Medicare Supplemental Plan F

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSMedicare Supplemental Plan F is the most popular supplemental plan because it provides the most robust coverage, and the premiums are not much higher when the benefits are compared to the plans offering less coverage. A patient with Plan F can in many situations pay nothing additional out of pocket for doctor and hospital services. People eligible for a Medicare Supplemental Plan should compare the benefits and premiums of the plans and purchase the best coverage they can afford. For many patients, that is Plan F.
Source: wastedenergy.net

Video: Medicare Supplement Insurance Plans – Where Do I Start?

What is Medicare Supplement (Medigap) Insurance

In order to sign up for Medicare Supplement coverage, you must already have Part A and Part B. These plans are offered by private insurance companies and come in 10 standardized policy types that are denoted by the letters A-N. The standardization of these plans means that no matter where you shop, the Medigap policy details remain consistent. For example, the benefits associated with Plan F are the same no matter where you buy it, though costs may differ across all carriers. Not every carrier of Medicare Supplement Insurance offers all 10 plan types, and three states in the U.S. have their own version of these plans: Massachusetts, Minnesota, and Wisconsin.
Source: ehealthmedicare.com

Medigap Insurance: What to Know About Medicare Supplemental Plans

For a Medigap policy to apply, a person does need to be signed up for Medicare first, including Parts A and B. Folks who have both pay two premiums, one for the Medigap plan and one for the Medicare Part B program. Further, it’s important to note that while Medicare will cover both a person and a spouse, a single Medigap policy with a private provider will not. A consumer has to take out two Medigap plans to cover a spouse and himself. Further, Medigap is no longer allowed to cover pharmaceutical costs under Part D of Medicare. Those have to come out of pocket from a consumer under federal law. Unfortunately, drugs tend to be the biggest medical expense for seniors on average.
Source: edvox.org

Medicare Supplemental Insurance

Another issue that should be kept in mind with Medigap policies, is that it is wiser to purchase a supplemental coverage within the first six months of being on Medicare Part B. This is when the insurers cannot deny the individual because of a preexistent health issue. Many insurance companies will tell the individual that they have better plans and better coverages. This is not true. The Medigap program is a national one and the coverage is the same no matter who one attains the policy from. The only difference may be the amount of the premium one is required to pay.
Source: youneedtoknowme.org

Medicare Supplement Plan F Options

In Oklahoma, there are 12 Medicare supplement plans available- 10 standardized plans and 2 additional plans. Each plan is identified by a different letter of the alphabet, A through L, and each has its own unique combination of benefits. While every plan offers the same standardized coverage, some cover deductibles, coinsurance for a skilled nursing facility, even foreign travel emergencies. It’s important to understand that while each plan is different, companies selling Medicare supplement insurance in Oklahoma must offer the same benefits for each plan. In other words, a Plan C is exactly the same regardless of what company you choose to buy it from.
Source: oklahomamedicarehealth.com

Medicare Supplement Insurance Plans and Medicare Part D

There are limited times when you can sign up for Medicare Part D. For instance, you can sign up when you are turning 65. You have a seven month enrollment period. This is called your Initial Enrollment Period (IEP). It begins 3 months before the month of your birthday, includes the month of your birthday and ends the last day of the third month after your birthday. There is also the Annual Enrollment Period (AEP). During the AEP you can enroll in a Part D plan for the first time or change from one plan to another. There are also various Special Enrollment Periods (SEP) when you can enroll under certain circumstances, for instance if you are losing employer coverage you may qualify for an SEP.
Source: allabout101.com

Medicare Advantage Plans vs. Medicare Supplemental Insurance Plans

Medicare Advantage Plans are private insurance companies that receive subsidy from Medicare Insurance. Medicare pays the private insurance company a premium to cover the individual. Medicare is essentially selling your insurance to the private insurance company. Your Medicare Advantage Plan is then liable to pay all of your covered benefits. All Medicare Advantage Plans are required to provide the same coverage as Medicare-covered benefits. Medical Advantage Plans include Health Maintenance Organizations (HMOs), Private Fee-for-Service Plan (PFFS) and Preferred Provider Organization (PPOs). Since these plans are private owned companies they have their own network of doctors and facilities. If you choose to use a provider out of network you may have to pay out of pocket costs. These cost are usually deductibles, co-pays and unreasonable charges incurred by non-participating doctors and facilities. Therefore, it is wise to find and establish doctors within your network. The biggest advantage to choosing a Medicare Advantage Plan is that the average premium is approximately $50 per month and sometimes free. The disadvantage is not every Medicare provider accepts these plans.
Source: maxinevoyance.com

Stephen L Morgan’s Personal Blog: Some Useful Information For Selecting Medicare Insurance

Insurance coverage is necessary. There is neo way around it then. If you perform not provide ourselves with enough insurance policy coverage you will possible find that you are facing huge doctor bills. Breastfeeding bills are a single the fastest exciting financial difficulties suffered by people thrity nine and over. The cost linked to medical care is expected to stay to increase, pushing many seniors within the long term family facilities before ought to to go. Now, some may to be honest believe that through process of obtaining further insurance, these are putting on their own and their futures more to the entire hands of folks rather then safeguarding command. Nonetheless, this can be just not the situation. Northern La visit is guaranteed to assist as well as , guard your financial situation. Who understands simply could happen? You possibly can potentially undergo from great enormous coronary heart assault and call for a wonderful deal more than the medicare will pay out. By acquiring supplemental insurance, happen to be able to lower the stress the payments will placement on both and also your your friends and in addition family. Concentrate on understand that Medicare supplemental insurance policies are traded by private corporations. The policy itself is similar no matter what individuals sells it however the cost to participants might change. When you actually buy Medigap Plan Delaware at one insurance company is the exact same coverage you get through another insurance agency. The difference being premium you reimburse them to offer the insurance. This is one of pushed it is essential to do background work before settling on the Medigap plan while provider. Expertise. There are many, many broker agents and brokers that a lot of sell insurance. Most of options are a jack most trades, masters within none. Medicare health insurance and Medicare option is quite unique. Work with someone who specializes in Treatment Supplemental and Medicare insurance Advantage plans also knows this area of expertise inside and to choose from. Feeling a best service that offers Medicare Supplemental Plan P can be little a challenging work, but if you have touch with a major national insurance forex broker that contain every and every insurance company and provides all Medicare plans, you will can save a considerable amount of time. Your agent or broker in order to be very knowledgeable on behalf of you regarding Medicare health insurance Supplemental Insurance and you’ll feel cool with his suggestion and consider he is producing honest deal. It is very necessary to discover the perfect plan from a insurance company gives great hospitality. One particular thing to end up cautioned about is without a doubt paying for currently the Medicare premiums along with credit cards. This is a hazardous practice to commenced in. Making payments on the premiums with a bank card raises the run you pay by bringing interest and expenses. It is better to make premiums withdrawn since your account in the market to pay the set you back of the Medicare health insurance supplemental plan at the time information technology is due and then withdrawn from all your checking account. About many it in many cases can be due to positively concerns they gain had their full lifestyle, but to receive others it would be just a some other sign of rising. No matter what the situation, without the need of dentist professionist insurance coverage the discomfort of common procedures can damage not only your very own teeth, but furthermore , your wallet together with. It will for this good reason that that the Blue Cross Blue Guard Dental of California system tends up to make so essentially sense. But also know that complex activities insurance company offer all 12 Medicare supplemental insurance plans. Service repair shop that carries the following policies is forced to have Plan A. Beyond that, the plans they offer are up to company, based at their own success and the sales of each policy or which of them they feel most comfortable offering. Hence, if you’ve selected Plan D, you’ll need search not exclusively for private companies that provide Medicare supplements, just companies that offer this specific program so that find the right protection for your requests. Upcoding of septicemia is apparently so rampant the fact according to this 1999 inspector general’s report in anyone sample of clinic billings investigators studied, 20 percent related with septicemia cases are upcoded.
Source: blogspot.com

Medicare Supplemental Insurance

Medicare was created to help senior citizens acquire health insurance at a reasonable price. The majority of people are in need of health insurance far more often in their senior years than in their younger ones. Realizing that seniors pose a bigger health risk to insurance companies than the younger generation, the United States government knew that if insurance providers were allowed to operate without any kind of regulation in how they dealt with seniors, they would charge much more expensive premiums to the elder generation. This would have priced many seniors right out of healthcare coverage.
Source: lindacoleman.org

Changing Medicare Supplement Insurance (Medigap) Plans

If you happen to have an old Medigap policy that was purchased prior to 1992, you may remain on a non-standardized version of that plan. If you purchased Plans D or G before June 1, 2010, you may keep the older versions of them, even though current iterations of those plans have vastly different benefits. Additionally, the old Plan H, I, and J once offered, but are no longer sold, with Medigap prescription drug benefits. Should you choose to make the switch to a newer Medicare Supplement plan, however, please note that you will not be able to get the old plan and benefits back as they are no longer offered.
Source: planprescriber.com

