Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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Source: medicare.gov

Video: Medicare Open Enrollment Preparations

535 people change Medicare address to ACT

The Australian Bureau of Statistics uses Medicare addresses to count population per State and Territory. That population data is used by the Federal Government to allocate GST funding to communities. For every year that an ACT resident is not counted, the ACT Government forgoes about $2,500 per person in GST funding.
Source: gov.au

Redesign of Medicare.gov site to improve online experience for beneficiaries

“We did a lot of research into what sort of information beneficiaries and their caregivers really wanted most at their fingertips, and I think users will find this redesign very helpful,” said Acting Administrator Marilyn Tavenner. “We’ve simplified the language and the homepage layout to make it easier and faster for visitors to get answers and a better understanding of Medicare necessary to get more control over their health care.”
Source: newsfromaoa.org

Democrats Heart Medicare Fraudsters

Posted by:  :  Category: Medicare

Love It! Improve It! Medicare For All! Poster - Washington DC by Glyn Lowe Photoworks1. Bookmark us now! Enter Ctrl D to save our URL to your bookmarks 2. Don’t miss an article! Use the RSS feed above or the Email below to stay informed! 3.We look Best with a minimum Screen resolution of 1024×768 and Firefox Browser. It’s Free and Safer than Internet Explorer! Upgrade Now! 4.Below are our Archives and other News and Blog Feeds for your viewing pleasure. Also our Blog Rolls, etc., of other worthwhile contributors to Fair and Balanced News and Commentaries that you won’t find in the Leftist Media that dominates the TV, Radio and Newspapers. Stay Honestly Informed!
Source: wordpress.com

Video: American Economy, Financial Security, Medicare, Social Security, Tax Cuts (2012)

Cops: Fugitive behind $1 million Medicare fraud nabbed in Canada

I personally know of 9 cases here in just one small area of Michigan that total almost 2 million, one defendant sentenced to 10 years and others have fled the country. Does anyone else thinks it time to stop screaming about cuts, and see what it would actually cost if it was administered correctly. Here its mostly Pakistani, Indian, and African doctors that operate for about three to five years before being indighted and then flee before trial. (these are just what I have seen and not a judgement on other well meaning doctors) My mother, for example, has retired from two jobs and has health care coverage for the rest of her life. She is the kind of person that looks at the bill, even if it is not hers. She had a little bit of a health scare and had to go to the hospital. When it was all said and done she found 5 different times that a service was double billed, billed without it being performed, or billed incorrectly. Most of those losses would have been to medicare, because private insurance denies first and pays second.
Source: nbcnews.com

International health insurance, a necessity for Spring vacations, not covered by Medicare

A second option that should be considered by Medicare-covered international travelers is emergency medical evacuation insurance. This type of insurance will provide coverage for medically necessary evacuation and transportation to medical facilities. Without this type of insurance coverage, travelers could easily owe more than $10,000 worth of out-of-pocket medical expenses if they aren’t covered. The service would become extremely useful if policyholders became stranded in a remote rural area without easy access to needed facilities.
Source: benefitspecialists.biz

No fix, more frustration for physicians over Medicare

He brought up the fact that there are many government-imposed mandates, such as converting to e-records, complying with Health Insurance Portability and Accountability Act guidelines and following other regulations. For example, making the switch to the latest edition of the International Classification of Diseases could cost smaller practices an estimated $83,000, Smith said. If the practice cannot keep up with these changes, it can be penalized.
Source: readingeagle.com

Paul Thomas Layman Pleads Guilty In $63 Million Medicare Fraud

HCSN also operated one location in Hendersonville, North Carolina. At the Hendersonville location, Layman served as the clinical director and assisted HCSN owner Armando Gonzalez in obtaining necessary licensing, credentials, and Medicare authorizations for HCSN. According to court documents, from 2008 through 2009, Layman purportedly supervised therapists at HCSN in Hendersonville, including Alexandra Haynes, who was an unlicensed therapist purportedly performing PHP therapy to HCSN patients. For their roles in the conspiracy, Gonzalez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering, and Haynes pleaded guilty to one count of conspiracy to commit health care fraud. On Monday, February 25, 2013, Gonzalez was sentenced to serve 168 months in prison for his role in the scheme.
Source: newsroom-magazine.com

Ambulance owner convicted in $1.7 million Medicare scheme

This case is being prosecuted by Trial Attorneys Christopher Cestaro and Laura M.K. Cordova of the Criminal Division’s Fraud Section with assistance from former Special Assistant U.S. Attorney James S. Seaman. The case was investigated by the FBI, HHS-OIG and the Texas Attorney General Medicaid Fraud Control Unit. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Source: ems1.com

New Lobbying Group Launched to Support Medicare Reimbursement Overseas

The group is currently in the application process of a 501(c) (4) designation by the Internal Revenue Service.  Section 501(c)(4) of the Internal Revenue Code provides for the exemption for educational and scientific organizations which are not organized for profit and no part of the net earnings of which insures to the benefit of any private shareholder or individual. The MTA and IHRC will be meeting in person Oct. 24 at 2 PM at the 5th Annual World Medical Tourism & Global Healthcare Congress, held on the beach in Ft. Lauderdale/Miami.
Source: drprem.com

Obama Talking Medicare, Social Security Cuts

U.S. President Barack Obama is talking to Democrats and Republicans about cutting Medicare and Social Security entitlements, a White House official said. “He’s reaching out to Democrats who understand we have to make serious progress on long-term entitlement reform, and Republicans who realize that if we had that type of entitlement reform, they’d be willing to have tax reform that raises revenues to lower the deficit,” Gene Sperling, director of Obama’s National Economic Council, told CNN’s “State of the Union.” When asked if that means Obama was talking to top congressional leaders, Sperling said, “Well, he just had the leadership in on Friday,” referring to House Speaker John Boehner, R-Ohio, Senate Minority Leader Mitch McConnell, R-Ky., House Minority Leader Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev. Sperling said Obama followed up Friday’s meeting by making phone calls Saturday to rank-and-file senators in both parties who had expressed interest in “the type of grand bargain that Bowles-Simpson have called for, that most budget experts called for, that recognize it’s not cutting defense and domestic spending like education and research we need.” Erskine Bowles, a former chief of staff to Democratic President Bill Clinton, and Alan Simpson, a former GOP senator from Wyoming, were co-chairmen of a White House bipartisan deficit-reduction panel created in February 2010 to find ways of reducing the mounting federal debt. The panel’s package of tax and spending changes fell three votes short of the required 14-vote support from its 18 members that would have sent the proposal to Congress for a vote. Sperling didn’t say who Obama spoke with Saturday. Boehner said on NBC’s “Meet the Press” that when he met with Obama Friday they discussed the need to avert an end-of-the-month budget showdown that could result in a government shutdown. Obama “agreed that we should not have any talk of a government shutdown,” Boehner said. “So I’m hopeful that the House and Senate will be able to work through this.” The House is scheduled to vote Thursday on a spending measure that would keep the government running after its current stop-gap funding mechanism elapses March 27. The House measure would provide funding through the end of the fiscal year, Sept. 30, and give new flexibility to the Pentagon to manage $40 billion in cuts it took Friday in the sequester. The sequester is the Washington term for $85 billion in across-the-board federal domestic and military spending cuts triggered when the White House and congressional Republicans failed to reach a compromise on an alternative. The cuts were included in the 2011 deal to raise the federal debt limit. They are projected to run through Sept. 30 and are the first of a decade-long plan to cut spending $1.2 trillion for nearly every federal program, except for military personnel and entitlement programs such as Medicare and Social Security. This year’s cuts represent 2.4 percent of the federal government’s annual $3.55 trillion budget. Sperling, who also appeared on “Meet the Press,” said Obama would work to undo the sequester cuts as part of a broader discussion about deficit reduction. “We will still be committed to trying to find Republicans and Democrats that will work on a bipartisan compromise to get rid of the sequester,” Sperling said. “That’s why the president was calling the leadership on Friday, that’s why he spent his Saturday afternoon calling Republican and Democratic senators who he thinks could be part of a caucus of common sense to help move our country forward,” he said.
Source: hispanicbusiness.com

