Oral Health and Medicare Beneficiaries: Coverage, Out

Posted by:  :  Category: Medicare

This brief describes the oral health of Medicare beneficiaries, examines sources of dental coverage for the Medicare population, and examines the utilization of dental services, out-of-pocket spending on dental care, and access problems. This analysis uses data from the National Health and Nutrition Examination Survey (NHANES), the Medicare Current Beneficiary Survey Cost and Use file (MCBS), the National Health Interview Survey (NHIS) and the Kaiser Family Foundation Survey of Health Care Among Nonelderly People with Disabilities and Seniors on Medicare, 2008.
Source: kff.org

Video: Dental Insurance Commercial for Folks on Medicare

Medicare Insurance Supplement Benefits To Gain Better Medicare Videos

A whole lot medsupp plans provide assistance for cracks in Medicare an insurance plan of skilled birkenstock care inside of a nursing home. The member have to have enter the an elderly care facility after a or even day stay in an acute care medical facility and deemed technically necessary to seem to get care in a competent nursing facility. The care would ultimately be pharmaceutical drug by an a lot of physician. Actual do not carry for custodial care. Thus, in reality despite the fact much skilled nursing care is provided within nursing homes, nursing home consideration as most think of it is instead of covered. Joining Medicare and applications F and G up to 100 days is covered by the insurers.
Source: tagamanent.org

Dental Insurance Healthplex

Senior citizens have different types of dental insurance plans obtainable to them. For several seniors, it’s difficult to understand where or how to get required insurance after they have retired from their job. Many times seniors do not think regarding their insurance coverage ending upon their retirement as they will have had coverage for a long time and currently have to get it themselves.One in all the most important carriers for dental insurance for seniors is American Association of Retired Persons, the Yankee Association of Retired Persons. Many seniors belong to Yank Association of Retired Persons to get travel discounts and different health insurance discounts, so dental insurance is additionally offered to members. Yank Association of Retired Persons dental coverage is fairly new, solely beginning within the year 2005. American Association of Retired Persons dental insurance for seniors provides not solely dental insurance coverage however data on the requirement and importance to take care of sensible dental coverage as you age. However, to get dental insurance coverage through Yankee Association of Retired Persons a private must initial become an Yank Association of Retired Persons member.Alternative major dental insurance carriers like Delta Dental offer some restricted plans to these days’s seniors. But, it is really vital for seniors to check out each carrier to work out the best set up for them. Sometimes our seniors don’t perceive the whole insurance lingo out there and could need someone else to advocate on their behalf. It can be tough to understand all the limitations and restrictions which will be in place on some insurance plans.There are unethical discount programs that advertise to senior citizens. These programs will promise coverage immediately, when the fine print on the bottom of the arrange could state that there are caps in the number the carrier will pay or waiting periods before full coverage kicks in. Additionally, these discount plans could not cowl all the essential dental care that everyone, no matter age, can need throughout their lives.Seniors may would like dentures which will not be coated in some plans, or plans might dictate the number that can be spent on dentures. If dentures are not fitted properly this will greatly impact the lifetime of a senior.Many seniors believe that traditional Medicare will pay money for dental work. But traditional Medicare can not cover routine dental procedures, like exams, x-rays or cleanings. Nor can they cover fillings. This is often problematic because many seniors have had previous fillings in place for a while and that they will want replaced. With that said, some of the new Medicare personal plans might give routine dental insurance coverage for seniors. Each individual who has coverage through one of these newer personal Medicare plans should contact their supplier to assure coverage and not assume that basic dental care is a covered expense.Whatever route a senior takes to get dental coverage, it’s very necessary that each senior have some type of routine coverage in place. Dental insurance for seniors can’t be understated in its importance. As we all age, our dental wants amendment together with our aging processes. Every senior desires to require action to get the simplest coverage for them.
Source: healthinsurancec.com

Medicare Plan C or Part C??Are They the Same or Different? » Toni Says

, 2013 answers questions such as the difference in Plan C or Part C., donut hole, difference between “Original” Medicare, a Medicare supplement or Medicare Advantage Plan. These questions and many more will be answered at the Confused about Medicare Workshop to be held at The Abbey at Westminster Plaza, 2865 Westminster Plaza Dr., Houston, TX 77082 on Wednesday, May 15th
Source: tonisays.com

AARP Dental & Medication Coverage

To fit the bill for any Aarp dental, medical or medication coverage plan you must be an Aarp part. Furthermore, for most plans you must be 50 to 64 years of age. More seasoned individuals fit the bill for Medicare and might requisition Aarp Medicare supplement insurance, which covers medication and medical liabilities not covered via Medicare. Qualification likewise relies on where you exist; not all plans are ready in all states. Contact Aarp straight to determine which, if any, plans are ready in your general vicinity.
Source: healthdentalinsurance.net

Retiree benefits projected to cost Lakeville School District millions

Tony Massaros, the district’s executive director of administrative services, called the provision “ambiguous,” and Randy Pronschinske, a former Lakeville School Board candidate and local representative of the education advocacy group LakevilleStudentsFirst.org said the language makes sure that the person always has the best fringe benefits currently provided in the district.
Source: sunthisweek.com

Navigating Medicare's Open Enrollment Period

Posted by:  :  Category: Medicare

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

Video: Medicare Advantage Enrollment Period Opportunities

Medicare Advantage Plan Enrollment Periods « Insurance News from Crowe & Associates