Medigap Plans Guide on the Basic Prescription of Medicare Supplement Insurance

If we are retirees and not covered by medicare fully then medical cost then it is impossible to meet the medical costs out-of-pocket and it is best to have a look at website http://www.medigapplansguide.com and get professional help and proper guidance. It is easy and simple to operate but most comprehensive and analytical in the content it provides. It is best to the different insurance companies in the area you live, their plans, amount of coverage and what premium one has to pay, also taking into account, the pre-existing health conditions and the ones that may eventually occur at that age. After comparison, choose the best quote and secure your health with supplement benefits like AARP.
Source: wordpress.com

Few may pay for skipping health insurance, new regs show

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 marsmet524I currently pay private insurance due to job loss and it is going up every year. By now I thought I’d have a job to at least cover the premiums. . I really believe most people will pay the fine if they know they will be getting treatment and can buy the insurance later anyway if necessary. And why wouldn’t they. Why should I not do it too after reading the IRS article. It doesn’t pay anyone to buy insurance ahead of time if you are healthy. When I stated this months ago some posters said I’d would get credits from the government if my income qualifies and all would be wonderful. Even if that were true, and I doubt it to be the case for me, then who is going to pay for those credit reimbursements? John Q. Public taxpayer that is who. Either through higher taxes or higher premiums or both. So the working class gets the shaft again and Obama said he’s all for helping middle class. I saw even the unions are having second thoughts now because they realize their premiums are going to rise with Obamacare. My God people, we are so dumbed down in this country. Too lazy to find out the facts prior to the legislation and allow the jerks in Washington to lead us like sheep to slaughter. Pelosi said to pass it first and you’ll see what’s in it. It’s full of BS and just more taxes in the future.
Source: nbcnews.com

Video: Senior Health Insurance Information : Disability Insurance & More

Affordable Senior Health Insurance

Senior wellness is a comprehensive issue that involves proper nutrition, the use of supplements, activity, keeping ones mind sharp and having routine medical care. The right insurance plan can help offset many of the costs associated with total wellness measures as the plans allow for coverage of such services and items. This can then give seniors even more of a feeling of relief as they can have the healthy lifestyle they want and need; while being able to afford to do so because they have found just the right insurance plan that takes the needs of seniors in to consideration in terms of coverage.
Source: seniorsandboomers.com

United Healthcare Telesales

Are you an Insurance Forums member yet ? To sign up for your FREE INSTANT account, please fill out the form below ! Username:     Password:   Confirm Password:     E-Mail:   Confirm E-Mail:          Question of the day:   In which state is Miami Beach ? I agree to forum rules 
Source: insurance-forums.net

Health insurance for a senior citizen

Health insurance for a senior citizen is available to help supplement the benefits received from Medicare. Since Medicare does not cover all medical expenses, having health insurance for seniors can assist in paying those additional costs and things like prescriptions that are not covered. The benefits of having a policy for older people are that it will allow the insured to go to any doctor Medicare pays for and it will allow a person to better budget medical expenses. With Medicare covering less and less, it is a good idea to have a policy to aid with those additional out-of-pocket expenses and non-covered expenditures.
Source: wordpress.com

7 Common Reasons for Hospital Transactions

We have observed an increase in the number of transactions between hospitals over the past three years. This increase is driven by a host of factors — most notably the Patient Protection and Affordable Care Act of 2010. Observed transactions include outright acquisitions of one hospital by another, as well as joint operating agreements or joint venture structures between previously independent hospitals. Through our direct experience with these transactions and supplemental research, we have compiled the following list of the seven most common drivers of hospital transactions. 1. Financial condition While demand for healthcare services continues to rise and healthcare constitutes an ever greater portion of the United States Gross Domestic Product, not all hospitals are experiencing robust financial performance. In many markets, hospitals are feeling strained by the increased competition of market consolidation and the pinch of crushing levels of debt and high fixed operating costs.  In some instances, this results in a violation of bond covenants, a reduction in bond ratings, or worse, bankruptcy. As a result, struggling hospitals have chosen to align themselves with a more financially secure health system, either as a proactive approach to remaining viable as a going concern, or as a last resort through the bankruptcy process. A recent case in point is a health system which experienced a credit rating downgrade from “CCC” to “C” in the beginning of this year. A suitor is currently in negotiations to acquire the health system and restructure its liabilities in an effort to save the troubled system from insolvency (names intentionally omitted). The high and relatively inflexible fixed cost structure of hospitals necessitates growth in size to achieve the economies of scale to remain both viable and competitive. The larger a health system, the better off it is in negotiating payor contracts, contracting for medical supplies and the more it can leverage the costly implementation of information technology systems such as electronic health records. This all comes at a time when hospitals must continue to do more with less. Revenue sources for hospitals are continually under pressure, with the recent sequestration in Washington, D.C. the latest in a string of cost cutting measures impacting the industry. As part of the sequestration, there will be a two percent decrease in Medicare payments to hospitals beginning April 1, 2013.  The pressure on revenues is not unique to government payors, and commercial payors are also taking actions to control cost that impact reimbursement. As such, hospitals must seek to find ways to maintain or increase revenues through additional services or increased volumes, or continually cut expenses in order to stay profitable and maintain the capital needed to stay competitive. 2. Access to capital The rapidly changing landscape of healthcare has taken the need for capital to new levels. As electronic health records replace paper charts, health systems have been required to invest millions in the software, hardware and staff training necessary to implement EHRs throughout their systems. Additionally, advances in medical technology have led to continuing increases in costs associated with the latest technologies available in medical treatment. Case in point would be proton therapy for cancer radiation, as a proton facility can cost in excess of $100 million to construct. Expansion of facilities to include new service lines or centers of excellence can be costly, though necessary, to stay competitive. Even routine maintenance capital outlays, such as building renovations or outdated equipment replacement, can prove costly given the highly capital intensive nature of health systems. Consolidation in local healthcare markets has been occurring rapidly in recent years, as health systems have purchased freestanding imaging centers, ambulatory surgery centers, physician practices and other outpatient ancillary businesses. Without adequate access to capital, a health system may find itself unable to participate in this consolidation activity and ultimately lose key services and market share to its competitors. An example of this includes formerly independent physician practices, who may have previously serviced multiple hospitals in a given market, but after being acquired they now only utilize the hospital where the physicians are employed. This may force the now weaker health system to seek a sale of itself to a larger health system, as it loses market share and has a harder time finding the providers necessary to provide adequate care to the system’s patients (Note: the volume and value of physician referrals may not be taken into consideration when determining the fair market value purchase price of a physician practice, regardless of any potential impact on health system). 3. Declining and/or changing census Population changes to a specific region have led to increased consolidation among hospitals as well. Certain hospitals have observed shrinking populations in their service area, which may not have been projected when a facility was built or expanded years prior. This is especially true in rural markets and in the Midwest, where several manufacturing plants have closed or been outsourced. By merging with another health system in the local market, a hospital struggling with revenue associated with its low patient census may be able to realize overhead expense synergies and relieve margin pressures.  Another population trend relates to a shift of patients to more high-deductible plans with health savings accounts. Health systems generally have a harder time collecting fee-for-service payments from their patients as opposed to payments remitted from commercial payors. As a result, a shift toward more private payors will put pressure on revenue, and in turn, profit margins. 4. Pricing power Commercial payor consolidation has been increasing in recent decades. According to IBIS World, in the five years ended 2012, the number of health insurance companies decreased by approximately 1.8 percent annually due to consolidation, and consolidation is expected to continue at a 0.3 percent annual rate through 2017. According to the Department of Justice and Federal Trade Commission, an industry is highly concentrated if the Herfindahl-Hirschman Index is greater than 2,500. Based on this standard and based on research conducted by The American Medical Association, 70 percent of the United States’ 385 metropolitan areas are highly concentrated for insurers, while in 38 percent of areas one insurer had a share of at least 50 percent. This consolidation in the managed care industry has led to payors having more clout in regards to contract negotiations with regional and community health systems.  As a result, health systems have consolidated themselves as a way to increase their size, and in turn increase their own negotiating clout with managed care companies.  While much of the consolidation happened in the mid-1990s through the early 2000s, recently we have observed mergers of several of the big commercial payors. In 2012 alone, the industry experienced Aetna’s $5.6 billion merger with Coventry Health Care, WellPoint’s $4.9 billion acquisition of Amerigroup, and Cigna’s $3.8 billion acquisition of HealthSpring. These large industry consolidations are possible due to the decades old antitrust exemption for the health insurance industry contained in the McCarran-Ferguson Act of 1945. There has been effort in recent years to amend this piece of legislation through the Health Insurance Industry Fair Competition Act, which requires that the health insurance industry be held to similar antitrust standards as other industries. While in 2010 the bill passed on a 406 to 19 majority vote in the United States House of Representatives, the bill did not make it to a vote in the Senate before the Congressional recess of the 111th Congress. The bill was reintroduced to the House Judiciary committee by sponsors Rep. Peter DeFazio (D-Ore.) and Louise Slaughter (D-N.Y.) in February of 2012. The legislative attention the industry has received in recent years has likely helped spurn the recent wave of consolidation. 5. Management Frequently large health systems have more experienced leadership and greater breadth and depth of management. The benefits of having an experienced and proven leadership team in place for a health system can be easily overlooked given the multitude of seemingly macro-level pressures. While many of these industry pressures are universally shared, a savvy leadership team can navigate these turbulent industry conditions with a greater likelihood of success. Frequently, smaller hospitals do not have the manpower or depth and breadth of management experience to steer through the many nuances of PPACA and/or prepare for the outcomes the new law will create.  Smaller hospitals may also have difficulty with succession planning, particularly as seasoned management teams opt for retirement instead of retooling for the forthcoming industry transformations. Without resources it can be very difficult to train and groom a new set of executive leaders, and it may be more effective to simply tap into an already proven executive team at a different health system. 6. Lack of name recognition A number of transactions have involved the use of a more recognized name, in the hopes of shoring-up or expanding the existing services offered to patients. Hospitals may look for the use of a more recognized name in order to stop patient leakage from primary and even secondary markets. Health systems such as the Mayo Clinic, Cleveland Clinic and Johns Hopkins Hospital are internationally known for their reputation of quality and innovative patient care. On a more regional level, many areas throughout the country contain a health system whose reputation, though not national, is recognized as providing the highest quality of patient care for their local or regional market. For a lesser known hospital, an alignment strategy that permits re-branding with the trade name of a better known system may prove beneficial in boosting a declining or stagnant patient base. A transaction such as a joint venture or similarly structured alignment between hospitals allows a lesser known hospital to not only utilize the brand name of a better known competitor, but may also improve access to care. This is particularly true when the alignment partner has specific expertise, including centers for excellence in oncology, orthopedics, and cardiology. 7. Increased patient base The quickly changing, and often ambiguous, landscape in healthcare has required health systems to become more dynamic and nimble to remain profitable, avoid regulatory violations and to provide the care their patients have come to expect. Recent developments include the emergence of accountable care organizations, which are expected to replace traditional fee-for-service payment models. This has resulted in health systems acquiring a variety of healthcare entities from physician practices to hospitals as they seek to increase their ability to provide adequate healthcare at all phases of the care process as efficiently as possible. The continued rollout of PPACA will also lead to a larger amount of the population seeking healthcare, which has led health systems to acquire other health systems as they seek to prepare for the increase in demand for their services. The Congressional Budget Office projects the number of people gaining insurance coverage the newly developing exchanges will rise from 7 million in 2014 to 24 million in 2016, while the number gaining coverage through Medicaid will rise from 8 million in 2014 to 11 million in 2016.  Given the high fixed costs associated with running a health system, a failure to increase its patient base as a result of the aforementioned increase in demand may result in a health system finding itself at a disadvantage to its competitors. Conclusion There are numerous factors driving the increased number of hospital transactions in recent years. Regardless of the driving force behind the transaction, it is more important than ever to understand the opportunities and risks that may present.  Whether looking to acquire a hospital or enter into a joint venture or other alignment, hospital management must be prudent in selecting advisors who are well versed in the various structural, legal, and valuation issues manifest in these deals. Contact the authors at (303) 688-0700 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Learn more about HealthCare Appraisers, Inc. at www.hcfmv.com.
Source: beckershospitalreview.com