Senators Urge CMS To Reform Medicare Fraud Prevention Program

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481The OIG report looked into activities from April 2010 to March 2011 and found that the Medicare Drug Integrity Contractor, or MEDIC, program identified most of the few cases referred to law enforcement through passive and external means, such as a fraud hotline, rather than proactive, internal means, such as research and investigation. Specifically, the report found that:
Source: californiahealthline.org

Video: How to report Medicare Fraud

NHSMP: Always Be Aware of Medicare Fraud

As I told Helen, the community is the best defense against Medicare fraud, which is we all need to get involved in the fight to protect Medicare. The National Hispanic SMP can help Medicare beneficiaries protect, detect, and report Medicare, but it also trains beneficiaries, their family members, and caregivers to teach others within the community about Medicare fraud. For more information, call us 1-866-488-7379. Se habla español.
Source: nhcoa.org

Paul Thomas Layman Pleads Guilty In $63 Million Medicare Fraud

HCSN also operated one location in Hendersonville, North Carolina. At the Hendersonville location, Layman served as the clinical director and assisted HCSN owner Armando Gonzalez in obtaining necessary licensing, credentials, and Medicare authorizations for HCSN. According to court documents, from 2008 through 2009, Layman purportedly supervised therapists at HCSN in Hendersonville, including Alexandra Haynes, who was an unlicensed therapist purportedly performing PHP therapy to HCSN patients. For their roles in the conspiracy, Gonzalez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering, and Haynes pleaded guilty to one count of conspiracy to commit health care fraud. On Monday, February 25, 2013, Gonzalez was sentenced to serve 168 months in prison for his role in the scheme.
Source: newsroom-magazine.com

Melgen, Menendez throw spotlight on Medicare, Medicaid fraud

“Normally, federal searches of businesses occur during the day during normal business hours. The fact that this search began on Jan. 29 and lasted some thirty-plus hours and ended Jan. 30, tells us the scope of this search was major,” Ken Boehm, chairman and cofounder of the National Legal and Policy Center, said by email. “Also, the presence of crow bars and drills would seem to indicate that materials being sought were locked up. By any conventional yardstick, all of this activity tells us this is a very serious investigation.”
Source: freebeacon.com

Medicare Fraud Sting Operations by Federal Government Includes Senior Volunteers Spying on Doctors and Health Care Providers: Expect to See More National Stings and Sweeping Arrests of Medical Pros in the Future

As a part of the new resources dedicated to fighting fraud, the Obama Administration has significantly expanded funding for Senior Medicare Patrols – groups of senior citizen volunteers who educate and empower their peers to identify, prevent and report health care fraud. In 2012, the Secretary awarded 54 states and territories with funding to support the Senior Medicare Patrol programs Last year, these programs taught more than 2 million beneficiaries how to look for Medicare fraud. Local Senior Medicare Patrol offices provide assistance when such issues are identified, so that mistakes are corrected and suspected fraud referred to the appropriate authorities. Since 1997, more than 1.5 million seniors and their caregivers have contacted the Senior Medicare Patrol to ask questions or report potential fraud.
Source: dallasjustice.com

Beware of Medicare Fraud Calls

These calls are completely fraudulent. Medicare will NEVER ask for a beneficiary’s Medicare number unless the beneficiary initiates the call, and they will NEVER ask for a bank account number under any circumstances. The only beneficiaries that need to get new Medicare cards are those who are first applying for Medicare coverage, or those who have asked for a new card because their card is lost or damaged.
Source: mauryriversc.org

Cops: Fugitive behind $1 million Medicare fraud nabbed in Canada

I personally know of 9 cases here in just one small area of Michigan that total almost 2 million, one defendant sentenced to 10 years and others have fled the country. Does anyone else thinks it time to stop screaming about cuts, and see what it would actually cost if it was administered correctly. Here its mostly Pakistani, Indian, and African doctors that operate for about three to five years before being indighted and then flee before trial. (these are just what I have seen and not a judgement on other well meaning doctors) My mother, for example, has retired from two jobs and has health care coverage for the rest of her life. She is the kind of person that looks at the bill, even if it is not hers. She had a little bit of a health scare and had to go to the hospital. When it was all said and done she found 5 different times that a service was double billed, billed without it being performed, or billed incorrectly. Most of those losses would have been to medicare, because private insurance denies first and pays second.
Source: nbcnews.com

SCOOTER Store Busted For Medicare Fraud

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program — they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”
Source: addictinginfo.org

Man pleads guilty in Medicare fraud conspiracy

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Source: crainsdetroit.com

Senior Medicare Patrol: Help Stop Medicare Fraud

The Wisconsin Council of Churches and CWAG want seniors to be trained to detect Medicare fraud and help keep our health care costs under control. For more information about how to get involved, or to secure a speaker to come and address your seniors group, please check out the Wisconsin Senior Medicare Patrol website at www.wisconsinsmp.org or call Judy Steinke Wisconsin SMP Volunteer Coordinator at 800.488.2596 ext. 342.
Source: cwagwisconsin.org

Examples of Medicare Fraud

“One doctor ordered so many unnecessary blood tests that he was given the nickname ‘Dracula’ investigators said. Similarly, a high level of fraud was found in the companion Medicaid program. One doctor received $2 million in Medicaid payments over two years for performing”abortions” on women who were not pregnant. The women were misled about the results of their pregnancy tests.”
Source: lewrockwell.com

Summit Medigap: What Is Medicare Supplement Plan F?

Posted by:  :  Category: Medicare

The basic and original coverages provided by Medicare are Part A (hospitalization) and Part B (doctor visits and required medical equipment). Currently, there are at least 11 supplement plans referred to as Medigap policies that fill any coverage gaps involved with Parts A and B. One of these is Plan F. It’s important to know that not every company offers all 11 supplement plans. However, if they do offer at least 2 of them, they are required to offer Plans C and F. Plan F premiums typically cost between $65 and $295 per month. The premium will vary depending on the insurance carrier and the state you live in. Coverage Provided By Plan F The coverage required of Medigap coverage plans is mandated and regulated by the Centers for Medicaid and Medicare. Plan F also has a “high deductible” plan because it will not pay for any type of services covered by Medicare until the plan beneficiary has paid an out-of-pocket minimum of $2,000. Once that deductible has been met, Plan F will cover 100% of the co-insurances, co-pays, and deductibles of Parts A and B including hospice care co-insurance as well as preventative services. If you get the regular Plan F you will have no deductibles or coinsurance. When speaking to an insurance professional it’s important to make sure which Plan F you are being quoted. Comparisons There are only two supplements that covers any deductible expense of Part B, one of which is Medicare supplement Plan F. Additionally, this is the only supplementary plan that covers excess Part B charges. These charges typically accrue if doctors can legally charge more than what Medicare considers as reasonable service charges. Other supplement plans will usually pay for expenses that Medicare classifies as allowable. Finally, the excess amount that is allowable according to Medicare is covered by F. Is Plan F Right For You? Medicare supplement Plan F is viewed as one of the most popular plans because it covers 100% of the gaps encountered with Plans A and B meaning that it provides the highest amount of coverage of any of the Medigap insurance plans. For many individuals, the plan may seem a bit confusing initially. However, if you answer a few questions, it will not only explain the plan more thoroughly, you will be able to decide whether or not it is right for you. Basically, if you are someone who is willing to pay for 100% coverage, then this plan is tailored to meet your personal needs. With Medicare supplement Plan F, your only expenses will be your monthly premiums. For more information regarding this supplement plan, you can visit the official Medicare website or speak to a licensed insurance professional.
Source: blogspot.com