There are only certain times when you can enroll/dis enroll or change a Medicare Advantage plan. Note that Medicare Advantage plans are sometimes called Medicare Part C or an MAPD plan.   There is a general period when someone turns 65 in which they can enroll.  This time frame is 3 months before the month they turn 65, the month they turn 65 and three months after they turn 65.  There is also the AEP period during which current members can make any type of plan change. This period runs from October 15th to December 7th every year. During this time, an application can be put in to make a change for a January 1 effective date.   The last type of period is the SEP period (Special Election Period) in which a change can be made at any time during the year.  Click on the link below for access to a grid showing all elections.
Source: croweandassociates.com

The Medicare Advantage Disenrollment Period Explained

It’s important to note that this time is not an additional enrollment period, which means that you cannot enroll in Medicare Advantage or switch between Medicare Advantage options. However, if you are planning to disenroll from Medicare Advantage, you may use this opportunity to enroll in a Medicare Supplement policy upon returning to Original Medicare. Any other changes to your Medicare plans must wait until the next valid Part D election period
Source: bradeninsurance.com

2013 Medicare Participation Enrollment Period for DMEPOS Suppliers Extended until April 15, 2013 : Health Industry Washington Watch

CMS is extending the 2013 Medicare participation enrollment period for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) until April 15, 2013. By way of background, a supplier that signs a participation agreement commits to accepting the Medicare Part B rate as payment in full for all beneficiaries. Changes in a supplier’s participation status can only be made during the annual open enrollment period. While CMS is extending the deadline because some suppliers apparently were not aware of a previous deadline extension to February 15, the new announcement gives suppliers another opportunity to examine their participation status in light of recent Medicare payment developments, including sequestration and upcoming Medicare cuts for retail diabetic testing supplies. Any change in election status will be effective January 1, 2013, but CMS will not reprocess claims already filed. 
Source: healthindustrywashingtonwatch.com

Medicare Advantage Enrollment Periods

The Initial Enrollment Period lasts 7 months. It would be to your advantage to submit an application prior to the month that your Medicare will be effective so your Medicare Advantage plan can be in place at that time.
Source: medicareprofs.com

"General Enrollment Period for Medicare

If you do not have enough work history in the Medicare System you can still purchase coverage. For 2013, the premium for Medicare Part A is $441.00. Most people do not have to pay a premium for Medicare Part A if they are age 65 and already received retirement benefits from Social Security or Railroad Retirement Board, are eligible for such benefits, or had Medicare-covered government employment. If an eligible person does not sign up for Medicare Part A when he or she is first eligible, Medicare assesses a 10% penalty on the $441.00 monthly premium. You will pay the higher premium for twice the number of years that you could have signed up for Part A and chose not to.
Source: elderplanningsolutions.com

Deductibility of Medicare premiums as Self Employed Health Insurance Deduction

Posted by:  :  Category: Medicare

Background Prior to 2010, self-employed individuals were not allowed to take an above the line self-employed health insurance deduction under Section 162(l) for Medicare premiums. Health insurance is only considered deductible under the statute if it is established by your trade or business.  The purpose of the health insurance deduction is to equalize the treatment of owners of corporations who are allowed to exclude health care benefits as a fringe benefit and self employed individuals who cannot. Since Medicare is established by the Federal government the IRS did not consider Medicare premiums deductible as self employed health insurance. Recently the IRS reversed their opinion on the matter referencing Notice 2008-1. Notice 2008-1 states that as long as the self employed individual’s business ultimately pays for the health insurance and follows certain reporting requirements, the health insurance premium payments are deductible as above the line for the self employed individual. The Office of Chief Counsel IRS Memorandum extended Notice 2008-1 to apply to self employed individuals who pay Medicare premiums. Now all Medicare premium parts-A, B, C and D-paid by the self-employed individual for themselves, their spouse and dependents are deductible as self employed health insurance. The premium payments need not be paid directly by the self-employed individual. For example, the S corporation of a more-than-2% shareholder can make the payments directly and the self-employed individual is entitled to the deduction. 
Source: marcumllp.com

Video: Medicare Part B Deductible

Medicare Part A deductible to rise by $32 in 2010

The beneficiary pays the deductible when admitted as a hospital inpatient. Medicare Part A pays for skilled nursing facility, inpatient hospital, hospice and certain home healthcare services. Beneficiaries must pay an additional $275 for days 61 through 90 in 2010, and $550 for lifetime reserve days. Only about 1% of Medicare beneficiaries have to pay a premium for Part A services.
Source: mcknights.com

DSCC Hits On $2K Medicare Deductible Again

Noah, If Conway has done more in the last few days to help your support of Rand Paul, apparently you were not a strong supporter anyway. I just had a friend murdered in Eastern KY this past week and he was killed by a guy on drugs. Drugs arent a problem in EKY according to some senate candidates though huh? Lets let the local governments take care of this problem. Grow up people, this is real stuff!
Source: pageonekentucky.com

How to Claim Medicare B for the Self

adjusted gross income business deduction business tax Credit Claims federal income tax Filing filing taxes income tax Income Tax Help installment agreement installment payment agreement IRS Audit IRS Audits IRS Debt IRS fees IRS help IRS penalties IRS problem IRS relief IRS Tax Help IRS trouble medical deduction Offer In Compromise schedule a Taxable Income Tax Attorney tax code tax credit tax credits tax deadline tax debt tax deductible tax deduction tax deductions tax filing tax help Tax payment tax problem Tax Professional tax refund Tax Relief tax relief help tax relief programs tax trouble unfiled tax returns
Source: limonwhitaker.com