Who can shop the health insurance exchanges?

If you can get health insurance through your job, you still can shop on the exchange, according to the Kaiser Family Foundation. But, in most cases, you probably won’t find a better deal than you’re getting through work, experts say. That’s because employers often pay at least 50 percent – and sometimes up to 90 percent – of the premiums for employees covered in their group plans. “Anyone can go to the exchange,” says Claire McAndrew, senior health policy analyst for Families USA, a non-profit health care advocacy organization. “But you’d be turning down an employer subsidy, which is hard to imagine.”
Source: insurancequotes.com

Health Care Insurance: Senior Health Care Insurance

As folks attain their senior years the activity of defending assets and placing in spot the proper legal, economic and overall health coverage could be very confusing and somewhat daunting. As folks attain their senior years the activity of guarding assets and placing in spot the acceptable legal, economic and wellness insurance coverage could be really confusing and somewhat daunting. 1 in the most complex matters which is essential to become addressed is the fact that of placing in location an acceptable senior health care insurance program. As such it truly is vitally essential to recognize that you can find really several alternatives that ought to be regarded with regards to this specialized sort of insurance coverage. Nevertheless, as soon as the essential data is obtained it tends to make the job of picking the acceptable senior health care insurance strategy a lot easier process. The Seniors’ Wellness Insurance coverage Data Plan is a single resource that you simply certainly must make the most of just before you decide on any senior health care insurance strategy. This plan will make sure all of your concerns relating to Medicare supplements, Medicare prescription drug plans, long-term care insurance coverage as well as other crucial matters are adequately answered. Armed with this details you’ll be within a a lot much better position to determine around the greatest possibilities for the certain situations If you start off to choose a senior health care insurance program, the initial point you should do is always to truly operate out what the offered possibilities are and which ones will greatest suit your demands. It’s strongly advised which you make contact with providers of senior health care insurance. It is possible to get in touch with them by telephone or verify out their sites and even undergo the Much better Enterprise Bureau. The critical concerns you must address are: * How lengthy has each and every insurance coverage firm been in enterprise? * How reliable are they? * What kinds of plans are they supplying?
Source: blogspot.com

Private Health Insurance – Good For Senior Citizen

Accidents are frequent in the present days. Most of the time, you can see people falling ill and suffering to treat without having enough money. You will be able to get many Private health insurance for concession rates and this will be an encouragement to the citizens to have one policy for them. People who are single or couple can prefer taking this private policy, as its coverage is huge for low fees. You can even choose your own doctor for treatment and you can make them be your family doctor for rest of the days. The patients will be treated immediately during emergency times and you need not wait for a long time. It is possible for you to demand a private ward according to the convenience of the patients.
Source: zacharykitnick.com

Seniors Get Hung Up In Health Care Scams

Many people see through those sorts of simple scams, says Sally Hurme, an elder law attorney at AARP.  “But even if one in a thousand falls for the scam and gives up info or agrees to send information off to who knows where, they’ve made [the scammer’s] day. That’s what their job is,” says Hurme.  As the Affordable Care Act ramps up, the country is likely to see more frequent insurance scams, and they’re likely to get more sophisticated, she adds.
Source: kaiserhealthnews.org

Report: Private Medicare Advantage Plans Make Progress in Combating Chronic Disease

Posted by:  :  Category: Medicare

Raging Grannies: No Private Parts by Grant NeufeldSince its start in 2003, Medicare Advantage has gained popularity because of its high quality, coordinated benefits and patient-centeredness.  Its central role for private health plans makes MA extremely popular with seniors.  The best practices of these plans should be integrated into conventional Medicare.  That’s the only hope if Medicare is to contain its costs without sacrificing quality and care in the process.
Source: hlc.org

Video: Medicare and Private Insurance

Cuts to Hospital Medicare Rates May Not Shift Costs to Private Insurers, Study Says

In the healthcare finance world, it’s conventional wisdom to believe lower Medicare payment rates to hospitals lead to higher rates, or cost-shifting, to private health insurers, but according to a May article in Health Affairs, that may not be the case. Chapin White, PhD, a senior health researcher at the Center for Studying Health System Change in Washington, D.C., conducted a study to test the cost-shifting theory. He analyzed discharge claims data for Medicare and private payment rates for inpatient hospital care from 1995 to 2009, and he found the gap between Medicare and private rates widened from 45 percent to 57 percent during that timeframe. Further, Medicare payment rates increased 3 percent annually on average compared with 3.56 percent per year for private payors. However, Dr. White said that gap could’ve been even more if Medicare rates were not kept in check. He ran a simulation, reducing Medicare payment rates to hospitals by 10 percent, and he found that private payment rates actually dropped between 3 and 8 percent. The gap between Medicare and private payor rates to hospitals could be due to many different factors — such as hospital consolidation, higher labor costs, etc. — but Dr. White wrote that cuts to Medicare are not one of those factors. “Hospital executives, understandably, want higher payment rates from private payors. To put a socially acceptable spin on higher rates, they blame Medicare for being a stingy payer — this study should put that notion to rest,” Dr. White said in a news release. The study also mentioned how the Patient Protection and Affordable Care Act permanently slows the growth in Medicare hospital payment rates, which will save the federal government billions over the coming decade, and Dr. White said repealing those cuts would increase federal spending and also boost the growth of private insurers’ costs and premiums. “My results indicate that cuts in Medicare payment rates have not caused the rapid rise in private rates,” Dr. White wrote. “My hope is that the dynamic cost-shifting theory is hereby put to rest. If so, then future research can focus on identifying the real drivers of increases in private hospital payment rates, quantifying any volume shifts resulting from changes in Medicare payment rates and testing for broader impacts on access and quality of care.”
Source: beckershospitalreview.com