Video: Medicare Supplement plan F High Deductible Explanation

joydukesinty: Medicare Health Insurance Supplement Plan F

Exactly how. Your about to go on Medicare, and your mail window and phone actually are being inundated due to eager sales workers and insurers expecting you to for sale sign up with the whole bunch. So, you want to assist you to out smart every one of them and go for the and try to actually wade through miles of information in regards to Medicare-Medigap- plans. You have good intentions but supply in and go to a website exactly who promises multiple prices from different carriers and agents. Now you in control and you have your market face on. You fill out and the form along with push that magic button. Yes, I did out. may have heard of as effectively of the Parts C Medicare Gain Plan, sometimes known as as Medicare Replacement Plan or Medicare Alternative Plan. Because this statement seems to mix both medicare parts, the medicare favour plan looks resembling a good option. Note however the idea only a limited number of doctors and hostipal wards accept this agenda as this method is a privatized Medicare introduced at the time of for-profit insurance agencies. In addition e that, you will still pay for the purpose of the part Ful premiums and turn into ineligible to end up getting a medicare merchandise insurance plan simply because medicare supplement delivers not include filling the gaps created by part C. Overall, Medicare Supplement Plan F, G, and N are the three most popular intentions of the market. With the state of the economy, the general public are looking to build good coverage at an affordable price. In this is what situation, Medicare Vitamin and mineral Plan G is actually usually recommended. Medicare insurance complement insurance will not some subject that should exchangeable you or make you’re feeling overwhelmed. Just consider the spare time to learn over each with our own twelve ideas obtainable, and select make certain that functions surprisingly best for families. Then, you are able to visit and / or maybe get in affect with private automobile insurance businesses to determine which companies now have the best expenses around the coverage that you aspire or need. Choosing a non-public business is going to be completely subjective. Significant image that you’ll are required to store a close to and look at the charges can are able time for get, as adequately because the products that every agency offers, to decide on the best 1 independently. Medicare insurance originally is thought as Part A, and hospital insurance as well Part B, can be medical insurance. This original an insurance plan allows for a number of but not every medical or health related service and nourish. There is insurance available, called Medigap along with Online Medicare Supplement Plan Comparison and Rates that covers expenses that are not covered under the general Medicare Part Another and Part G. This includes things regarding copayments, coinsurances, insurance deductibles and expenses when traveling outside of united states. Believe it not really the out regarding pocket expenses will add up very quickly and before you know it you may well easily paid often the monthly premium of this Medicare Supplement Package. In general, all men and women 65 years old or older who have been legal consumers of the United states for at least amount of 5 years meet the requirements for Medicare. Also, all together with disabilities in that this United States, so long as their condition(s) is/are congenital or otherwise not permanent, are naturally entitled to Medicare, regardless of age bracket. This is due on the fact that such disabled people furthermore inherently entitled and Social Security Issues Program (SSD); assigned their involvement as part of SSD, physically incompetent people both aged old are automatically entitled to Medicare insurance. You may get insurance about most of the health expenses in order to might incur at the time of purchasing Medicare Fraction C and Medicare insurance Part D, the best Medicare Part C plan that guarantees prescription drugs or a Medicare Dietary supplement policy and Treatment Part D. Medicare health insurance is health policies for people getting older 65 or older, under 65 complete with certain disabilities otherwise any age with End-Stage Renal (permanent kidney failure). More or less virtually every event, after you buy in a build at one these sorts of insurance policy web-sites, you will include Five and via a flight realtors contacting your primary self the phone and seeking to positively market the plan that creates these people the most fee. By way of example, a female, non-tobacco consumer, age sixty seven and consequently dwelling in Macon, GA would expend 5 per thirty days for Medigap prepare F from Black Cross. Should it be she have begun a very watchful shopper she can easily come across not less than fifty percent twelve month period carriers providing the identical method for as the tiny as 6 per 30 days to weeks.
Source: blogspot.com

Medicare Supplement Plan F

At first glance this doesn’t make any sense at all since I just told you that it was more expensive on a monthly basis, but when you break down what it covers and the risk involved the Medicare supplement plan f will save you money in the long run.  With the coverage gaps left by Medicare Part A and Part B you can choose any of the ten Medicare supplement plans.  The problem is that each plan covers a different amount or combination of those coverage gaps.  So if you choose plan A you are still open to extra costs from a need for skilled nursing care, the Medicare part A deductible of $1,156, the Medicare part B deductible of $140 annually, any foreign travel expenses, and an charges that fall under Medicare Part B that are above the Medicare approved amount.  In this example if you went into your doctor’s office he would charge you $140 before any of your coverage comes into play.  If that same doctor decided you need to be admitted to the hospital you would then owe the $1,156 for being admitted.  After that you would be subject to additional charges if they moved you to a skilled nursing facility.  Just one quick incident can add up fast and instead of worrying about all this you can moderate your life by just getting a Medicare supplement plan F.
Source: dzida.org

Facebook and Medicare Supplement Plan F in New Jersey

Can you find a Medigap plan F in New Jersey?  Absolutely, but the companies that sell Medicare Supplements in NJ are fewer than other states like Pennsylvania.  If you search Google or Facebook, you may find there are a lot of insurance companies that sell Medigap policies.  In NJ, the Medicare rates for supplements are higher than some states and not as many companies are giving medigap quotes.  Not only is Medigaplist on FB but also Google+, Tagged, Yahoo Answers, LinkedIn, Stumbleupon, Digg, Delicious, and even MySpace.
Source: medigaplist.com

Medigap (Medicare Supplement) Plan F or Plan G?

Isabel Hogue is a licensed insurance agent offering health insurance plans to people over age 65 and under age 65 on disability. Serving the Lafayette, Indiana area — Tippecanoe and surrounding counties. Isabel Hogue is proud to be an independent insurance agent and not employed or contracted by the Federal government. Isabel Hogue may be compensated based on your enrollment in a plan. Call 765-714-4202.
Source: typepad.com

What is the Cadillac Medicare Advantage plan

A plan’s network of providers: People often think Medicare Advantage plans are only offered as part of healthcare management organizations (HMOs), but many are also preferred provider organizations (PPOs). With HMOs and PPOs, insurance companies typically have a list doctors, specialists and hospitals that are preferred so when you go to those providers, you presumably pay a lower price for care. Either that, or the insurer covers more of your out of pocket costs, or both. Your costs typically differ if you get “in network” care versus “out of network” care. You’re more likely to think of a plan that includes your doctors, specialists and hospitals at a lower price to be a Cadillac plan.
Source: ehealthinsurance.com

Greatest Medicare Supplemental Indemnity For Better Benefits

Casually that there could be more to our own actual cost akin to Medicare than an initial premiums with regards to Medicare Part Any and B. You will have co-pays and subjected office visits to meet. This is even the different picks in Medicare extra insurances come on the road to play. Medicare insurance supplemental plans while policies help that will cover deductible and additionally co-pays. Individual policy offers a variety of coverage options. You will would prefer to determine exactly what policy will give good results best for your situation.
Source: plaintiffs-law.com

Medigap Plan F Discontinuance for 2014? « Insurance News from Crowe & Associates

Utilization for people with plan F has trended much higher than that of other supplements.  If someone is paying for a plan that will cover all of their Medical expenses, they are probably going to be more inclined to go to the doctor or get a test than someone who has a cost share.   Given that Medicare is primary when using a supplement, people with a plan F supplement are utilizing more than someone without a plan F supplement.
Source: croweandassociates.com

West County Podiatrist Sentenced For Medicare Fraud

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481According to court documents, during 2008-09, Dr. Dailey requested reimbursement from the Medicare program, falsely claiming that he had examined and treated three patients in his office.  Actually, he was on vacation and outside of the State of Missouri on the dates of these office visits, taking trips to Las Vegas, Nevada and Honolulu, Hawaii.  In his plea agreement, Dr. Dailey admitted that he held and abused a position of trust as a Medicare provider and licensed podiatrist when committing these crimes.
Source: patch.com

Video: Medicare Fraud Case

Senators Urge CMS To Reform Medicare Fraud Prevention Program

The OIG report looked into activities from April 2010 to March 2011 and found that the Medicare Drug Integrity Contractor, or MEDIC, program identified most of the few cases referred to law enforcement through passive and external means, such as a fraud hotline, rather than proactive, internal means, such as research and investigation. Specifically, the report found that:
Source: californiahealthline.org

How big is Medicare fraud?