2010 New modernized Medicare Supplement plans

Insurance Medicare is a health insurance program for people who have over 65 years. covers different types of treatments, doctors visits as well as shelter and many other related medical costs beyond those that are incurred by long-term care. Cares for up to 80% and depends on a number of things such as the type of coverage, the patient is under. There are times when people are not able to do co-payment in cash, so they opt for the extra insurance of Medicare that are available and are managed by different companies but work with national guidelines Medicare supplements have 12 options from which customers can choose. Although everyone has different terms and conditions contain the fundamental benefits of Medicare. The difference is seen in the premium, as well as the costs that the client will pay ranging from one company to another.
Source: allabout101.com

For Example: Medicare Doesn’t Cover Dental Care

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i


What is ironical is that yesterday while I was on hold on the telephone waiting to talk to a Medicare representative, I was informed by a recording that I am currently eligible for coverage under Medicare for cardiac screening, colon-and-rectal cancer screening, prostate cancer screening, diabetes screening, osteoporosis screening, a flu shot, and an annual examination by my primary care doctor.
Source: blogspot.com

Video: Medicare Dental Plans | Medicare supplemental Plans dental plans

Dental and Vision Coverage for Medicare Recipients

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:   What is the fifth letter of the word Insurance? I agree to forum rules 
Source: insurance-forums.net

Health Care Proponents of America

Affordable Health Insurance Affordable Insurance Company Insurance Deductibles Disability Doctors Good Health Health Care Health Care Bill Health Care Insurance Health Care Legislation Health Care Plan Health Care Providers Health Care Reform Health Care System Health Insurance Health Insurance Companies Health Insurance Company Health Insurance Coverage Health Insurance Plan Health Insurance Plans Health Insurance Policy Health Insurance Reform Health Plan Home Health Care Individual Insurance Insurance Insurance Companies Insurance Health Insurance Plan Medicaid Medicare Medicare Coverage Medicare Medicaid Medicare Plans Money Obama People Pre Existing Conditions Premiums Private Health Care Republicans Social Security Universal Care Vote
Source: hcpam.com

Oral Health and Medicare Beneficiaries: Coverage, Out

This brief describes the oral health of Medicare beneficiaries, examines sources of dental coverage for the Medicare population, and examines the utilization of dental services, out-of-pocket spending on dental care, and access problems. This analysis uses data from the National Health and Nutrition Examination Survey (NHANES), the Medicare Current Beneficiary Survey Cost and Use file (MCBS), the National Health Interview Survey (NHIS) and the Kaiser Family Foundation Survey of Health Care Among Nonelderly People with Disabilities and Seniors on Medicare, 2008.
Source: kff.org

Many Kids on Medicaid Don’t See a Dentist

Even though this number has improved by 16% between 2002 and 2007, there are still many children who cannot access care due to the loss of school-based dental education programs, state budget cuts, low reimbursement rates that prevent providers from accepting Medicaid patients, and the overall lack of Medicaid dollars going toward dental care. Although the Centers for Medicare and Medicaid Services (CMS) has put goals in place for preventive services, the only long-lasting solution will be an increased investment in dental care.
Source: pilcop.org

89 Arrested In $223 Million Medicare Fraud Schemes

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i


The Associated Press/Washington Post: Doctors And Nurses Among Nearly 100 Charged In $223 Million Medicare Fraud Busts In 8 Cities Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. It 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 (5/14).
Source: kaiserhealthnews.org

Video: Company accused of massive Medicare fraud

Medicare Fraud Bust at Least Gave Holder Something Good to Report

It 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

89 arrested in crackdown by Medicare Fraud Strike Force

JOIN THE DISCUSSION We welcome comments. To post one, you must sign in using either your McClatchyDC login or your login for Facebook, Twitter or Disqus. Just click the appropriate box below. Please keep your comment civil, short and to the point. Obscene, profane, abusive and off topic comments will be deleted. Repeat offenders will be blocked. If you find a comment abusive or inappropriate, please flag it for the moderator by placing your cursor on the comment, then clicking the “flag” link that appears. Thanks for your participation.
Source: mcclatchydc.com

Judge dismisses claims of ‘nationwide’ Medicare fraud in Omnicare antipsychotics case

Fox Rx Inc., a sponsor of Medicare Part D drug plans, brought a whistleblower action against Omnicare in 2011. Fox alleged that Omnicare submitted “thousands” of false Medicare claims between 2006-2010 for atypical antipsychotic medications being used to treat long-term care residents with dementia. This is an “off-label” use of these drugs, and therefore these prescriptions would not qualify for Medicare reimbursement.
Source: mcknights.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

12 Southland Residents Arrested On Medicare Fraud Charges

In addition to fraud, Dr. Pavehzadeh is charged with aggravated identity theft in connection to information taken from Medicare beneficiaries in order to file false claims. When authorities tried to conduct an audit, federal prosecutors said Dr. Pavehzadeh lied to Los Angeles Police, claiming that he had been carjacked and patient files had been stolen from his vehicle.
Source: cbslocal.com

89 charged in Medicare fraud busts in 8 cities

It 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: chicagobusiness.com

89 SUSPECTS ARRESTED IN MAJOR MEDICARE FRAUD BUST

Last week 89 people in eight cities across the country were charged for their roles in separate Medicare scams that collectively robbed the program of approximately $223 million. Among those charged are 14 doctors and nurses, both real and fraudulent, who wrote bogus prescriptions for medicines and psychotherapy, and bribed beneficiaries for their ID numbers. On Tuesday, roughly 400 agents dispersed across the country to raid various businesses, seizing documents and charging suspects in Miami, Los Angeles, Houston, Brooklyn, Detroit, Chicago, Tampa, Fla. and Baton Rouge, La.
Source: nhcoa.org

Miami Therapist Gets Nine Years For His Role In $63 Million Medicare Scam

Layman was aware that HCSN-FL personnel were fabricating patient medical records, federal prosecutors alleged. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment and were utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and Florida Medicaid. During his employment at HCSN-FL, Layman signed fabricated PHP therapy notes and other medical records used to support false claims to government sponsored health care programs.
Source: miaminewtimes.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