Improving Care, Reducing Costs in Medicare

The discussion made clear that the goals of the “Triple Aim” — better care for individuals, better health for populations and communities, and care that is affordable — is becoming widely accepted as a worthy goal for the health care system.  However, the path from intention to actionable steps for change is challenging. Our speakers coalesced around three central points. The first is that movement towards large-scale system-wide improvement requires changing the culture in health care organizations and systems to become more patient-centered. The second is that wider adoption of health information technology to improve communication among providers and across care settings is desperately needed. And, last but certainly not least, the system needs better quality and resource use measures for greater accountability and transparency, and these measures need to be publicly reported.    
Source: aarp.org

Medicare Lags In Project to Expand Hospice

The 2010 health law required Medicaid to pay for joint hospice and curative treatments, called concurrent care, for children. More than half the states have taken steps to implement that in the joint federal-state program for low-income residents. It also instructed the secretary of Health and Human Services to select up to 15 sites to test concurrent care for patients in Medicare, which provides health coverage to seniors and disabled people. That test is to last for three years, but Medicare has yet to take any concrete steps toward beginning it.
Source: kaiserhealthnews.org

The Dramatic Difference: What A Hospital Charges Vs. What Medicare Pays

Looking at the price charged without considering the full scope of services the hospital provides is like looking at the tires on a car without considering the vehicle being driven. Sure, you can find cheaper tires, but are you putting tires on an economy vehicle or a full size sedan. One has to consider whether it is a teaching hospital or a community based facility. How many of the patients who arrive through the emergency department are insured, and how many will require critical care? Does the facility have advanced diagnostic equipment or are the clinicians basing their decisions on fuzzy images? Sure we can continue to complain about the cost of healthcare, but we should stop to think what is we are complaining about.
Source: kaiserhealthnews.org

GAO Report Finds Excess Spending in Medicare

According to a recent U.S. Government Accountability Office (GAO) report, private insurers offering Medicare Advantage plans receive inflated payments because insurers tend to use relatively high risk rates when calculating what Medicare should pay insurers per enrollee. The Centers for Medicare and Medicaid Services (CMS) offsets these higher rates by decreasing payments using a risk score adjustment, but the GAO reports that the CMS has not adequately adjusted these payments. The GAO estimates that this has resulted in “substantial excess payments” to Medicare Advantage plans—totaling in the range of $3.2 to $5.1 billion between 2010 and 2012.
Source: upenn.edu

Study: Cuts to Medicare trim costs to insurers

Chapin White, a senior health researcher at the Center for Studying Health System Change, analyzed data on payment rates from 1995-2009 and found a widening gap between Medicare rates and private rates. Medicare had an average annual growth rate of 3 percent while private insurance grew more quickly — at 3.56 percent — he found.
Source: politico.com

Study Takes on the Myth of Medicare Cost Shifting

Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995–2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used.
Source: firedoglake.com

Protect Medicare: Reject Paul Ryan’s Budget Proposal 

The way to protect Medicare is not to destroy its intent ­­– to protect older people, people with disabilities, and their families, from illness and related financial ruin. The Center for Medicare Advocacy offers six real solutions. On the other hand, Mr. Ryan again proposes a private voucher system. His plan would unravel Medicare, leave its beneficiaries and their families adrift, and continue unnecessary, wasteful overpayments to private companies. There are ways to preserve and strengthen Medicare for future generations, but Ryan’s recycled voucher plan is not one of them.
Source: medicareadvocacy.org

Study: Public Medicare Trumps Private Medicare

The one percent figure is the one that should be used to analyze several hotly debated health reform issues, including whether to expand traditional Medicare to all Americans and whether to turn Medicare over to the insurance industry, either by expanding the Medicare Advantage program of by converting Medicare to a voucher program as Rep. Paul Ryan has proposed.
Source: singlepayeraction.org

Humana says internal review started after private Medicare leak

On April 1, the government was due to announce after the stock market closed details of how much it would pay insurers who provide private Medicare plans for the elderly, called Medicare Advantage. But about 20 minutes before the market closed, the investment research firm Height Securities sent out an alert saying that the government had decided to go with a more favorable payment plan, according to the Wall Street Journal.
Source: medcitynews.com

Blended Medicare Plan Could Save $180B Over 10 Years, Study Finds

Both studies — the Commonwealth Fund Medicare reform proposal and the Rand analysis of others’ Medicare reform proposals — are seriously flawed and illustrate no real-world understanding of Medicare. It is good that the Commonwealth Fund includes the catastrophic coverage and annual OOP limits that are not included in Original Medicare. All Part C plans and a few Medigap plans include such protection today. In fact, the Commonwealth Fund looks like a Part C health plan — except that it costs more than the average Part C plan and does not have as many other benefits (other than the OOP limits). The one-size-fits-all drug plan proposed by Commonwealth Fund will lead many low-income seniors back to the two-tier VA-like prescription drug coverage that pre-dated Part D (one inferior tier for low-income seniors, one better plan for the rest of us seniors). Because I cannot take Essential without taking this inferior two-tier drug plan is bad news for we middle-income seniors also
Source: californiahealthline.org

Medicare’s Role for Older Women

Posted by:  :  Category: Medicare

Dr Fixit is on the Job / Alternate title The Proctologist by bitzceltThese gaps in benefits and cost-sharing requirements, together with spending for premiums for Medicare and supplemental coverage (described further below), can translate into high out-of-pocket expenses for people on Medicare.  On average, older women spent more on health care (including premiums) than older men in 2009 ($4,844 versus $4,230), a greater financial burden given their lower incomes.  Notably, older women spent more than twice as much on average for long-term services and supports (LTSS). (Exhibit 3) For all older Medicare beneficiaries, out-of-pocket spending escalates as they age, but women ages 85 and older have considerably higher out of pocket costs than older men, largely due to their higher health and social needs and greater use of long-term care services.  Often the need for these services comes at the time when women have fewer resources.   Among women ages 85 and over, out-of-pocket spending amounts and the share with low incomes are higher than for younger women and men of all ages on Medicare (Exhibit 4).
Source: kff.org

Video: David Rouzer: Ending Medicare, Outsourcing Jobs

The Bonddad Blog: A thought for Sunday: the best jobs program = allow Medicare eligibility at age 55

- by New Deal democrat Regular economic blogging will resume tomorrow (and I know, because the post is already cued up). In the meantime, consider the following thoughts over my Sunday morning coffee, which hopefully aren’t too incoherent…. One of the many ranting points I see on progressive blogs is against “the top 20%” who are apparently presumed to be the functional equivalent of Jamie Dimon. Not so. Many of “the top 20%,” in terms of wealth as opposed to income, are also known as “mom and dad.” If you look at the Census Bureau’s breakdown of average wealth by age group, the most prosperous are those on the verge of retirement. They’ve had 30 or 40 years to gradually build up savings. For example, a couple who each have $50,000 jobs (in today’s dollars) and live frugally by spending half of their net earnings and saving the other half (roughly giving them $30,000 savings per year) will become millionaires in about 25 years (thanks to compounding and return on investments). Obviously this isn’t the majority – the median wealth of people in the 55 – 64 cohort is something like $200,000 – but a non-trivial percentage of middle class workers ultimately reach this milestone. And you know what they would like to do more than anythings else? Retire! I know this not only from personal conversations with my fellow fossils, but also through a discussion with an accountant recently in which he told me that the number one reason most of his older clients haven’t retired yet is because they are afraid to before they are eligible for Medicare. Or they have to continue to work after age 65 themselves because they need their health insurance to cover their spouse until their spouse reaches age 65. Meanwhile, people like David Leonhardt in the New York Times are writing about Today’s Idled Youth,” describing how the ongoing Hard Times have hit the young perhaps harder than any other group. They bought into the American Dream of studying for a degree, becoming a professional of some sort, and hoping for a decent middle class existence. Instead, they are taking clerical or entry level service jobs, or even worse, unable to find a job. You can see where I’m going with this now, right? Here we have the older workers, hobbling to the finish line, but unable to end the race. And here we have young workers, itching to get started, and they can’t because there are no jobs, or no middle class jobs, for them. And the one thing that would cause the many older workers who have saved for retirement to be able to leave the workfoce, and clear the way for those frustrated younger workers, is guaranteed medical care. Fortunately, we have a program that provides exactly that: it’s called Medicare, and according to those already on it, it works really really well. And it works at much lower administrative costs than for-profit private coverage (If I recall correctly, Medicare’s administrative costs are something like 3%, vs. 15% for for-profit plans)(UPDATE: According to the CBO, Medicare’s administrative costs are 2%, vs. 17% for for-profit plans. And Medicare premiums have consistently risen less than private health insurer premiums) . And also unlike for-profit plans, in Medicare there’s no incentive to deny coverage. As in, yes you can buy into a private plan at age 60 for example, but it will be very expensive and you’d better pray they don’t come up with an exclusion if a disease of age catches up with you. Atrios has written a number of times about increasing Social Security payments. Balderdash, say I. If you really and truly want to make a dent in the persistent employment problem facing younger workers, allow anyone age 55 or above to buy into Medicare. Charge them annual premiums equal to what they would have to pay into Medicare at their same wage or salary until age 65 if they continued to work. You would be amazed to see how quickly Boomers can still move, cleaning out their offices and cubicles, when properly motivated. And then younger workers could move right in. It’ll never happen, of course, because it smacks of the New Deal, not the “21st Century” privatized solutions Barack Obama has touted since 2009. And of course the GOP will never allow it, not just because it smacks of the New Deal, but because if Obama came out in favor of it, they would oppose it for the simple reason of opposing everything Obama wants. But that doesn’t mean we shouldn’t acknowledge that it is a real solution to a real problem, and collectively rub Washington’s Very Serious People’s noses in it.
Source: blogspot.com