The government is working on the problem. In 2012, the Department of Justice and the FBI together recovered $4.2 billion in fraudulent payments. They opened 1,311 new criminal health care fraud investigations involving 2,148 defendants. Once these crooks are convicted, the Affordable Care Act authorizes more jail time. Medicare scammers will receive 20 percent to 50 percent longer sentences for crimes that involve more than $1 million in losses.
Source: bankrate.com

Man pleads guilty in Medicare fraud conspiracy

If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.com

Ambulance owner convicted in $1.7 million Medicare scheme

This case is being prosecuted by Trial Attorneys Christopher Cestaro and Laura M.K. Cordova of the Criminal Division’s Fraud Section with assistance from former Special Assistant U.S. Attorney James S. Seaman. The case was investigated by the FBI, HHS-OIG and the Texas Attorney General Medicaid Fraud Control Unit. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Source: ems1.com

Cops: Fugitive behind $1 million Medicare fraud nabbed in Canada

I personally know of 9 cases here in just one small area of Michigan that total almost 2 million, one defendant sentenced to 10 years and others have fled the country. Does anyone else thinks it time to stop screaming about cuts, and see what it would actually cost if it was administered correctly. Here its mostly Pakistani, Indian, and African doctors that operate for about three to five years before being indighted and then flee before trial. (these are just what I have seen and not a judgement on other well meaning doctors) My mother, for example, has retired from two jobs and has health care coverage for the rest of her life. She is the kind of person that looks at the bill, even if it is not hers. She had a little bit of a health scare and had to go to the hospital. When it was all said and done she found 5 different times that a service was double billed, billed without it being performed, or billed incorrectly. Most of those losses would have been to medicare, because private insurance denies first and pays second.
Source: nbcnews.com

Medicare Fraud – 90 individuals arrested

Medicare Fraud Strike Force Operations in seven cities have led to charges against 91 individuals – including doctors, nurses and other licensed medical professionals – for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced in late in 2012. Dozens of individuals were arrested or surrendered as indictments were unsealed across the country. Together, those indictments charge more than $230 million in home health care fraud; more than $100 million in mental health care fraud; and more than $49 million in ambulance transportation fraud. HHS also suspended or took other administrative action against 30 health care providers following a data-driven analysis and based upon credible allegations of fraud. Under the Affordable Care Act, HHS is able to suspend payments until the resolution of an investigation. The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators and prosecutors designed to combat Medicare fraud through the use of Medicare data analysis techniques. The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering. According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. In Dallas, 14 individuals – including two doctors and two registered nurses – are charged for their alleged participation in various fraud schemes involving a total of $103.3 million in false billings. In one case, three defendants – a medical doctor and two registered nurses – are charged with participating in a fraud scheme at Raphem Medical Practice and PTM Healthcare Services which led to approximately $100 million in fraudulent billing for home health care services. According to court documents, Dr. Joseph Megwa signed approximately 33,000 prescriptions for more than 2,000 unique Medicare beneficiaries from 2006 to 2011.  Many of these Medicare beneficiaries had primary care physicians who never certified home healthcare services for them.  Seven individuals are charged in Houston for their participation in a fraud scheme at a hospital which led to $158 million in fraudulent billing for community mental health center services. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. To learn more about the HEAT program, please go to: www.stopmedicarefraud.gov
Source: gp1.com

City explores options after The Scooter Store furloughs staff

Hopp said The Scooter Store paid well. In some cases, she says entire families working for the power chair manufacturer at its New Braunfels headquarters. Hopp said her close friend saw the writing on the wall when federal agents raided the headquarters February 20th amid a Medicare fraud investigation. Federal officials said The Scooter Store received as much as $87.7 million in Medicare overpayments from 2009 to 2011.
Source: ynn.com

Medicare for “Dummies”

Posted by:  :  Category: Medicare

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Source: wordpress.com

Video: Medicare for Dummies

swat: Medicare for Dummies

WSJ edit: The thing about the bully pulpit is that Presidents can make the most fantastic claims and it takes days to sort the reality from the myths. So as a public service, let’s try to navigate the, er, remarkable Medicare discussion that President Obama delivered on Wednesday. It isn’t easy. Mr. Obama began by depicting a crisis in the entitlement state, noting that “our health-care system is placing an unsustainable burden on taxpayers,” especially Medicare. Unless we find a way to cauterize this fiscal hemorrhage, “we will eventually be spending more on Medicare than every other government program combined. Put simply, our health-care program is our deficit problem. Nothing else even comes close.”
Source: blogspot.com

Medicare Enrollment Begins Early This Year

[…] LouAnn Lefere Shawver of Priority Health says in the past five years, Medicare enrollment began November 15th and ended December 31st.  This year, enrollment began October 15th and will end December 7, 2011.Source: cbslocal.com […]
Source: cbslocal.com

Medicare Expert Patricia Barry, Ask Ms. Medicare

Eligibility Learn about how you can qualify for health coverage under Medicare. Enrollment Learn about when and how to sign up for Medicare according to your circumstances. Disenrollment Learn about how to opt out of Medicare if you are already enrolled. Out of Pocket Expenses Learn about your share of Medicare costs. Medical Coverage (Part A and Part B) Learn about medical services covered under Part A (hospital insurance) and Part B (outpatient insurance). Prescription Drug Coverage (Part D) Learn about how Medicare’s prescription drug program works. Medicare Private Health Plans Learn about the Medicare Advantage program, an alternative way of receiving Medicare benefits. Sources of Information and Help Learn about how to find personal help on Medicare issues.
Source: aarp.org

DUmmie FUnnies: Sequester disaster! DUmmies blame Rethuglicans!

 training for the military. Push-up training for transgendered female recruits, so they can do five push-ups wearing their specially issued push-up bras. That sort of thing. But no. Can’t cut those things. Planes will fall out of the sky first. Obama’s Obedient Media (OOM) lap it all up. They’ve got Fiscal Cliff 2.0 to play with. Obama’s Obedimedia couldn’t be happier. And the DUmmies–well, the DUmmies of course swallow the snake oil that Our President is selling. We’re all gonna die!! Women and minorities hardest hit! And it’s all the Rethuglicans’ fault. Boehner, he’s the chief villain. Johnny Sequest. Cryin’ Sequest. We’ll look at just a couple of the DUmmieland threads, namely, this THREAD, “Obama Warns Looming Sequester Would Devastate Economy,” and this THREAD, “MSNBC’s Matthews: Sequester Cuts Are a ‘Doomsday Machine.” So let us now go to DUmmieland and witness the deep doom and despair, in Bolshevik Red, while the commentary of your humble guest correspondent, Charles Henrickson, who would prefer to see government spending cut by at least 50%, is in the sequestered [brackets]:
Source: blogspot.com

Medicare liens for dummies

So writes Angelica Wawrzynek in the latest issue of the ISBA YLDNews. And, she wryly observes, “Medicare started having liens on cases after many of your senior partners started practicing, and the procedures for getting these liens resolved have become more and more particular over the years. Make yourself a valuable part of the team by mastering the process.”
Source: isba.org

Medicare Attorney: Personal Finance For Dummies

The bestselling Personal Finance For Dummies has helped countless readers budget their funds successfully, rein in debt, and build a strong foundation for the future. Now, renowned financial counselor Eric Tyson combines his time-tested financial advice along with updates to his strategies that reflect changing economic conditions, giving you a better-than-ever guide to taking an honest look at your current financial health and setting realistic goals for the future.
Source: americastop100attorneys.com

4 More State Partnership Health Insurance Exchanges Approved

Posted by:  :  Category: Medicare

Health Care for Poverty by Korean Resource Center 민족학교HHS added Iowa, Michigan, New Hampshire and West Virginia to the list of conditionally approved partnership health insurance exchanges, which will share design and operation responsibilities between the state and the federal government. So far, 24 states and the District of Columbia will run all or part of their own online marketplaces for health insurance, established as part of the Patient Protection and Affordable Care Act. The rest defaulted to have federal regulators implement exchanges for them.
Source: beckershospitalreview.com