Medicare Insurance Plans Available Inside Washington State

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i


Medicare supplemental insurance plans will covers (depending on strategy design you take) some portion or possibly a as much as the all of the cost sharing the Treatment leaves for this particular member to pay out out. Also, select Medicare vitamin supplement plans also give the portion above Medicare insurance allowable (which is really a 15% surcharge) which experts claim out of infrastructure providers, (those offerers who do undoubtedly accept Medicare assignment) are allowed under the laws to impose a fee. This provision assistance quite a ounce for those who usually get an major accident or illness and need treatments in an location where the easily available doctors who snack food Medicare enrollees could be somewhat limited.
Source: salonstylesforyou.com

Video: AARP, Medicare and DSHS ( Washington State)

Rock You Like A Miami Hurricane

From now on a day excellent people around the continent does not attain through knowledge relating to these I think I need a medicare plan f review this year. These supplements are familiar with fill the difference of your Medicare policy. The reason is that your original Medicare policy would not cover your entire medical expenses need of. However, these supplements are helpful at that to be able to resolve your market issue regarding Systematic bills. These great Medicare policies end up being almost covers your very own medical expenses. However, there are usually some gaps this kind of policy does not considered covers, at that time these supplements entire fill your medical needs.
Source: huffpozer.com

Massachusetts and Washington: Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared

This fact sheet examines the similarities and differences between the five-year demonstrations in Massachusetts and Washington state to integrate care and align financing for people dually eligible for Medicare and Medicaid. The states finalized memoranda of understanding (MOUs) with the Centers for Medicare and Medicaid Services in fall 2012, and the demonstrations in each state are set to begin in April 2013.
Source: kff.org

Medicare Health Insurance Plans Available Inside Of Washington State

Now is the best time to secure a medicare plan f program before 2014 are not asked for but offer a particular significant blanket including financial protection. They cost the particular monthly premium also most find one particular cost to often be well worth our own protection provided. They also quote the protection a few want when you go away out of their surface area or the earth. With a new supplement you can get care just about anyplace in the Australia even non emergent care. At the end it is a personal choice in order to get a vitamin or not, nevertheless one most All of us know choose which will make in desire of the security.
Source: salonstylesforyou.com

CMS Sequestration Guidance for State Surveyors, Medicare Part C & D Plans : Health Industry Washington Watch

CMS has issued guidance to state survey agencies explaining adjustments CMS is making to survey and certification operations to "accommodate sequestration with as little impact on the public as possible." The guidance discusses revisions in the frequency and timelines for various surveys and other survey changes in light of a 5% reduction to the FY 2013 survey and certification Medicare budget. CMS also issued a May 1, 2013 memo to Part C and D plans on sequestration, covering rules regarding reducing payments to contracted and non-contract providers, beneficiary liability under sequestration, coverage gap discount program payments, Part D risk corridor reconciliation, and Electronic Health Records (EHR) Incentive Program payments, among other topics. In a related development, President Obama has signed the sequestration order for FY 2014, as required by law, although the Obama Administration’s proposed FY 2014 budget, if adopted, would replace sequestration.
Source: healthindustrywashingtonwatch.com

Medical company declines to answer Senate questions on Medicare billing

JOIN THE DISCUSSION We welcome comments. To post one, you must sign in using either your McClatchyDC login or your login for Facebook, Twitter or Disqus. Just click the appropriate box below. Please keep your comment civil, short and to the point. Obscene, profane, abusive and off topic comments will be deleted. Repeat offenders will be blocked. If you find a comment abusive or inappropriate, please flag it for the moderator by placing your cursor on the comment, then clicking the “flag” link that appears. Thanks for your participation.
Source: mcclatchydc.com

Medicare Plans Available Here In Washington State

Treatment Advantage Plans are offered to individuals that eligible and will have Medicare Plan A and B as well as live in a community that offers final results . plan. When enrolled in Medicare Advantage Plan clients are still an area in the government offered Medicare insurance however they are not eligible to extra supplemental an insurance policy such as usually the Medigap policies said earlier. Medicare insurance Advantage is in the simplest term a progression of study in which Medicare health insurance offers contracts to certain area hospitals and so doctors for approved amounts. Consequently individuals enrolled in this insurance plan must attend to currently the facilities of some of these medical professionals.
Source: myworkathomehq.com

Creepy Attitudes Fantacized By The Famous Surf Pro
:: Medicare Health Insurance Plans Available Here In Washington State ::

http://sheldongotowka3347.myworkathomehq.com

Medicare insurance Advantage Plans are accessible to individuals which are eligible and have Medicare Plan A and B and that live in a section that offers edge plan. when enrolled in Medicare insurance Advantage Plan on the receiving end are still aspect of the government produced Medicare insurance however are not eligible get hold of extra supplemental an insurance policy such as all of the Medigap policies said earlier. Treatment Advantage is on the simplest term a course of study in which Medicare offers contracts to certain area hospitals and so doctors for authorized amounts. In turn individuals enrolled in this insurance plan am obliged to attend to the very facilities of these medical professionals.
Source: myworkathomehq.com

White House Backs States’ Power To Cut Medicaid Payment Rates

I don’t know about payments in California but in Washington state Medicaid doesn’t cover the cost of providing care in a long term care facility. Without Medicare beds to provide some profit margin, a facility is going to be running in the red. In Oregon, one LTC facility (mixed Medicare and Medicaid) is closing (old, run-down, non-accessible building) and its beds are being transferred to a new facility in the same community BUT the new facility will only take Medicare and private-pay residents. The Medicaid residents have to find somewhere else to go. My guess is that this kind of transition will happen more frequently across the country as reduced payments put a squeeze on private companies trying to provide a positive return to their investors.
Source: californiahealthline.org