Actuarial Job at S.C. International

View All Actuarial Jobs Jobs by State Casualty Actuarial Jobs Investment Actuarial Jobs Health Actuarial Jobs Life and Annuities Actuarial Jobs Pension Actuarial Jobs Other Actuarial Jobs Consulting Actuarial Jobs Jobs by State View All Jobs by State Arizona California Connecticut Florida Georgia Illinois Indiana Maine New York Michigan New Jersey North Carolina Ohio Pennsylvania Texas Virginia Jobs by City Atlanta Boston Chicago Dallas Hartford Houston Los Angeles New York Orlando San Diego Seattle
Source: actuary.com

Medicare Matters for Young Americans: Expect It, Protect It! 

The Center for Medicare Advocacy hears from many individuals under 65 who either lack health insurance, or have inadequate coverage, often inquiring as to how they might obtain Medicare coverage before age 65.  These individuals eagerly await their Medicare eligibility, when many finally receive the needed health care they could not otherwise afford to get.  People with Medicare are less likely than those with private insurance to report going without care because of cost, and are also less likely to report problems paying medical bills. They are also far less likely than those with employer-sponsored or individual coverage to spend over 10% of their incomes on health related costs.[5] The changes in the Budget introduced by Rep. Paul Ryan, chairman of the House Budget Committee and now the Republican vice presidential candidate, would, on the other hand, actually harm current beneficiaries, and completely end Medicare as we know it for those under 55 – decimating a critical American value.[6]
Source: medicareadvocacy.org

Give Medicare Locals a chance to improve health equity

Medicare Locals are a good idea, but at this point in time are being starved of funding and also appear to have very little engagement with local health care workers. They appear to have been started with to plan on how they were going to fit into the overall health system. If they are suppose to be assisting with Primary Care and providing co-ordination, I know in my area (Brisbane South) they are doing a very poor job. They have already had to restrict service to Mental Health Care through the ATAPs program. They have not come up with a solution for after-hours care, despite funding being withdrawn from General Practice in under 3 months. This funding is being directed to the local Medical Local and yet we still have no idea how much if any will be available. This makes planning your after-hours service very difficult. I hope in the long run they succeed because their is an urgent need for coordinated chronic disease service delivery, this is where in my humble opinion medical locals will be able to provide a good service. After the failed GP super clinics lets hope the medical locals can do a better job of assisting and coordinating primary Health care
Source: theconversation.com

RS Medical Settles Medicare Fraud Charges

RS Medical has agreed to settle Medicare fraud claims following a whistleblower suit by one of its South Carolina employees, U.S. Attorney Bill Nettles said. The Vancouver, Wash.-based company, which maintains an Upstate location at 1200 Woodruff Road, has agreed to pay $1,214,665 to settle the claims against it, he said.  According to Nettles, employees of RS Medical in South Carolina and Illinois submitted claims to Medicare for Transcutaneous Electrical Nerve Stimulation (TENS) Units, conductive garments for TENS Units, back braces, cervical traction systems, muscle stimulators, and custom-fit knee braces that either lacked physician orders, lacked the required supporting documentation, and/or lacked medical necessity.  The investigation in the District of South Carolina began in February of 2011 when whistleblower Sally Balentine filed a qui tam lawsuit in federal court under the False Claims Act, Nettles said.   The False Claims Act allows the government to bring civil actions against entities that knowingly use or cause the use of false documents to obtain money from the government or to conceal an obligation to pay money to the government.   Under the False Claims Act, Balentine is entitled to a share of the government’s recovery, Nettles said. She will receive approximately $242,933 from the proceeds of the settlement, he said. Additionally, Balentine will receive $80,000 for her attorney fees and costs.  The settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the District of South Carolina and agents from Health and Human Services Office of Inspector General, and United States Postal Service Office of Inspector General, Major Fraud Investigations Division, Nettles said. If you suspect Medicare or Medicaid fraud, report it by phone at 1-800-447-8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov.
Source: patch.com

Marci’s Medicare Answers

Posted by:  :  Category: Medicare

Original Medicare, the traditional fee-for-service Medicare program offered directly through the federal government, only covers eyeglasses after you have had cataract surgery. Original Medicare generally does not cover routine eye care, such as examinations for prescribing or fitting eyeglasses. However, Original Medicare will cover a standard pair of untinted prescription glasses or contacts, if you need them after cataract surgery. If considered medically necessary, Medicare may cover customized eyeglasses or contact lenses following the procedure.
Source: homeboundresources.com

Video: Does Medicare Cover Dental Services?

Got $220,000? You’ll need about that much for medical bills in retirement if you and your sweetie are hanging it up this year, says Fidelity Investments

“While lower, this year’s estimate is still daunting for many retirees, and it will consume a considerable amount of a couple’s retirement savings,” said Brad Kimler, executive vice president of Fidelity’s Benefits Consulting business. “It is extremely important that health care costs are factored into retirement savings strategies today so that retirees can be prepared to pay their medical bills throughout retirement.”
Source: dallasnews.com

Cosmetic Dentist: Cosmetic Dentistry Covered By Medicaid

The above services only represent a partial listing of benefits covered by this plan. 2012 Rates (Annual) • Referrals Not Cosmetic Dentistry & Implants) exceed the Medicaid fee schedule! American Dental has treated over 1 million New Yorkers in the past 50 years! Our new . owners have
Source: blogspot.com

Best Dental Insurance: Dental Insurance For Individuals On Medicare

Individuals under the age of 21, dental services are a mandatory benefit as part of the Centers for Medicare & Medicaid Services By contrast, more than half of children with private insurance had received dental care in the prior year. The report also notes that survey data from the
Source: blogspot.com

Mouthing Off: Oral Health for Seniors is a Matter of Social Justice

abortion ACCESS AJOB Animal Ethics art autism autonomy behavioral economics bioethical issues bioethics biotechnology brainethics cancer children clinical ethics clinical study clinical trial clinical trials cloning conflict of interest Corporate Ethics & CSR Corruption Critical Decisions cultural Doctor patient communication doctors Drug Pricing economics economism end of life end-of-life care enhancement environmental ethics Ethics euthanasia favorite quotes genetic genetic testing genetics genomics global warming health Health & Well-being health care health care costs health care reform health disparities health insurance health law health policy health regulation healthcare healthcare costs HIV HIV/AIDS Human Rights and Discrimination incidental findings informed consent insurance IRB law managed care media medical Medical Countermeasures Medical Decision Making medical education medical ethics medical futility blog medical genetics Medicare mental health neuroethics neuroscience Obamacare obesity organ donation organ transplant organ transplantation pediatrics personal genetic information personalized medicine pharmaceutical industry pharmaceuticals policy politics primary care privacy psychiatric ethics public health quality of care Quality of Life Issues religion reproduction reproductive medicine research research ethics resource allocation Risk Exposure & Bioethics shared decision making Social Matters social media sports ethics stem cells Stem Cells and Cloning study surrogate decision making Sweet nation.org technology Thomas Jefferson US history
Source: bioethics.net

Dental Surgery: Does Msp Cover Dental Surgery

This benefit plan is part of the Medicare Savings Program (MSP), also known as the "Buy-In" program. A client must be entitled to Medicare Part A. 40 Oral Surgery . 41 Preventive Dental . 42 Home Health Care . 43 Home Health Prescriptions . 44 Home Health Visits . 45 Hospice . 46 Respite Care .
Source: blogspot.com

Medicare Advantage: Providing Quality Care to More than 14 Million Beneficiaries

Medicare Advantage plans are a valuable resource in protecting beneficiaries from unpredictable out-of-pocket costs. In 2012, all Medicare Advantage plans offered an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less. These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: medicare.gov

Mental Health and Medicare

After meeting your yearly Medicare Part B deductible ($147.00), the amount you pay for mental health services depends on whether the purpose of your visit is to diagnose your condition or to get treatment. For visits to diagnose your condition, you would pay 20% of the Medicare-approved amount. For outpatient treatment of your condition, like psychotherapy, you would pay 35% of the Medicare-approved amount in 2013. If you have a Medicare Supplement Insurance policy or Medicare Advantage, contact your plan for information on your out of pocket responsibilities.
Source: patch.com

Older Americans Month 2013: Unleash the Power of Age!