Video: Rick Scott State of State Address

State Health Insurance Exchange Will Provide Gateway to Affordability, Official Says

Under the federal health care reform law, each state can establish purchasing exchanges through which individuals and small businesses can select from a menu of private health insurance policies that meet minimum coverage standards. Individuals will still be able to buy directly from companies or through private brokers, but only those who buy through the exchange will be able to access government subsidies that will be available to those with incomes of up to 400 percent of federal poverty guidelines, or about $93,000 a year for a family of four.
Source: greenlining.org

State officials unveil new Health Insurance Exchange explanatory website

The state defines the Health Insurance Exchange as “a new central marketplace where individuals, families and small employers can access quality, affordable health insurance and receive tax credits or assistance to help pay for coverage. The exchange will empower families, small businesses, and low-income Minnesotans to choose the quality health coverage they need at a price they can afford.”
Source: minnpost.com

Funds Run Low for State Health Insurance ‘High

Tens of thousands of Americans who cannot get health insurance because of preexisting medical problems will be blocked from a program designed to help them because funding is running low. Obama administration officials said Friday that the state-based “high-risk pools” set up under the 2010 health-care law will be closed to new applicants as soon as Saturday and no later than March 2, depending on the state. But they stressed that coverage for about 100,000 people who are now enrolled in the high-risk pools will not be affected. “We’re being very careful stewards of the money that has been appropriated to us and we wanted to balance our desire to maximize the number of people who can gain from this program while making sure people who are in the program have coverage,” said Gary Cohen, director of the Department of Health and Human Services’ Center for Consumer Information and Insurance Oversight. “This was the most prudent step for us to take at this point in time.” The program, which was launched in summer 2010, was always intended as a temporary bridge for the uninsured. But it was supposed to last until 2014. At that point, the health-care law will bar insurers from rejecting or otherwise discriminating against people who are already sick, enabling such people to buy plans through the private market. From the start, analysts questioned whether the $5 billion that Congress appropriated for the Pre-Existing Condition Insurance Plan — as the program is called — was sufficient. Initial fears that as many as 375,000 sick people would swamp the pools and bankrupt them by 2012 did not pan out. This is largely because, even though the pools must charge premiums comparable to those for healthy people, the plans sold through them are often expensive. But it was also because the pools are open only to people who have gone without insurance for at least six months. The result is that, while only about 135,000 people have gotten coverage at some point, they are proving far more costly to insure than predicted. Many people who are uninsured go untreated, exacerbating their medical problems. When they finally do get coverage through a high-risk pool, they are in immediate need of expensive care. “What we’ve learned through the course of this program is that this is really not a sensible way for the health-care system to be run,” Cohen said. Of the original $5 billion, about $2.36 billion remains available for the last three quarters of 2013 — enough only to continue coverage for those already in the pools, according to administration estimates. The law gave states the option of either administering their pools directly or allowing federal authorities to operate them. In 27 states that have chosen direct management, applications for new enrollment can be accepted only through March 2. In 23 states and the District, where the pools are operated by the federal government, only applications received through Friday will be considered. Obama administration officials said they did not have estimates for how many more people would have sought coverage through the pools beyond then. But Cohen said that new enrollment has averaged about 4,000 people per month in the past several months, suggesting that the figure could number in the tens of thousands. READ FULL SOURCE ARTICLE: 02/16/2013
Source: newmediajournal.us

Daily Kos: Half of states leave health insurance exchanges to the federal government

Setting up a system for 25 states puts a strain on the federal government that wasn’t really planned for in the development of the law. It means a massive ramp-up to Oct. 1, one that has to deal with all the varying existing state regulations and create a mega-exchange. More significantly, it’s a massive technological challenge. Because it will essentially be a huge database behind the online interface the public will use, all of the disparate state database systems will have to be reconciled. It’s all about who’s eligible and at what subsidy level, including Medicaid eligibility. So the large exchange will have to merge tax files, immigration status, Medicaid rolls, and more from the varying states. By not participating, these mostly Republican governors are attempting to throw the ultimate monkey wrench into the mix, still hoping to kill the law.
Source: dailykos.com

Health care reform’s impact on medical ministries uncertain

The Episcopal Church, through General Convention legislation, has called for universal access to health care, and 94 percent of the church’s domestic dioceses participate in the denominational health plan. Resolution A040, approved by General Convention in Indianapolis in 2012, directed that “every member of the Episcopal Church make a moral commitment to health care for all, by actively supporting health care reform in the United States.”
Source: episcopaldigitalnetwork.com

Feds look set to run most state health insurance exchanges

The new health insurance exchanges that will be set up by the federal government in those TEA-Republican held regions will provide federally insured backed insurance with protection for the insured. These insurance exchanges will charge insurance companies who want to participate a premium for providing coverage and will adhere to strict guidelines benefiting constituents rather than overpaid CEO’s. The party with the fringe on top who so desperately wanted to limit federal intervention have played into Obama’s hand and an explosion of federal agents and employees will occur. The current leadership of the TEA-Republican House and Senate have vowed to cut funding for the programs helping the middle and marginal class and every improvement of the last(111th) Congress. The current(112th) Congress has been obstructive and reticent to help the president achieve the goals of protecting the people. Every state is in play in the mid-term with representation that must be changed to Democratic. In the next election cycle(the 2014 mid-terms) every effort to recognize who is running under which banner must be made as radical TEA-types used the (R) when they should have used the scarlet (T). The TEA-Evangelical-Libertarian-Republican radicals have all tried to get their candidate in line for the run, but they used the (R) when they ran and should have used the (T), (E) or (L) so the voting public could determine exactly who was running and what he stood for. The public’s best bet is to vote for the Democratic side in the 2014 Mid-terms. Every effort to increase the number of swing states to twenty or more with concentration on getting everyone eligible to vote registered to vote. The 2014 Mid-term is crucial to ousting as many of the radical extreme and garner a democratic Congress. And the 2014 Mid-terms are a-coming!
Source: nbcnews.com

Minnesota Facing Bigger Bill For State’s Health Insurance Exchange

ST. PAUL, Minn. — Minnesota’s state health insurance exchange will cost $54 million in 2015 to operate, according to the Gov. Mark Dayton administration. The cost comes in at greater than earlier estimates of $30 to $40 million. The state would not have to find the money until 2015, when the state exchanges are required to be financially self-sustaining. But the cost rises to a projected $64 million in 2016. State officials are still weighing how the exchange will pay for itself. Options include user fees, a sin tax, and selling ads. The exchange, a cornerstone of the federal health care overhaul, will create an insurance marketplace where consumers and small businesses can comparison shop for health insurance policies starting in October of next year. Coverage would take effect in 2014. The Dayton administration also announced it will seek an additional $39 million to fund development of the state’s exchange. If the federal government approve the additional grant, Minnesota will have received a total of about $110 million from the feds. The new financial details emerged earlier this month when the state submitted its application for the exchange to the federal government.  Many states are behind in their plans for exchanges, and the Obama administration has already agreed to a request by Republican governors for more time to decide whether they’ll build their own state exchange or use the federal alternative. The federal government extended that deadline to Dec. 14.
Source: kaiserhealthnews.org

Feds Approve 8 More State Health Insurance Exchanges For A Total Of 20 – Consumerist

The federal government has given the thumbs up to eight more states that will be able to run their own health insurance exchanges, with seven of them being wholly in charge of the process and one, Arkansas, working with the feds on its program. California, Hawaii, Idaho, Nevada, New Mexico, Vermont and Utah are all approved now as well, for a total of 20 states with exchanges.
Source: consumerist.com

Expand Medicaid to provide quality health insurance

Posted by:  :  Category: Medicare

Carolyn Comeau On The Impact Of Health Insurance Reform by Leader Nancy PelosiExpanding Medicaid also ensures that older Iowans have access to nursing care and other long-term care. Medicaid expansion has broad support in Iowa, including the AARP, the National Alliance on Mental Illness, and the Iowa Hospital Association. It’s time Branstad listened to the people of Iowa and dropped his reckless idea to expand IowaCare, an inadequate program that provides limited benefits and forces people with few financial resources to drive long distances for minimal care.
Source: thegazette.com

