as well as Uintah county in Wyoming.  Altius Advantra is an HMO-POS plan, and Altius Advantra Preference is a plain HMO only available in Davis, Salt Lake, and Tooele counties.  The coverage does include Part D drug coverage as well as health benefits.  Below is a review of the benefits they offer:
Source: medicare-plans.net

Video: Ultra Support Back Brace – Covered by Medicare

Advantra Medicare Advantage Changes

A major benefit of an Advantage plan is having a limit on your annual maximum out-of-pocket costs but the required coinsurance feature makes it a lot more likely that you will need this benefit compared to other Advnatra Medicare Advantage plans.
Source: affordablemedicareplan.com

Do You Have An Advantra Freedom Medicare Plan??

[…] You can blame this on your congressmen, senators, and yes even the president. The funding for medicare and Medicare has been drastically cut causing  some companies to raise rates and lower benefits. Other companies have simply decided to drop out of the market (which produces less competition). I would suggest writing a letter to your congressman or senator.Source: wordpress.com […]
Source: wordpress.com

Advantra Rx NOT Renewing Their Medicare Contract

one of my customer’s sent me a copy of the letter from AdvantraRX dates October 2. Here is what it says (sorry about typos, i type fast): Dear Mr. Smith, AdvantraRx Preimer by Coventry Life and Health Insurance Company, a stand-alone prescription drug plan with a Medicare Contract, will no longer operate as of January 1, 2011 so your Medicare Prescription drug coverage through AdvantraRx Premiuer will end December 31, 2010. If you want Medicare prescription drug coverage starting January 1, you need to join a new Medicare drug plan by December 31, 2010. Take Action by December 31 to avoid losing drug coverage. If you want Medicare Rx drug coverage after December 31, you need to join another Plan or medicare advantage plan that offers drug coverage. You can join a new medicare drug plan anytime between October 1 and January 31, 2011. However your AdvantraRx Premier coverage ends December 31, so you should join a new medicare drug plan by december 31 to make sure you have drug coverage january 1. If you join a new plan AFTER december 31, your new coverage won’t start until the month after you join. What happens if you don’t join another medicare drug plan? if you don’t join another medicare drug plan by January 31, your next chance to join will be from october 15 through december 7, 2011. You may also have a pay a late-enrollment penalty to join later. The the letter gives a list of a bunch of companies and the 1-800 Medicare number and website. It doesn’t state anything anywhere about automatically enrolling them into another plan if they do nothing. In fact, it states the opposite.
Source: insurance-forums.net

Geisinger Health System will No Longer Participate with Advantra Medicare in 2011

Geisinger Health System is a hospital system in Northeastern PA.  Here is a press release announcing that they will not be considered in network for Advantra Medicare PPO and will not participate with the Medicare HMO.
Source: ritterim.com

Coventry Health Care Adds Cornerstone Health Care (P.A.) to their Advantra Medicare Advantage Provider Network in North Carolina.

Cornerstone Health Care has nearly 300 providers (including primary care and specialty physicians, and mid-level professionals) in more than 70 locations in High Point, Winston-Salem, Greensboro, Summerfield, Thomasville, Archdale, Trinity, Jamestown, Kernersville, Lexington, Asheboro, and Advance.
Source: wordpress.com

Pennsylvania Health Insurance

HealthAmerica’s Commercial and Medicare Advantage Plans Among Tops in Nation for Quality and Service on U.S.News & World Report/NCQA “America’s Best Health Plans 2008-09″ List Harrisburg and Pittsburgh, Pa. – November 10, 2008 — HealthAmerica’s HMO, POS, and Medicare Advantage plans were ranked among the nation’s top 20 best commercial and Medicare health plans according to a joint ranking by U.S.News & World Report and the National Committee for Quality Assurance (NCQA). Nationally, HealthAmerica was ranked 12th among 287 commercial plans; HealthAmerica’s Medicare Advantage plan, Advantra, ranked 18th among 216 plans nationally. HealthAmerica and HealthAmerica Advantra have ranked as one of the top 50 best health plans in the U.S. News/NCQA “Americaýs Best Health Plans” list* every year since 2005. “We are honored to be recognized among the best health plans in the nation,” said Kirk E. Rothrock, president and chief executive officer of HealthAmerica. “We are dedicated to providing the best possible quality and service, so we are pleased to see our efforts recognized by NCQA, U.S. News and World Report, and, most importantly, by our members and our customers.” The National Committee for Quality Assurance and U.S.News and World Report collaborated to rank the nationýs best commercial, Medicare, and Medicaid health plans. The ranking appears in the November 17 issue of U.S.News and on its website www.usnews .com/healthplans HealthAmerica”s and Advantra”s rankings are based on their Healthcare Effectiveness Data and Information Set (HEDISý)** 2008 scores and the results of a Consumer Assessment of Healthcare and Provider Systems (CAHPS) survey of members. HEDIS is a set of standardized performance measures covering effectiveness of care, preventive care, treatment, and customer satisfaction. CAHPS is a standardized survey in which members rate the quality of care and service that they receive from doctors, specialists, office staffs, and insurers. In these ratings, HealthAmerica’s commercial health plans were rated higher than the national average in all 15 key measures of medical services and member satisfaction and higher than the Pennsylvania state average in 12 of the 15 key measures***. HealthAmerica’s HMO, POS, and Medicare Advantage plans’ status of “Excellent” from NCQA was also a factor in determining the U.S. News/NCQA “America’s Best Health Plans 2008″ ranking**** The U.S.News/NCQA “Americaýs Best Health Plans 2008″ list is drawn from measures of prevention, treatment, and customer experience. These measures are compiled in NCQA”s Quality Compass 2008*****, which publicly reports comparative results of more than 400 commercial health plans covering 85 million Americans. Health plans throughout the country were evaluated on issues such as access to care, prevention efforts, treatment of diseases such as diabetes and heart disease, and members were surveyed on their satisfaction to calculate an overall quality score. * “America’s Best Health Plans” is a trademark of U.S. News & World Report. **HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). ***The source for this data is Quality Compass 2008 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. The 12 measures are: Child immunization (combo II), well child visits 3 to 6 years, colorectal cancer screening, prenatal care, first-trimester postpartum care, cervical cancer screening, breast cancer screening, diabetes-lipid profile (screen), controlling hypertension, cholesterol screening for patients with cardiovascular conditions, rating of all health care, rating of health plan. ****National Committee for Quality Assurance accreditation outcomes are: Excellent, Commendable, Accredited, and Denied. Applies to HMO and POS plans. *****Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. About HealthAmerica For over 33 years, HealthAmerica has provided health benefit solutions to employers across Pennsylvania. HealthAmerica offers a broad range of traditional and consumer-directed health insurance products, including managed care, HSAs, self-funded, Medicare, indemnity, nongroup and pharmacy plans. Serving 12,000 businesses and over 660,000 members as of December 31, 2007, in Pennsylvania and Ohio, HealthAmerica offers progressive medical management, innovative wellness programs, and statewide and national provider networks. HealthAmerica is ranked as one of “Americaýs Best Health Plans, 2006″ by U.S. News & World Report; its HMO and POS products have an “Excellent” accreditation by the National Committee for Quality Assurance. HealthAmerica has corporate offices in Pittsburgh and Harrisburg, Pennsylvania, and employs over 2,200 people in the commonwealth.
Source: blogspot.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org