Quick Read: When Medicare Launched, Nobody Had Any Clue Whether It Would Work

“Medicare workers in Washington are learning that door-to-door selling is a rugged job,” a writer in this newspaper declared 47 years ago. It was March 3, 1966, after a Washington Post reporter had spent the day trailing Medicare workers who tried to sign seniors up for new program. Some didn’t answer the door.
Source: kqed.org

Trial against Da Vinci Robot, Medicare Costs and Benefits, Tough Week for Hospitals, HHS Fundraising, But there’s Plenty of Money out There

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, are 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: www.stopmedicarefraud.gov.
Source: oconnorreport.com

89 arrested in crackdown by Medicare Fraud Strike Force

JOIN THE DISCUSSION We welcome comments. To post one, you must sign in using either your McClatchyDC login or your login for Facebook, Twitter or Disqus. Just click the appropriate box below. Please keep your comment civil, short and to the point. Obscene, profane, abusive and off topic comments will be deleted. Repeat offenders will be blocked. If you find a comment abusive or inappropriate, please flag it for the moderator by placing your cursor on the comment, then clicking the “flag” link that appears. Thanks for your participation.
Source: mcclatchydc.com

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

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i


Author Jack Hoadley of Georgetown University examines the evidence on both sides of this debate. In addition to a discussion of the role of plan competition, the brief cites a number of other factors that contributed to lower spending, including the growth in generic alternatives for popular-but-expensive brand-name drugs and a reduction in new brand-name drugs entering the market – trends that dampened prescription drug spending outside of Medicare as well.
Source: kff.org

Video: How to Understand Medicare Plans

Understanding Medicare Suplemental Insurance

Medicare supplement insurance (or Medigap) is one of the most important new drug coverage options available (home page: http://medigapplansguide.com). I first learned about it when we found out that the premiums for my father were going through the roof. Even with coinsurance options, the out-of-pocket costs were killing us. After saving a ton of money, I decided to start offering Medigap consulting for others. This article shares some of my knowledge on the subject. %%iframe$url=http://www.youtube.com/embed/
Source: wordpress.com

Workshop Offered to Help with Understanding of Medicare Plans, Part D

The presentation will weigh the benefits and drawbacks of Medicare Advantage plans and discuss why so many people are switching over to them. Participants also will hear a description of Medicare Part D, the different phases of coverage and how the Affordable Care Act affects the coverage gap (doughnut hole) in Part D benefits.
Source: trtnj.com

Maximize Your Medicare: Understanding Medicare, Protecting Your Health, and Minimizing Costs ebook

Maximize Your Medicare: Understanding Medicare, Protecting Your Health, and Minimizing Costs.. Maximize Your Medicare explains Medicare, so you choose correctly, as soon as you become eligible for Medicare. This book will provide a short inside look into the world of. . called “This Happens.”This book is not a glorified. New Book Released on Medicare – Maximize Your Medicare. publisher of “Maximize Your Medicare: Understanding Medicare, Protecting Your Health and Minimizing Costs. Maximize Your Medicare: Understanding Medicare, Protecting Your. Oh, CLU(r). Amazon.com: Medicare: Books Maximize Your Medicare: Understanding Medicare, Protecting Your Health, and Minimizing Costs by Jae W. Term Life Nook-Shops. Canada’s health costs for seniors rising slowly: Points way to. Answer Book (3) BookDaily.com – Book Samples for Book Lovers Find thousands of new titles and emerging author sample chapters only on BookDaily.com. You first need to understand the mechanics, and they. the end.Maximize Your Medicare How to Use This Book Medicare is. New Book Released on Medicare – Maximize Your Medicare: Understanding Medicare, Protecting Your Health, Minimizing Cost. Com – The world of term life insurance. Promote your book to thousands of new readers daily. Maximize Your Medicare: Understanding Medicare, Protecting Your Health, and Minimizing Costs. Maximize Your Medicare: Understanding Medicare, Protecting Your. Free senior health fair held at the Bay City Mall
Source: typepad.com

Understanding Medicare "Cuts"

Medicare Advantage is a 15-year failed experiment in privatization. Running Medicare through private insurance companies was supposed to save money through the magic of the marketplace; in reality, private insurers, with their extra overhead, have never been able to compete on a level playing field with conventional Medicare. But Congress refused to take no for an answer, and kept the program alive by paying the insurers substantially more than the costs per patient of regular Medicare. All the ACA does is end this overpayment.
Source: nytimes.com

Understanding Medicare Advantage Plans

When choosing this or any other health insurance option, you should learn as much as possible about the plan before you make a commitment. The importance of this advice was proven recently in relation to some Medicare Advantage private fee-for-service plans. A Medicare Advantage Plan is designed to make it possible to extend your coverage beyond the basic Medicare programs. These plans, which are sometimes referred to as “Medicare Part C,” are typically similar to a PPO or HMO and can combine hospital, medical and prescription drug coverage in one plan that is available through private insurers approved by Medicare.
Source: wordpress.com

Navigating and Understanding Medicare Supplemental Insurance

What Is Covered Under Supplemental Plans A supplemental plan covers most, if not all of the costs associated with a doctor’s visit. The amount you pay depends on the type of plan you chose. Keep this in mind; the lower premium that you are paying for your supplemental plan, the more you can expect to pay out-of-pocket. If you have a deductible under Part A (hospital visits), the supplemental plan covers the entire deductible. Supplemental plans do not cover any vision, dental or long-term care you may need. You must buy those policies separately from private insurance companies. Plus, make sure you carefully review your current coverage and look to see if any items are covered by your current policy. This saves you thousands of dollars a year in out-of-pocket costs.
Source: tradeexaminer.com