Video: Don Gaetz on Medicaid

Medicaid v. Private Insurance in Arkansas

[…] The logic behind the proposed changes rests in the different needs of the “three programs” represented within Medicaid. Those covered by acute care Medicaid (45-50 million persons) most of them pregnant women and children, are relatively inexpensive to care for on a per capita basis. Increasingly, such beneficiaries have trouble finding providers who will care for them, due to a double whammy of stigma (it is insurance for persons who are poor) and the fact that it pays providers below what Medicare pays, which is less than what private insurers pay. This has lead to a systematic access problem for some Medicaid beneficiaries who have trouble finding a physician willing to treat them. There is nothing inherently wrong with the structure of Medicaid; we could decide to make it the best payer of care tomorrow, but that of course, is not going to happen. Buying them into private insurance policies will mainstream their care and remove a layer of cost shifting. [emphasis added]Source: samefacts.com […]
Source: samefacts.com

McCrory wants surplus state money to go to Medicaid

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Source: ncpolicywatch.org

Who now has Medicaid insurance in Pa. and N.J.

Expansion of Medicaid in January is at the core of the federal health-care overhaul’s effort to reduce the number of Americans without health insurance. In June, the U.S. Supreme Court decision on the constitutionality of the Affordable Care Act, however, made Medicaid expansion optional for states, rather than mandatory.
Source: philly.com

What’s the ‘Medicaid Expansion’?

How many older adults could gain access to Medicaid as a result of this expansion? About 4 million uninsured adults ages 46 to 64, including about 1.5 million who are working, according to the AARP Public Policy Institute. Do people on Medicaid pay insurance premiums or other out-of-pocket expenses? Some do, yes. States are allowed to charge some people premiums. They may also allow providers to collect copayments, deductibles and the like. How can I find out if I’ll qualify for Medicaid? Check with the agency in your state that administers the Medicaid program. (Follow this link to find your state’s Medicaid website.) Some states have already expanded their Medicaid programs. If you live in California, Connecticut, Colorado, Minnesota, New Jersey, Washington or the District of Columbia, you may already be eligible for Medicaid even if you were not before. Can states refuse to expand Medicaid? Yes. But the health care law aims to level the Medicaid field nationwide with a powerful incentive: money from Uncle Sam. The federal government will pick up 100 percent of the extra costs a state incurs to expand its program. That will begin phasing down in 2017 and level off at 90 percent in 2020.
Source: aarp.org

Health care workers rally to expand Medicaid coverage

Kate, it’s really not that difficult to understand if you open your mind and switch the channel from Fox News to some other more balanced news outlets including the internet. Just because they say their fair and balanced doesn’t make it so. Hospital workers know that the spiraling cost of providing medical care to the un-insured is not sustainable. They know that the people who are insured are paying for those who are not. The so called charity care provided by hospitals is actually passed on to those of us with insurance in the form of cost increases paid for by higher premiums and reduced benefits requiring higher co-pays and deductibles. Raising Medicaid income qualification to 138% of the poverty level will provide coverage for the working poor trying to do the right thing by becoming part of the workforce and eventually a middle class citizen. A $10K unpaid medical bill can ruin your credit rating which destroys your chances of getting a good well paying job regardless of your qualifications. Furthermore it’s only the republicans in congress spouting the Medicare will go broke cliché and its only true according to the GAO based on the healthcare’s cost increase trend and decreasing revenue stream created by republican tax cuts. This country would be a lot better off if more people would actually take the time to read and understand the facts and make informed decisions at the voting booth. Both political parties at their extreme ends are a crazy lunatic fringe crowd bent on achieving their own utopian vision at any cost. In their world people who compromise with the other side for the good of the country are considered traitors called out by the likes of Mark Levin, Rush Limbaugh and Keith Oberman. Please educate yourself and change the channel.
Source: postonpolitics.com

Economist’s View: Paul Krugman: Mooching Off Medicaid

Mooching Off Medicaid, by Paul Krugman, Commentary, NY Times: Conservatives like to say that their position is all about economic freedom, and hence making government’s role in general, and government spending in particular, as small as possible. And no doubt there are individual conservatives who really have such idealistic motives. When it comes to conservatives with actual power, however, there’s an alternative, more cynical view of their motivations — …it’s all about comforting the comfortable and afflicting the afflicted, about giving more to those who already have a lot. And if you want a strong piece of evidence in favor of that cynical view, look at the current state of play over Medicaid. … Last year’s Supreme Court decision upholding Obamacare also opened a loophole that lets states turn down the Medicaid expansion if they choose. And there has been a lot of tough talk from Republican governors about standing firm against the terrible, tyrannical notion of helping the uninsured. Now, in the end most states will probably go along with the expansion because of the huge financial incentives… Still, some of the states grudgingly allowing the federal government to help their neediest citizens are … insisting that it must be run through private insurance companies. And that tells you a lot about what conservative politicians really want. … Don’t tell me about free markets…, privatizing Medicaid will end up requiring more, not less, government spending, because there’s overwhelming evidence that Medicaid is much cheaper than private insurance. … You might ask why, in that case, much of Obamacare will run through private insurers. The answer is, raw political power. Letting the medical-industrial complex continue to get away with a lot of overcharging was, in effect, a price President Obama had to pay to get health reform passed. And since the reward was that tens of millions more Americans would gain insurance, it was a price worth paying. But why would you insist on privatizing a health program that … does a much better job than the private sector of controlling costs? The answer is pretty obvious: the flip side of higher taxpayer costs is higher medical-industry profits. So ignore all the talk about too much government spending and too much aid to moochers who don’t deserve it. As long as the spending ends up lining the right pockets, and the undeserving beneficiaries of public largess are politically connected corporations, conservatives with actual power seem to like Big Government just fine.
Source: typepad.com

Florida governor, a health reform foe, expands Medicaid

I am a medical software rep for one of the major and most established Healthcare software companies in the world. I talk to 2 or 3 Ambulatory practices (Non-Hospitals, Your doctor’s office) everyday. They are required to implement Electronic Healthcare Records or they eventually will be hit with penalties that increase year over year. If you heard the conversations I engage in everyday on a typical Doctor’s office plan to deal with Obamacare, you would be PETRIFIED!!! Even though the government has offered an incentive to PAY for the software they need to meet the government requirement. They are saying no. Many have now planned retirement, are converting to a concierge practice, refusing to take additional Medicare or Medicaid patients, refusing to submit the Medicare or Medicaid claims for their current patients, INSTEAD requiring payment upfront then giving those patients the claim forms to attempt to get reimbursed themselves. SO, for those on Medicare or Medicaid… providers are going to be few and far between. This means, long wait times for appointments, less quality healthcare for these folks (C’mon if your boss paid you less for doing a particular task, how much effort would you put into it?) AND in 2014 things are going to get REALLY expensive for all of us, if you understand the law. This is going to be a disaster!
Source: nbcnews.com

Chris Christie joins the GOP’s new Medicaid fan club

Christie is in good company as he changes his tune. Seven other Republican governors, including such die-hard Obama foes as Jan Brewer of Arizona and Rick Scott of Florida, have made the same move since the start of the year. As Scott conceded when he joined the trend last week, “I cannot, in good conscience, deny the uninsured access to care”―not when the feds are paying the cost anyway. With today’s announcement, Christie brings to 27 the number of states committed to expanding Medicaid through Obamacare. Seventeen, all led by Republican governors, have declined. Six are still undecided. Christie’s decision may not win him friends at CPAC, which is denying him a speaking role at its annual meeting, but his own constituents may take a brighter view. “The decision to accept federal funds to expand health coverage will not only help balance the state budget,” Dena Mottola Jaborska of the watchdog group New Jersey Citizen Action told the New Jersey Star-Ledger. “It will save lives.” That was as true a year ago as it is today, but Christie deserves credit for seizing the chance while he has it.
Source: msnbc.com