For 50 years, May has been the month we celebrate older adults across the nation. You could say that Older Americans Month is coming of age. This year’s theme—“Unleash the Power of Age!”—emphasizes older Americans’ potential for energy and activism and urges them to embrace it.
Source: medicare.gov

Social Security, Medicare & Government Pensions: Get the Most of Your Retirement and Medical Benefits download

Medicare Contacting Social Security Visit our website Our website, www.socialsecurity.gov, is a valuable resource for information about all of Social Security’s Medicare.gov: the official U.S. Social Security Administration It’s convenient, quick and easy. There’s no need to drive to a local Social Security office or wait for an appointment with a Social Security representative. government site for Medicare A federal government website managed by the Centers for Medicare & Medicaid Services 7500 Security Boulevard, Baltimore, MD 21244 Sign Up / Change Plans; How to Apply for Social Security Retirement Benefits Using Our. Medicare Premiums: Rules For Higher-Income Beneficiaries Contacting Social Security Visit our website Our website, www.socialsecurity.gov, is a valuable resource for information about all of Social Security’s Medicare card – Social Security Administration We can’t show a description for this result because the site does not allow it. Social Security’s Supplemental Security Income (SSI) Program (includes Social Security and Medicare) and ; Check your information, benefits and earnings record. Social Security and the Medicare Program – Medicare Enrollment Social Security and the Medicare Program – Medicare Enrollment Information and Resources Apply online for Medicare – The U.S. This Social Security page tells you how to apply for benefits online and contains information about the Online Retirement/Medicare application. You do not need a my Social Security account to:
Source: typepad.com

RS Medical Settles Medicare Fraud Charges

RS Medical has agreed to settle Medicare fraud claims following a whistleblower suit by one of its South Carolina employees, U.S. Attorney Bill Nettles said. The Vancouver, Wash.-based company, which maintains an Upstate location at 1200 Woodruff Road, has agreed to pay $1,214,665 to settle the claims against it, he said.  According to Nettles, employees of RS Medical in South Carolina and Illinois submitted claims to Medicare for Transcutaneous Electrical Nerve Stimulation (TENS) Units, conductive garments for TENS Units, back braces, cervical traction systems, muscle stimulators, and custom-fit knee braces that either lacked physician orders, lacked the required supporting documentation, and/or lacked medical necessity.  The investigation in the District of South Carolina began in February of 2011 when whistleblower Sally Balentine filed a qui tam lawsuit in federal court under the False Claims Act, Nettles said.   The False Claims Act allows the government to bring civil actions against entities that knowingly use or cause the use of false documents to obtain money from the government or to conceal an obligation to pay money to the government.   Under the False Claims Act, Balentine is entitled to a share of the government’s recovery, Nettles said. She will receive approximately $242,933 from the proceeds of the settlement, he said. Additionally, Balentine will receive $80,000 for her attorney fees and costs.  The settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the District of South Carolina and agents from Health and Human Services Office of Inspector General, and United States Postal Service Office of Inspector General, Major Fraud Investigations Division, Nettles said. If you suspect Medicare or Medicaid fraud, report it by phone at 1-800-447-8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov.
Source: patch.com

Hospitals Charge Medicare ‘Wildly Different Amounts’

Collaborative Justice: Transforming Criminal Justice Services Through Unified Collaboration This issue brief examines video collaboration in every stage of the human justice process, demonstrating how this technology can not only make services more efficient, affordable, and accessible. Cloud-Based Services Accelerate Public Sector Adoption of Video Collaboration Today, thanks to new cloud technologies and high-quality networks, mobile video services – which provide not only cost savings but which help governmental interactions become more efficient – are more feasible than ever before. Modernization as a Service: Acquiring IT through Innovative Procurement Five Ways Collaboration is Driving Government Performance Mobile Video Collaboration: The New Business Reality
Source: govtech.com

A repeat trip down the expressway to cutting Medicare, Medicaid and repealing the ACA

Posted by:  :  Category: Medicare

Love It! Improve It! Medicare For All! Poster - Washington DC by Glyn Lowe Photoworks“Can I be honest with you? I don’t have any money. But I can’t stand this anymore, I can barely walk it hurts so bad. Everybody told me I need to go the hospital but I don’t have any money and I don’t know what they are going to say. I got my wife and kids and I work, but you know I just don’t have more money for the hospital. And I need to go back to work. Can you just do something so I can go to work?”
Source: seiu.org

Video: Medicare international health insurance

Study Takes on the Myth of Medicare Cost Shifting

Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995–2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used.
Source: firedoglake.com

Impacts of the CMS/Medicare Competitive Bidding Program on NPWT Market

[…] Until now, Medicare prices for durable equipment and related supplies have been set according to a fee schedule that was established in the 1980s and has been updated for inflation. But officials at the Department of Health and Human Services say the older system has proved vulnerable to fraud and price inflation. About 20 million people who receive Medicare fee-for-service benefits live in the 100 metropolitan areas where the program is scheduled to operate, according to officials with the Department of Health and Human Services. Only a fraction of those beneficiaries need durable equipment supplies. But the initiative is expected to save $27 billion for Medicare Part B, which covers physician and out-patient services, and $17 billion for beneficiaries, between 2013 and 2022Source: devonintlgroup.com […]
Source: devonintlgroup.com

Medicare claim process (International Non

    FOR MORE DETAILS CALL US ON 9773553319     OR EMAIL YOUR RESUME ON hyflyjobsgmail.com     HY FLY CONSULTANCY We have an immediate requirement for our company:- Medicare claim process (Back End)   Please find below the JD: – Medicare claim process (International Non-Voice Process)-Back End Job Description: ·         Non-Voice ·         Good Communication Skills in English, Marathi, Hindi. ·         9 working hours inclusive of 1hr break. 6 working days and 1 day off. ·         Needs to be in compliance with all the operational requirements and work as per the company’s norms and policies. ·          Two years Compulsory bond ·         Flexible to work in Shifts (Day/Night) Transport provided Eligibility Criteria: ·         Candidate should be Graduate(Compulsory) ·         We require candidates who stay only in Harbour Line (CST to Panvel & Vashi to Thane ) ·         Any Graduates ·         No BE/B Tech/M.C.A/M.B.A   Salary Offered: – 1, 40,000 PA Taken Home: – 8,200+1800 as PF+ESIC facility+ Gratuity (8.33%)+ Statutory Bonus of Rs800 per quarter.      No. of Working Day is 6, Job Location: – Vashi (Navi Mumbai) Total Requirement is for 30 Agents. If your profile suits for this particular opening Please carry a copy of your resume and original mark sheets at the time of Interview.
Source: spanjobs.com

GPM Life Medicare Supplements

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

Nationalized health care would have saved Medicare an extra $34.1 billion in 2012, say advocates

“We’ve long known that Medicare has been paying private insurers more than if their enrollees had stayed in traditional fee-for-service Medicare, but no one had added up the total extra cost to the taxpayer since contracting with private insurers began 27 years ago,” said Hellander, lead author of the study. “Nor has anyone systematically examined the many ways that private insurers have gamed the system to maximize their bottom line at taxpayers’ expense. In 2012 alone, private insurers are being overpaid $34.1 billion, or $2,526 per Medicare Advantage enrollee.”
Source: sciencecodex.com