Understanding Medicare Supplemental Insurance

One comes across all sorts of insurance, Medicare supplement insurance features among these. It is always better to be well-informed when it comes to Medicare supplement insurance as there are constant changes to the insurance policy, often a change for the better but sometimes it is not. It is important to observe these changing trends whether you are already on the Medicare supplement insurance or desire to enroll for the same. To be forewarned is to be forearmed. There is a significant change to the plan; even as the plans are being revised the companies are beginning to quote their new rates. This is the first step of change since the year 1992. The two plans that feature in this change are the M and N plans; it is likely that the pair of these plans will have a better effect on the Medicare supplement insurance market. The idea behind these plans is that though they cost lower it will be all the more complicated to qualify medically in case a person desires to upgrade his plan. People tend to go in for an insurance that is lower than about what they fail to recognize or realize is that the benefits are less in this case. However, these modified plans are being offered as alternatives to the more expensive Medicare supplement insurance plans.
Source: allabout101.com

Viewpoints: Assessing The Oregon Medicaid Experiment; Health Insurance Hysteria; In Florida, ‘Toxic Politics’ Beats Out Common Sense

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i


The New York Times: What Health Insurance Doesn’t Do As liberals have been extremely quick to point out, these findings do not necessarily make a case against the new health care law, which includes a big Medicaid expansion as well as subsidies for private insurance. After all, the first purpose of insurance is economic protection, and the Oregon data shows that expanding coverage does indeed protect people from ruinous medical expenses. The links between insurance, medicine and health may be impressively mysterious, but staving off medical bankruptcies among low-income Americans is not a small policy achievement. This is true. But it’s also true that the health care law was sold, in part, with the promise (made by judicious wonks as well as overreaching politicians) that it would save tens of thousands of American lives each year (Ross Douthat, 5/4).
Source: kaiserhealthnews.org

Video: Paul Ryan Speech on Medicare in Florida, on August 17 2012

Good news: Florida legislature halts Medicaid expansion

Kliff has long held a bias in her reporting – for example, she called the infamous Gosnell trial in Pennsylvania a “local crime” to justify why she did no reporting on it, yet she wrote a gun control post on the “local crime” of the shooting in Newtown – but this particular post is rather telling. Rather than provide two sides to the story on a site calling itself a place for wonks – i.e. people “who [study] a subject or issue in an excessively assiduous and thorough manner,” Kliff merely repeats the big government line of how less federal intrusion in states is a bad thing.
Source: teapartypatriots.org

Dozens Arrested for Medicare Fraud in South Florida

Federal authorities arrested nearly 100 individuals across the country for their involvement in Medicare fraud. Twenty-five arrests were made in South Florida alone. Miami-Dade County is often considered to be the hotbed for healthcare fraud. Miami criminal lawyers have kept busy over the past few years representing clients arrested for Medicare fraud. The highest profile defendant arrested in the most recent sweep was Roberto Marrero, a Cuban born actor and businessman, who is accused of stealing millions of dollars from the federal healthcare program. Both Marrero and his wife were arrested for submitting $20 million in bills to Medicare. The bills were submitted to the program for home health care for diabetic patients. The indictment alleges that the treatments were either not necessary or never provided.
Source: miamicriminaldefenselawyerblog.com

Feds Arrest 36 More California & Florida Providers On Defrauding Medicare Of More than $66 Million

If you need assistance providing compliance or other training, reviewing or responding to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 24 years experience advising health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to 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/ She also regularly designs and presents risk management, compliance and other training for health care providers, professional associations and others.   Her publications and insights 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
Source: wordpress.com

With Time Running Out, Florida Medicaid Expansion Is In Doubt

The Service Employees International Union 1199, which represents many health care workers, has posted billboards in the Tallahassee Regional Airport, saying “Medicaid Expansion Will Save Lives.” Members are also holding vigils in the districts of Republican House members expected to face competitive races next year. “We are urging Republican House members to not put politics and ideology over the needs of constituents,” says Monica Russo, president of SEIU Healthcare Florida.
Source: kaiserhealthnews.org

An Economic and Policy Analysis of Florida Medicaid Expansion

French economist Frédéric Bastiat introduced the concept of the “fallacy of the broken window.” Economics instructors use this classic parable to explain opportunity costs and alternative uses for resources. In the parable, a shopkeeper’s son accidently breaks a shop window pane. As a result, the store owner will have to pay someone to haul the broken glass away; then order a new glass pane, hire a craftsman to install it and possibly someone else to clean up afterward. This is an example of “economic activity” created by a simple broken window. The broken window pane will create work and wages for the glassmaker, carpenter and anyone involved in the repair; but the shop owner will suffer a loss of disposable income. Moreover, society is worse off by one pane of glass that was needlessly broken. The resources employed to remove the broken glass and install a new pane could have been employed to produce something else that would please the shopkeeper more and possibly make society richer.
Source: ncpa.org

Nonprofit with ties to Rep. Brown overbilled Medicaid

According to an audit by the Florida Agency for Health Care Administration, the Community Rehabilitation Center in Jacksonville overbilled Medicaid by nearly $1.4 million. Reggie Gaffney, a former Jacksonville Port Authority board member, runs the nonprofit, which provides medical services for mental illness, substance abuse, and HIV/AIDS for low-income residents.
Source: freebeacon.com

Daily Kos: Florida lawmakers, who rejected Medicaid, have really sweet health insurance deal