Employee Benefits Gone Wild

Posted by:  :  Category: Medicare

Tax Penalties and Bureaucratic Burden of Domestic Partner Health Insurance by Third WayAt Deloitte, the consulting firm, employees can get a backup care worker if an aging parent or grandparent needs help. The company subsidizes personal trainers and nutritionists, and offers round-the-clock counseling service for help with issues like marital strife and infertility. Deloitte executives, and other experts, said they believe that such benefits were likely to spread. At Google, the company has expanded its benefits beyond free meals, dry cleaning and other services on campus to offering $500 to new parents. The company has also arranged for fresh fish to be delivered to the office for employees to take home. At Facebook, employees can take home a free dinner or, if working late, their families can come in to eat with them, leading to a regular sight of children in the campus cafeteria. The company also pays $3,000 per family in child care expenses, and offers adoption assistance of up to $5,000.
Source: thehealthcareblog.com

Video: small-business-group-health-insurance.mp4

Money Matters: Five benefits that women get exclusively

Stamp duty: When you buy a property or get a property transferred in your name, you have to pay a stamp duty. Women pay lesser than men in many states in India. So, the total cost of property is lower, when you buy the property in a women’s name. Even if the woman is a co-owner in the property, the discount is available. For instance, if the stamp duty which a man pays is 5 percent, for a woman it could be 3 percent, while for joint property it would be 4 percent. Keep in mind that this benefit varies from state to state and there are a few states which do not give this benefit.
Source: firstpost.com

Health care benefits for UAE residents are being eroded in value by unethical and fraudulent claims, 999 Magazine report reveals

In a survey of 450 respondents conducted by 999, more than a quarter (28%) affirmed that they have experienced being advised and billed to undergo unnecessary tests that only inflate the bill. It also showed that 81% of the respondents had medical coverage, and more than half know of a person who files sick leaves even if they are not sick, while 49% know a person who has used fake medical certificates, confirming that the misuse of sick leaves is a common practice. The region may be losing more than Dhs3.67bn on health insurance abuse or fraud, Daniel Whitehead, MENA Region Healthcare Lead for consultants Booz Allen & Hamilton, told 999. Based on studies made by insurance companies in 2011, misuse accounts for 30% of health insurance spending, and this fact is raising alarm bells all over the country. This gaping hole in expenditure is the main cause of higher premiums, which in turn scare off many employers, the ripple effect of which is ultimately felt by workers who either miss out on coverage completely or are afforded lesser quality health insurance. The UAE’s health care sector is booming, with a projected 271% growth by 2015, up from $3.2bn to $11.9bn; and hand in hand with that growth comes the rise of health insurance, a benefit that all nationals and most employed expatriate residents get. The flipside is that the misuse of this health coverage means health care benefits for UAE citizens and residents are being eroded in value by unethical and fraudulent claims. The cost of paying out unfair claims is ultimately recovered through higher premiums – fraud and misuse, therefore, rob those who really need the cover. It was reported that thousands of workers in Abu Dhabi might have their health benefits cut as employers were looking to manage premiums that had gone up by about 20%. Daman has 2.1 million members, representing 80% of Abu Dhabi’s health insurance custom. Chief Commercial Officer Dr Sven Rohte said, “We recognise that fraud exists here. We have a dedicated audit and investigation team, all with medical backgrounds, who look at suspicious claims and also follow the claims trend from medical service providers for any irregularities in billings. Last year, the team audited 500 medical services providers and investigated over 1,000 claims.” Whitehead added, “As rates increase, it would be surprising if there were no pressure on employers to cut back on benefits in order to maintain their profitability.” The cost of fraud, he said, “Was astronomical. “Simple structural changes in reimbursement and claims processing systems can prevent millions in payouts for exaggerated services,” he concluded. One challenge is ensuring that fraud is seen as the crime it is, rather than just a little mathematical tweak here and there that no one will notice. Laws are in place, but Dr Rohte said, “We noticed that, in general, the acts of misuse or health insurance fraud are not perceived as a crime. For example, one would ask a pharmacist to exchange the drugs in their prescription for diapers (to the same value as the drugs) and bill the insurance company for the cost. We are, therefore, working to raising the awareness on fraud and abuse.” Whitehead agreed that the perception of insurance fraud as a soft offence added to the problem of curbing it. For instance, he said, “The simplest and perhaps the most pervasive fraud schemes are system exploitations such as ‘upcoding’ in which otherwise honest providers adjust their billing to maximise payout.” Other sneaky ways include over-prescribing medication and duplicate billing, where the same procedure is paid for twice. Insurers and regulators warn against over-prescribing of medicines for both financial and medical reasons. Lt. Colonel Awadh Saleh Al Kindi, Editor-in-Chief of 999, said, “Exploitation is seen in the health industry, where the dishonest practices of a few take vital health cover away from the many who need it. We refer to false claims, whether by patients or health service providers, pushing up the cost of insurance. In this issue, we look at the health insurance industry to pinpoint responsibility for this corruption. We encourage everyone to be vigilant and report any misuse and abuse to UAE authorities so that we can help each other in protecting ourselves as well as the premiums that either we or our employers pay.” The English 999 magazine is a part of the Strategic Plan of the Ministry of the Interior to provide media coverage for the activities and efforts of the Ministry and Abu Dhabi Police. It also aims to encourage the public to contribute to the reduction of crime and enhancement of safety in the UAE.
Source: ameinfo.com

30,000 McDonald’s Employees Risk Losing Health Care Benefits, Thanks to ObamaCare

It is the goal of the statists (thank you Mark Levin for reintroducing that term) in the Democrat party to take the American health care system down the road to a single payer system. They understand they cannot achieve this goal outright. They have to take it one deceitful step at a time. They promise that you can keep your insurance plan if you like it and promise that you can keep your doctor. They tell the masses there is no plan to take over health insurance.
Source: allamericanblogger.com

States Moving Ahead On Defining ‘Essential’ Health Insurance Benefits Under Federal Law

The health law lists 10 broad categories of essential benefits, including preventive care, emergency services, maternity care, hospital and doctors’ services, and prescription drugs.  States have latitude within those categories, and so far nearly all have selected as a benchmark for minimum coverage one of the three most popular small group health plans available to residents now. Because these plans vary and states can tinker with specific benefits to comply with federal requirements, the minimum benefits available to consumers in California will be different from those for people in New York, for example.
Source: kaiserhealthnews.org

Quinn’s AFSCME deal still has taxpayers paying 95% of retirees’ health insurance

When we met with Gov. Pat Quinn’s policy team last spring, we shared our plan for reform, which Quinn was free to implement with his new authority. Our proposal, which state Rep. Ron Sandack, R-Downers Grove, sponsored as House Bill 3309, would have retired state workers pay an average of what retired state workers in other states pay, with premiums set on a sliding scale, according to retirement age, years of service and pension income. This would reduce the enormous burden on taxpayers while still rewarding employees for lifelong service, discouraging early retirement and protecting low-income retirees.
Source: typepad.com

Hostess workers eligible for trade act benifits

Labor Department announcement: WETHERSFIELD, March 8, 2013 – Former employees of Interstate Brands Corp. (Hostess Inc.) in East Windsor, Norwich, Cheshire, Bridgeport and Uncasville who produced baked goods were certified on Feb. 19, 2013 as eligible to apply for federal Trade Adjustment Assistance. The Connecticut Labor Department is mailing an eligibility notice regarding the benefits to all adversely affected employees and is providing information on how to apply for benefits. Employees eligible to apply for federal benefits are those who are or will be totally or partially separated from employment due to lack of work on or after Feb. 19, 2011 and on or before Nov. 15, 2015. Available assistance may include training; income support in the form of Trade Readjustment Allowances (TRA); job search and relocation allowances for qualified workers who seek or obtain employment outside their normal commuting areas; and participation in the Health Coverage Tax Credit (HCTC) program, covering a portion of qualified health insurance premiums. Individuals 50 years of age and older who return to lower‐paying work may be eligible to receive Reemployment Trade Adjustment Assistance (RTAA) wage subsidies. Adversely affected incumbent workers, individually threatened with total or partial separation as of the date of certification and through Feb. 19, 2015 may access reemployment services, including TAA training, prior to layoff. Workers who qualify yet do not receive eligibility information are urged to contact their nearest Labor Department CTWorks Career Center for information and assistance. Those who need to apply for unemployment benefits are reminded that claims can now be taken over the Internet or by telephone. Benefit filing information can be found on the Department of Labor’s website at www.ct.gov.
Source: ctnews.com