HHS Proposes $9.9M Reward for Reporting 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 marsmet481HHS is proposing a rule that would boost rewards to as much as $9.9 million to people whose reports about suspected Medicare fraud lead to successful fund recoveries. The changes are modeled on an IRS program that has returned $2 billion in fraud since 2003. Over the past three years, President Barack Obama’s administration has recovered more than $14.9 billion in fraud, some of which resulted from fraud reporting by individuals. Under HHS’ proposed changes, a person that provides specific information leading to the recovery of funds may be eligible to receive a reward of 15 percent of the amount recovered. The reward currently sits at 10 percent.  HHS’ new proposal would also increase the cap on the recovery fund awards to $66 million. That means a person can earn as much as $9.9 million if CMS collects more than $66 million as a result of his or her fraud tip. A new funding opportunity released this month supports the expansion of Senior Medicare Patrol activities to educate Medicare beneficiaries on how to prevent, detect and report Medicare fraud. SMP is a national, volunteer-based program that empowers Medicare enrollees to report potential fraud and abuse in the program.
Source: beckershospitalreview.com

Video: How to report Medicare Fraud

Proposed Rule Increases Incentive for Medicare Fraud Whistleblowers

In fact, “[i]n the June 8, 1998 Federal Register (63 FR 31123), we [HHS] published a final rule with comment period titled, ‘Medicare Program; Incentive Programs-Fraud and Abuse.’ This final rule with comment period implemented section 203(b) of HIPAA by establishing a reward program to encourage individuals to report potential fraud and abuse to Medicare and by adding a new section, 42 CFR 420.405, to the regulations. Section 420.405(a) specifies a collection threshold of at least $100 (consistent with section 203(b) (2) of HIPAA).” Since that time, the Incentive Reward Program and certain provider enrollment provisions changed from “10 percent of the overpayments recovered in the case or $1,000, whichever is less, to 15 percent of the final amount collected applied to the first $66,000,000.” This was released in the Federal Register on April 29, 2013.
Source: physicianspractice.com

HHS Proposes Increasing Health Care Fraud Reporting Rewards To Up To $9.9 Million

Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer compliance and risk management policies and to respond to DEA and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns including a number of programs and publications on OCR Civil Rights rules and enforcement actions. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to ask about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here. 
Source: wordpress.com

89 Charged in Medicare Fraud Busts in 8 Cities, Including Houston

It’s the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder. Tuesday’s bust marks the sixth national Medicare fraud takedown. Nearly 600 individuals have been charged in schemes involving almost $2 billion.
Source: kbtx.com

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

CMS Proposes Higher Rewards for Medicare Fraud Whistleblowers

Subcommittee Chair Claire McCaskill (D-Mo.) said the projections were necessary to measure CMS’ effectiveness in recouping improper DME payments, noting that in 2011 CMS recouped only $34 million from DME suppliers out of an estimated $5.2 billion in improper payments. She and other subcommittee members also criticized the infrequency with which CMS banned fraud-prone DME suppliers, pointing out that the agency investigated only 75 of 96,000 DME companies in 2012 (Daly,
Source: californiahealthline.org

Bad Apples: Combating Medicare Fraud While Ensuring Access for Beneficiaries 

The ACA requires that a medical provider or supplier must disclose any current or previous affiliation with a provider of medical or other items or services or a supplier that has uncollected debt, has been or is subject to a payment suspension under a federal health care program, or has been excluded from participating in Medicare, Medicaid, or CHIP.[7] Medical providers or suppliers must place their NPI on all applications to enroll in Medicare, Medicaid, or CHIP and on all claims for payment submitted to Medicare, Medicaid, or CHIP.[8]  Moreover, the Secretary may suspend Medicare and Medicaid payments pending investigation of credible allegations of fraud.[9] In addition, the Secretary may impose an administrative penalty if a Medicare beneficiary or a CHIP or Medicaid recipient knowingly participates in a health care fraud scheme.[10]
Source: medicareadvocacy.org

Proposed Rule Would Increase Rewards to Medicare Fraud Whistleblowers to Nearly $10 Million : Whistleblower Protection Blog

The proposed rule would increase the potential reward amount for individuals who report information that leads to a recovery of Medicare funds from 10 percent to 15 percent of the final amount collected. The current program caps the reward at $1,000, meaning HHS pays a reward on the first $10,000 it collects as a result of a tip. HHS is also proposing to increase the portion of the recovery on which HHS will pay a reward up to the first $66 million recovered – this means an individual could receive a reward of $9.9 million if HHS recovers $66 million or more. 
Source: whistleblowersblog.org

Medicare Supplement Plan F Options

Posted by:  :  Category: Medicare

In Oklahoma, there are 12 Medicare supplement plans available- 10 standardized plans and 2 additional plans. Each plan is identified by a different letter of the alphabet, A through L, and each has its own unique combination of benefits. While every plan offers the same standardized coverage, some cover deductibles, coinsurance for a skilled nursing facility, even foreign travel emergencies. It’s important to understand that while each plan is different, companies selling Medicare supplement insurance in Oklahoma must offer the same benefits for each plan. In other words, a Plan C is exactly the same regardless of what company you choose to buy it from.
Source: oklahomamedicarehealth.com

Video: AARP Medicare Supplement Plan F

Medicare Supplement Plan F from Anthem Blue Cross Covers All of Your Health Care Needs

In addition to all of this, Plan “F” also has a foreign travel emergency benefit, which is useful for seniors on the go. If this sounds like a program that you would be interested in, find out more information today by calling the insurance agents at Benefit Packages. At Benefit Packages, we are an independent insurance agency that works with many different insurance companies. We can help you find the best Medicare supplement for your situation.
Source: benefitpackages.com

Medicare Essential – Is this the future of Medicare?

The combined deductible idea is echoed in a recent article in Health Affairs that proposes unification of Parts A and B, and Part D drug benefits. The Health Affairs article also proposes reducing beneficiary cost sharing to levels comparable to Medicare Advantage plans, eliminating the need for Medicare Supplemental coverage. The new Medicare plan, called Medicare Essential, would become the default for people who qualify for Medicare for the first time. New Medicare beneficiaries could opt out and take old traditional Medicare, and go buy their own Part D and Medicare Supplement plans, or they could buy Medicare Advantage plans. Medicare Essential would have a much higher premium than Medicare Part B, but the authors of the article claim that the overall cost would be less than Part B plus Part D plus the full-coverage Medicare Supplement Plan F that most seniors select. So proponents could argue that the added cost of the increased premium is a bargain and that people could always opt out and avoid the higher cost if they wanted to. Medicare Essentials could show significant savings by avoiding the broker commissions that add to the cost of Medicare Supplemental and Medicare Advantage plans. Whether the new program would be able to achieve the supposed 2% administrative cost ratio sometimes claimed for Medicare is highly suspect, but elimination of the need to re-process claims to pay Supplement benefits, along with simplification of coverage rules overall, would probably yield some further efficiencies.
Source: gormanhealthgroup.com

Blended Medicare Plan Could Save $180B Over 10 Years, Study Finds

Both studies — the Commonwealth Fund Medicare reform proposal and the Rand analysis of others’ Medicare reform proposals — are seriously flawed and illustrate no real-world understanding of Medicare. It is good that the Commonwealth Fund includes the catastrophic coverage and annual OOP limits that are not included in Original Medicare. All Part C plans and a few Medigap plans include such protection today. In fact, the Commonwealth Fund looks like a Part C health plan — except that it costs more than the average Part C plan and does not have as many other benefits (other than the OOP limits). The one-size-fits-all drug plan proposed by Commonwealth Fund will lead many low-income seniors back to the two-tier VA-like prescription drug coverage that pre-dated Part D (one inferior tier for low-income seniors, one better plan for the rest of us seniors). Because I cannot take Essential without taking this inferior two-tier drug plan is bad news for we middle-income seniors also
Source: californiahealthline.org

Medicare Supplement Plan F in New Mexico

Now that you’re 65, you’re eligible for New Mexico Medicare and that’s a good thing. Unfortunately, Medicare alone doesn’t cover everything and with deductibles, copays and coinsurance, it can get expensive fast. Luckily, Medicare supplement insurance, or Medigap, is available to help shoulder out-of-pocket expenses associated with obtaining health care. If you’ve started asking around, you’ve probably found that Plan F is the most popular medigap plan in New Mexico and there’s a pretty good reason why. Take a few minutes and read some information that will help you make the best choice in Medicare supplement insurance going forward.
Source: newmexicomedicarehealth.com

Medicare Supplement Insurance Information

(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

Low Cost Auto Insurance Quotes Chicago

Getting financial aid to meet your college tuition and other related expenses can help improve your career prospects. However, borrowing needs to be done in the right manner because the moment you have borrowed your first loan, you have opened your credit history page. You can get a helping hand on how to handle your credit facility by consulting a student loan counseling service to bring out some of the sensitive aspects about loans repayments.
Source: insurancenavy.us

What is Medicare Supplement (Medigap) Insurance

In order to sign up for Medicare Supplement coverage, you must already have Part A and Part B. These plans are offered by private insurance companies and come in 10 standardized policy types that are denoted by the letters A-N. The standardization of these plans means that no matter where you shop, the Medigap policy details remain consistent. For example, the benefits associated with Plan F are the same no matter where you buy it, though costs may differ across all carriers. Not every carrier of Medicare Supplement Insurance offers all 10 plan types, and three states in the U.S. have their own version of these plans: Massachusetts, Minnesota, and Wisconsin.
Source: ehealthmedicare.com