I am sitting here reading from the FEHBP book. A federal employee who elects Blue Cross/Blue Shield pays, for his coverage, for Standard Option, $433.63 per month for self and family (and the same if the family is only him and his wife—there is no reduction for a couple) or $186.14 if he elects coverage for himself only.  This plan is identical whether the employee is the President, a Congressman, a secretary or  janitor at a federal building anywhere in the US,  a cancer researcher at the NIH,  or a driver of the shuttle bus that runs between federal buildings in the DC area. That’s a bit more than Florida’s legislators are paying.
Source: dailykos.com

FL House GOP’s balking at Medicaid cash could hurt party, Florida

They said they didn’t care to take nearly $9.8 billion from the federal government over three years to help provide coverage to as many as 816,000 low-income Floridians. Their plan covers fewer people and costs the state treasury more money than proposals by Republican Gov. Rick Scott or the GOP-led Senate, who want to take the federal money for at least three years by expanding the Medicaid program.
Source: typepad.com

Satisfaction of Medicare and Medicaid liens from recoveries in Florida personal injury cases

If you or a loved one has been injured in any type of accident due to the negligence of another person, call Belle Glade Personal Injury Lawyer Shannon J. Sagan at 1-800-FLA-LAWYER today to schedule your free consultation.  Belle Glade Personal Injury Lawyer Shannon J. Sagan is committed to thoroughly reviewing your case and honestly discussing any options you may have to recover damages for injuries resulting from any type of accident.
Source: 1800flalawyer.com

Comments Off  :  Add Comment
May 25, 2013

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

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i


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

Video: Medicare Advantage Rate Decision (4/1/2013)

Doctors billing Medicare patients at higher rates, report finds

“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”
Source: nbcnews.com

Medicare’s Role for Older Women

These 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

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

Browse the Medicare Hospital Charges and Payment Data

If anyone’s wondering, the alphabet soup at the end of most of the diagnoses in Jonathan’s app is the “severity-adjusted diagnosis-related group [DRG]” coding that Medicare uses to reimburse hospitals for patient care. First adopted in 1982, DRGs were a major step away from pure cost-based reimbursement and thus an important part of containing health-care cost increases (though prices have obviously continued to escalate rapidly over the last 30 years). The “severity-adjusted” refinement is a way of reducing the total number of codes required to be used when seeking reimbursement from Medicare. “Cc” means the base diagnosis PLUS common co-morbidities and complications, while “Mcc” means major co-morbidities and complications. “W” and “W/O” mean with or without, obviously. Now if we could just get to where ALL physicians and hospitals are paid based on OUTCOMES, rather than diagnoses. http://en.wikipedia.org/wiki/Diagnosis-r… http://www.irpsys.com/articles%5Cszh_med…
Source: thestranger.com

Medicare Data Show Huge Disparity in Charges by North Texas Hospitals for Inpatient Procedures

“The complex and bewildering interplay among charges, rates, bills and payments, across dozens of payers, public and private, does not serve any stakeholder well, including hospitals,” said Rich Umbdenstock, president of the American Hospital Association, in a statement. “This is especially true when what is most important to a patient is knowing what his or her financial responsibility will be.
Source: dmagazine.com

Technical Note: Are Providers Gaining Pricing Power over Medicare?

The actuaries have concluded from this analysis that preserving beneficiary health access to mainstream health services means Medicare rates must soon increase. “Hospitals,” they say, “have been pushing back in recent years against payment reductions aimed at further reducing inefficiency, a signal that much of the achievable gains may already have been made.” If nothing else, the Alternative Illustrative Scenario illustrates how difficult it is for public agencies—especially ones steeped in the stakeholder politics of a three trillion dollar per year industry—to imagine a slowdown in private prices.
Source: cahc.net

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

New Data Help Explain Hospital Pricing, But Experts Caution That Medicare And Insurers Get Much Lower Rates

The Associated Press: 2 Florida Teens Who Are Best Friends Help Each Other Pay For Expenses During Cancer Treatment Ashley was diagnosed with T-cell lymphoma in September. She needed a bone marrow transplant and would be in isolation for months. Tony knew how that would affect Ashley’s family financially. … Starting with a garage sale and car wash, he gathered donations. Then he opened an account with www.giveforward.com, a site dedicated to raising money for people with medical bills. Within months, Tony raised about $25,000 for Ashley. Ashley’s mom, Pat Myers, who had quit her job as a website programmer so she could care for her daughter, was overwhelmed. Myers recalled thinking: “I hope we never have to repay the favor.” But two weeks after Ashley’s diagnosis, Tony discovered his cancer returned. He would need costly treatment in Bethesda, Md., at the National Institutes of Health. Ashley, from her hospital bed, told her mother that she wanted to start an online fundraiser for her friend (5/9).
Source: kaiserhealthnews.org

AHIP Statement on Final 2014 Medicare Advantage Payment Rates

“By being responsive to the more than 160 members of Congress from both parties who raised concerns about the impact of the proposed payment rate on seniors, CMS has taken an important step to help stabilize Medicare Advantage at a time when the program is facing significant challenges. We are currently reviewing the final rate announcement and will continue to work with policymakers in both parties to strengthen this critically important part of Medicare that provides high-quality, affordable coverage to more than 14 million seniors and people with disabilities.”
Source: ahipcoverage.com

Medicare Payment Rates Should Not Be Based on Region, IOM Panel Says

As long as FFS mentality drives reimbursement, this problem will simply waffle from one inintended consequence to another. Regions with much higher cost of living will have higher baseline hospital costs and physician overhead. Abrupt rate cuts there will predictably drive providers out of Medicare…and Medicare patients into trouble. On the flip side, waste in excessive admission rates and excessive procedures in low cost areas already hides behind geographic indices. You can’t solve both problems with one switch. Some regional adjustment coupled with palpable risk may solve it. It works here for Medicare Advantage. Meanwhile, the disconect between hospital regional rates and individual provider rates has been known for a decade…and stonewalled.
Source: californiahealthline.org