Receipt of Shingles Vaccine Among Patients With Diseases Like Psoriasis and Rheumatoid Arthritis Not Associated With Increased Risk of Shingles

Posted by:  :  Category: Medicare

“A live attenuated vaccine reduces HZ risk by 70 percent and 51 percent among immunocompetent individuals 50 to 59 years and 60 years and older in 2 randomized blinded trials, respectively,” according to background information in the article. “The risk of HZ is elevated by 1.5 to 2 times in patients with rheumatic and immune-mediated diseases such as rheumatoid arthritis and Crohn’s disease. This increase has been attributed to both the underlying disease process and treatments for these conditions.” Currently, the Food and Drug Administration (FDA) and other organizations consider the live HZ vaccine to be contraindicated in patients receiving some immunosuppressive medications commonly used to treat these conditions, including all immune-modulating biologic agents and some nonbiologic immunosuppressive medications. The safety concern is that these individuals may develop varicella infection from the vaccine virus strain, the authors write.
Source: drugs.com

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Shingles Vaccine and Medicare

You may have noticed pharmacies advertising that the shingles vaccine is in stock and available. The CDC’s list of recommended immunizations is constantly evolving and the most recent addition is the shingles vaccine for all adults age 60 and over. This has many seniors wondering if they should receive the shot and if Medicare covers the cost. Should you get the shingles vaccine? Over 95% of the people in the United States are infected by the Varicella zoster virus at some point in their lifetime. The virus causes the common childhood disease of chickenpox and then lies dormant within the nerve cells. In approximately one third of the population the virus will re-activate later in life as shingles: a contagious, nasty, blistering rash that can cause severe, debilitating pain that may last for weeks, months or even years (called post herpetic neuralgia). It can also attack the eyes and permanently damage vision (though this is less common). These numbers equate to over 1 million people being affected by this virus. So it’s no surprise that the CDC recommends a single dose of the zoster vaccine Zostavax for men and women 60 years of age and older, even if they have had a prior episode of shingles. Recently, a study published online in the Journal of Internal Medicine has shown the vaccine to be safe, and well tolerated in a controlled study of 193,000 adults age 50 and over. Studies have also shown the vaccine to be effective; with results similar to those found in clinical trials in 2006 it was first approved. The vaccine reduced the risk of developing shingles by more than half, and minimized the effects of the disease in those that developed it. The over 60 crowd is often the higher risk group for contracting disease due to declining immunity, co-existing health issues, multiple diagnoses, or even increased stress factors. The CDC recommends the immunizations, but you should consult your doctor to determine if the vaccine is right for you. How much does it cost and will Medicare pay for it? Currently, the only vaccines covered under Medicare Part B are: Flu, H1N1, Pneumococcal, and Hepatitis B. So if you have strictly traditional Medicare the answer is no. Technically, Part D plans will cover the vaccine and administration, but it may require some advance planning and organization on behalf of the beneficiary to ensure the claim gets paid. In fact, Medicare.gov states: “Except for vaccines covered under part B, Medicare drug plans must cover all commercially available vaccines (like the shingles vaccine) when medically necessary to prevent illness. Contact the plan for its current formulary.” According to Merck, the manufacturer of Zostavax: “Medicare Part D = Prescription Drug Benefit 90% of Medicare Part D insured individuals are in plans that have ZOSTAVAX on formulary. The availability and amount of reimbursement will depend on a patient’s insurance benefit design, including applicable co-pays, coinsurance, deductibles and/or limits.”The vaccine is usually around $200, so the time and homework required to ensure re-imbursement is worth the investment. Check specifically with your Part D plan carrier as a first step. Some plans may require prior authorization, which means your doctor must first get approval before you can receive it. Your doctor may need to state that the drug is ‘medically necessary’ because he feels you are at high risk for contracting the disease for any reason. Some plans and/or some states may also authorize your pharmacist to administer the vaccine in the pharmacy and can bill insurance plans directly if they are in-network. To date, the shingles vaccine has been underutilized. Past stocking issues by pharmacies and physician’s offices, cost, and challenges with ease of reimbursement under Medicare part D plans are all to blame. Medical spending to treat shingles or its complications totaled $566 million in 2005 or an average of $525 per patient. When these expenses are projected on the sheer number of people who are subject to developing the disease, it seems the recommendation to receive this vaccine is a prudent one. As more patients request and file claims for vaccine re-imbursement, hopefully the process will become more routine to claim handlers and the confusion or misinformation regarding whether or not the vaccine is paid for and how, will diminish over time.
Source: blogspot.com

Shingles, Zostavax Vaccine

Shingles usually starts with a headache and then a rash on a band or section of skin, typically on one side of the face or body. The rash then turns into clusters of blisters, which fill with fluid and crust over. Shingles can be very painful. The virus travels along nerve pathways, causing inflammation and damage. The pain tends to be more severe and last longer in older people. In the worst cases, the shingles virus can cause blindness, if it infects the eyes or the area around your eyes, as well as hearing problems, brain inflammation (encephalitis) or death.
Source: aarp.org

Shingles vaccine offers ‘poor protection’ for seniors with untreated depression, study finds

University of California-Los Angeles researchers followed 92 study participants for two years. All were 60 or older and had been vaccinated for shingles. Some had a major depressive disorder (MDD) and were being treated for it, some had an MDD but were not receiving treatment, and some did not have a diagnosed MDD.
Source: mcknights.com

Talk with Your Doctor about the Shingles Vaccine

Patients who have had it describe it as “the worst pain ever”. According to Olmstead Medical Center researcher Dr. Barbara Yawn, “Often pain will begin around the jaw, back, shoulder, or abdomen—a telltale sign where the rash will break out. But the rash won’t emerge for a week or 10 days, and the pain can get misdiagnosed as a heart attack or appendicitis,” she says. Once the rash breaks out, the pain becomes acute. It interferes with all areas of daily living and causes poor physical functioning. The nerve pain associated with shingles may never completely go away.
Source: robertleecarecenter.com

DOES MEDICARE COVER SHINGLES VACCINATIONS?

Medicare does NOT cover Shingles Vaccinations.  However; your Part D Drug Plan should cover the cost of the vaccination.  Any commercially available vaccine that is not covered by Part B should be covered by your Medicare prescription drug plan.
Source: wordpress.com

Things to Know about the Shingles Virus

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Source: cpaprotectplus.com

Shingles vaccine can help prevent the disease in older adults

But the Centers for Disease Control and Prevention recently found that only 6.7 percent of adults 60 and older had received the vaccine. Part of that low rate may be due to the high cost of storing and handling the vaccine, plus supply shortages may have limited interest from doctors and led manufacturers to promote it less forcefully. Regardless, according to the U.S. Food and Drug Administration, the vaccine shortage that occurred last year is now resolved.
Source: blogspot.com

Medicare Insurance: Medicare and the Shingles Vaccine (Zostovax)

As with any medication, check with your Part D plan to confirm that the Shingles vaccine (Zostovax) is part of their formulary. Many Part D plans have a deductible and most have copays. The Shingles vaccine is expensive. It is a higher tier drug on most plans, around $170 retail on average, so also check your cost. Most Part D plans have agreements with their network participating pharmacies to administer the Shingles vaccine at the pharmacy for a reduced charge (similar to the flu vaccine). Check with your Part D plan~Check with your pharmacy BEFORE getting the injection.
Source: medicareanswersfromconnie.com