Medicare Fraud Bust at Least Gave Holder Something Good to Report

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 marsmet481It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that’s believed to cost the program between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul. Sebelius and Holder partnered in 2009 to increase enforcement by allocating more money and staff and creating strike forces in fraud hot spots around the country.
Source: reason.com

Video: Company accused of massive Medicare fraud

Nationwide Takedown Leads to 89 Individuals Charged With $223 million in Fraudulent Billing to Medicare

This is the sixth national Medicare fraud takedown coordinated by the Medicare Fraud Strike Force, which was created in 2007. The Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT) initiative that combines the resources of the Department of Justice (DOJ) and HHS. Attorney General Holder stated that Strike Force operations over the last three fiscal years have resulted in recoupment of nearly eight dollars for every dollar spent on combating health care fraud. Additionally, he suggested that Strike Force actions have deterred illegal activity, noting that group psychotherapy bills to Medicare decreased by more than 70 percent after the Strike Force targeted group psychotherapy fraud in Detroit and that billings for home health services in Florida dropped by more than $1 billion after the Miami team targeted home health fraud. Holder expressed concern that sequestration, which cut more than $1.6 billion from the DOJ’s FY 2013 budget and is expected to continue into FY 2014, will reduce the DOJ’s ability to combat Medicare fraud.
Source: wolterskluwerlb.com

RS Medical Settles Medicare Fraud Charges

RS Medical has agreed to settle Medicare fraud claims following a whistleblower suit by one of its South Carolina employees, U.S. Attorney Bill Nettles said. The Vancouver, Wash.-based company, which maintains an Upstate location at 1200 Woodruff Road, has agreed to pay $1,214,665 to settle the claims against it, he said.  According to Nettles, employees of RS Medical in South Carolina and Illinois submitted claims to Medicare for Transcutaneous Electrical Nerve Stimulation (TENS) Units, conductive garments for TENS Units, back braces, cervical traction systems, muscle stimulators, and custom-fit knee braces that either lacked physician orders, lacked the required supporting documentation, and/or lacked medical necessity.  The investigation in the District of South Carolina began in February of 2011 when whistleblower Sally Balentine filed a qui tam lawsuit in federal court under the False Claims Act, Nettles said.   The False Claims Act allows the government to bring civil actions against entities that knowingly use or cause the use of false documents to obtain money from the government or to conceal an obligation to pay money to the government.   Under the False Claims Act, Balentine is entitled to a share of the government’s recovery, Nettles said. She will receive approximately $242,933 from the proceeds of the settlement, he said. Additionally, Balentine will receive $80,000 for her attorney fees and costs.  The settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the District of South Carolina and agents from Health and Human Services Office of Inspector General, and United States Postal Service Office of Inspector General, Major Fraud Investigations Division, Nettles said. If you suspect Medicare or Medicaid fraud, report it by phone at 1-800-447-8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov.
Source: patch.com

Feds Charge 89 People Across 8 Cities in Medicare Fraud Takedown

Eighty-nine people have been charged for their alleged participation in various schemes across eight cities that fraudulently billed Medicare $223 million. This latest raid is the sixth national Medicare fraud takedown the history of the Medicare Fraud Strike Force, which was created in 2007. The defendants charged are accused of various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of the Anti-Kickback Statute and money laundering. Here are the cities and the respective number of individuals charged in each: Miami: A total of 25 defendants, including two nurses, a paramedic and a radiographer, were charged for their participation in various fraud schemes involving a total of $44 million in false billings for home healthcare, mental health services, occupational and physical therapy, durable medical equipment and HIV infusion.   Detroit: Eighteen defendants, including two physicians and a physician’s assistant, were charged for their alleged roles in fraud schemes involving approximately $49 million in false claims for medically unnecessary services, including home health, psychotherapy and infusion therapy. Los Angeles: Thirteen defendants were charged for their alleged roles in schemes to defraud Medicare of approximately $23 million.   Baton Rouge, La.: Eleven individuals were charged, including five in New Orleans who allegedly participated in a $51 million home health fraud scheme. Tampa, Fla.: Nine individuals were charged in a variety of schemes. In one case, four individuals were charged for their alleged roles in establishing and operating four supposed healthcare clinics in Tampa — Palmetto General Health Care, United Healthcare Center, New Imaging Center and Lord Physical Rehabilitation Center. The individuals allegedly used those facilities to bilk more than $2.5 million from Medicare for surgical procedures that were never performed.   Chicago: Seven individuals were charged, including two physicians, with a variety of healthcare fraud schemes. Brooklyn, N.Y.: Four individuals, including two physicians, were charged in fraud schemes involving $9.1 million in false claims. Houston: Two individuals, including a nurse and a social worker, were charged with fraud schemes involving $8.1 million in false billings for home healthcare.
Source: beckershospitalreview.com

Medicare Fraud Strike Force Charges 89 Individuals for Approximately $223 Million in False Billing

In Brooklyn, N.Y., four individuals, including two doctors, were charged in fraud schemes involving $9.1 million in false claims. In one case, three additional individuals were allegedly involved in what is now alleged to be a $15 million scheme where massages by unlicensed therapists were billed to Medicare as physical therapy.  Six defendants were previously charged in the scheme. The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Eastern District of New York, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG and state Medicaid Fraud Control Units.
Source: geyergorey.com

89 Individuals Charged With About $233M in Alleged Medicare Fraud

The Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team, a joint initiative between HHS and the Department of Justice. Since its inception, the Strike Force’s operations — in nine locations — have charged more than 1,500 individuals for defrauding Medicare of more than $5 billion through false billing (HHS release, 5/14).
Source: californiahealthline.org

Medicare fraud whistleblowers may get massive reward increase

We are proposing to clarify that an individual is not eligible for an IRP reward if he or she has filed a qui tam lawsuit under the federal or any state False Claims Act. We are also proposing that we do not give a reward for the same or substantially similar information that is the basis of a payment of a share of the amounts collected under the False Claims Act or any state False Claims Act, or if the same or substantially similar information is the subject of a pending False Claim Act case.
Source: pathologyblawg.com

Michigan Physician Pleads Guilty to Role in Medicare Fraud Scheme www.privateofficer.com

WASHINGTON DC May 15 2013—A Detroit-area physician pleaded guilty today to making fraudulent referrals for home health care as part of a $1.6 million home health care fraud scheme, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade, Special Agent in Charge Robert D. Foley, III of the FBI’s Detroit Field Office, and Special Agent in Charge Lamont Pugh, III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office. Dr. Sonjai Poonpanij, 82, of Rochester, Michigan, pleaded guilty before Senior U.S. District Judge Arthur J. Tarnow in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. According to court documents, Dr. Poonpanij admitted that beginning in approximately July 2010, he conspired with others to commit health care fraud by referring Medicare beneficiaries for home health care that was not medically necessary and causing false and fraudulent claims to be submitted to Medicare. Dr. Poonpanij admitted that he saw patients at a psychotherapy center in Flint, Michigan, known as New Century Adult Day Program Services LLC, and referred Medicare beneficiaries at New Century to home health care companies—including a home health care company known as Angle’s Touch Home Health Care LLC—even though he knew that those beneficiaries did not qualify for home health care. According to court documents, Dr. Poonpanij wrote prescriptions for narcotics requested by the beneficiaries in exchange for their enrollment with Angle’s Touch for home health care that they did not need or receive. In addition to referring patients that he saw at New Century, Dr. Poonpanij also referred beneficiaries whom he had never seen or treated to Angle’s Touch and other home health agencies. Dr. Poonpanij signed plans of care for these beneficiaries that were used to bill Medicare for services that were either never actually performed or were not performed in the beneficiaries’ homes as required. Court documents allege that between September 2008 and September 2012, Dr. Poonpanij caused Angle’s Touch and two other home health agencies to submit claims to Medicare for services that were not medically necessary and/or not provided, which caused Medicare to pay these companies approximately $1,318,954. At sentencing, scheduled for August 14, 2013, Dr. Poonpanij faces a maximum penalty of 10 years in prison and a $250,000 fine. This case is being prosecuted by Trial Attorney Niall M. O’Donnell of the Criminal Division’s Fraud Section. It was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to http://www.stopmedicarefraud.gov.
Source: wordpress.com

DOJ Accuses Hospice Giant Chemed Of Medicare Fraud, Shares Plunge

“Vitas billed three straight days of crisis care for a patient, even though the patient’s medical records do not indicate that the patient required crisis care and, indeed, reflect that the patient was playing bingo part of the time,” DOJ said in a press release.
Source: investors.com