Time for a Change: Dissecting the Medicare Sustainable Growth Rate

Several organized medicine groups spent the latter part of 2012 lobbying legislators to permanently repeal the formula. Leaders from the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American College of Surgeons and the American Osteopathic Assn. all met with politicians to stress the importance of replacing what doctors consider a severely broken payment system.
Source: poweryourpractice.com

Comments Off  :  Add Comment
May 25, 2013

Illinois Federal Judge Orders Government To Provide Information In Medicare Suit

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i


CHICAGO – An Illinois federal judge on May 6 partially granted a defendant’s motion for an order directing the federal government to file a bill of particulars in its case against him for Medicare fraud (United States of America v. Robert Kolbusz, No. 12-782, N.D. Ill.; 2013 U.S. Dist. LEXIS 64043).Full story on lexis.com
Source: lexisnexis.com

Video: Is Illinois Forcing the Wrong Medicare Solution?

Medicaid expansion debate ahead in Illinois House

The commenter section of Crain’s Chicago Business is an opportunity for our readers to start a dialog on our content. While we don’t require you to use your real name, we do ask that you participate as though you were – that is, keep the conversation civil, stay on topic, avoid profanity, vulgarity and personal attacks, and please don’t post commercial or self-promotional material. We will remove comments that violate these standards.
Source: chicagobusiness.com

ObamaCare’s Medicaid expansion bill wrong for Illinois

Fifth, this bill includes a “trigger” to back out of the expansion in case the federal government reduces the enhanced matching rate, but the trigger is unlikely to be effective. Although the U.S. Supreme Court held that the federal government could not require states to opt into the Medicaid expansion, it did not hold that federal requirements on maintaining eligibility would not apply after a state agrees to expand Medicaid. Federal law classifies the expansion population as a new “mandatory population” for states that opt into the expansion, which brings with it the authority of the federal government to take away all federal Medicaid funds if the state were to ever try to roll back eligibility for that group.
Source: typepad.com

Shocking Medicare and Medicaid fraud exposed at Illinois’ Sacred Heart Hospital

“Between January 2010 and February 2013, May allegedly received $74,000 in the form of 37 checks, for $2,000 each, disguised as ‘rental payments'; Moshiri, a podiatrist, allegedly received $86,000 in 38 checks pursuant to a purported contract to teach podiatry students; and Maitra allegedly received $68,000 in 34 checks pursuant to a purported teaching contract – and the $228,000 total in alleged kickbacks were all in exchange for their referral of patients to Sacred Heart, the charges allege.   “In a recorded conversation last month, Maitra allegedly explained to Administrator A that he used to make Novak ‘so much money’ performing almost daily penile implant procedures on patients, but that he no longer performed as many of those procedures because Medicare had decreased its rates of reimbursement for the procedure. Maitra did not comment on whether the patient need for the procedure had somehow changed, according to the affidavit.”   “On March 1, 2013, Administrator A recorded Novak stating that tracheotomies are Sacred Heart’s ‘biggest money maker’ and the hospital can make $160,000 for a tracheotomy if the patient stays 27 days. On March 7, 2013, the Intensive Care Unit case manager told Administrator A that she must often ‘stretch’ a tracheotomy patient’s stay to 28 days to maximize Medicare reimbursements ‘to make Novak happy.’”
Source: wordpress.com

Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: California, Illinois, Massachusetts, Ohio, and Washington

This policy brief compares demonstration programs in California, Illinois, Massachusetts, Ohio and Washington state that will introduce changes in the care delivery systems through which people who are dually eligible for Medicare and Medicaid receive services, as well as changing the payment approach and financing arrangements among the Centers for Medicare and Medicaid Services, the states and providers.
Source: kff.org

Park Ridge Man Charged in Medicare Kickbacks

On March 4, 2013, investigators from CMS and the State of Illinois arrived at Sacred Heart to conduct an investigation of the hospital’s intubations and tracheotomies, and quality assurance and performance improvement protocols.  On March 6, Administrator A recorded Physician D acknowledging that Sacred Heart lacked policies for various aspects of intubations and tracheotomies and that he had given some practice guidelines and procedures obtained from other hospitals to the surveyors in response to their request for Sacred Heart’s policies.  At the same time, the ICU nurse manager told Administrator A that she had reviewed eight tracheotomy patient files in connection with the CMS investigation.  Physician D was the pulmonologist for all the patients and had performed all but one of the tracheotomies.  The nurse manager said that there was no documentation in the patient files explaining the decision to intubate the patients or any efforts to wean them from the ventilators.  The following day Administrator A reported the findings to Novak and others and regarding the lack of documentation, and Novak replied with an expletive, according to the affidavit.        
Source: patch.com

Illinois Attestation for Medicaid Payment Increase? Not Yet – Pediatric Inc

ICAAP and its partner medical associations have discussed this rate increase and urged HFS to act, at both individual meetings and Medicaid Advisory Committee meetings, beginning last year.  We have made recommendations to them and received some assurances that providers (rather than managed care or other third parties) will directly benefit from the increases, as required by the Centers for Medicare and Medicaid Services.  We have also been told they are making progress in determining rates, attestation processes, and other details but do not expect to receive final information for at least a few more weeks.  Technically, the state has until the end of March to determine and promote its processes.
Source: pediatricinc.com

Comments Off  :  Add Comment