ConnectiCare and Healthways Partner to Offer SilverSneakers® Fitness Program Through 2015

Posted by:  :  Category: Medicare

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

Video: CBIA Webinar on ConnectiCare’s Medicare Advantage Program for 2013

Connecticut Nursing Jobs: Health Navigator (NR12

Further informations about this occupation opportunity kindly read the description below. Reports to: Supervisor, Medicare Case Mgmt UnitFLSA: ExemptManages: NonePurpose: Provides telephonic health navigation services to high-risk dual eligible members enrolled in ConnectiCare’s Medicare Advantage products. Navigator services include Care Transition Interventions, appointment scheduling, transportation coordination, telephonic outreach, dissemination of educational messages, and linkage to internal and external/community resources. Works directly with members, caregivers and other health care delivery system entities, and communicates with physicians and nursing staff to enhance the coordination of care for members.KEY ACCOUNTABILITIES:1. Independently completes designated call outreach to Medicare beneficiaries for the purpose of program introduction, health screening, psychosocial assessment, functional assessment, health coaching and/or triage.2. Expected to manage a flexible work schedule in order to meet the needs of beneficiary and to optimize reach rates.3. Utilizes good judgment and discretion in referring cases to a Nurse Case Manager, Social Work Case Manager and/or Pharmacist when appropriate.4. Enters and maintains critical data in ConnectiCare case management/ physician office electronic medical record systems meeting defined timeframes and performance standards.5. Provides Care Transition Interventions including discharge plan review, medication review, ensures post-discharge appointment with PCP or specialist, assists with scheduling needed tests, arranges for transportation identifies early warning signs for re-hospitalization and creates a plan of action with member, and links member to internal and external resources6. Identifies all HEDIS measures for which the member is eligible, determines if member is already compliant and if works with the member to achieve HEDIS compliance for all eligible measures7. Identifies chronic conditions that have not been diagnosed and documented in the calendar year and works with PCP to ensure member has a PCP visit and the conditions are appropriately captured. Actively collaborates with medical group physicians and nursing staff as well as other ConnectiCare case managers and navigators.8. Actively collaborates with medical group physicians and nursing staff as well as other ConnectiCare case managers and navigators.9. Performs other related projects and duties as assigned. 1. At least 3 – 5 years experience in a managed care setting with familiarity with care coordination is required. Experience in discharge planning, care transition interventions, HEDIS measures and HCC coding preferred is desirable.2. Excellent oral and written communication, organizational, and interpersonal skills required.3. Previous system user experience in a highly automated environment and strong personal computer literacy on Windows products required.4. Demonstrated ability to work independently and effectively offsite, and to prioritize multiple tasks required.5. Experience with coordination of internal and external/community resources preferred6. Bilingual in English/Spanish or English/Polish preferredCOMPETENCIES:1. Member and Customer Focus: Recognizes that members and customers (internal & external) are the driving force behind every business activity. Continuously makes an effort to exceed the expectations of members and customers.2. Quality Orientation: Assumes responsibility for providing the highest level of quality to members and customers.3. Innovation: The ability to see opportunities for change, to capitalize on them and implement them when appropriate for the benefit of ConnectiCare.4. Communication: The ability to communicate with clarity both orally and in writing.5. Teamwork: Demonstrates enthusiasm for the mission of ConnectiCare and inspires the same in others.6. Results Orientation: The ability to break a complex problem down into its component parts and arrive at the appropriate solution in a timely fashion.7. Change Mastery: Embraces change.8. Learning Orientation: Assumes responsibility for personal and professional development.ConnectiCare is an equal opportunity employer. M/F/D/V – . If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to ConnectiCare Inc..
Source: blogspot.com

ConnectiCare Enters Medicare Advantage Market

Consumers looking for a Medicare Advantage product will find many options to match their health insurance needs from ConnectiCare. Individuals, who enroll in our Medicare Advantage plans, will receive all the benefits of original Medicare plus benefits such as disease management programs, health and wellness support, limited dental benefits and more.
Source: wordpress.com

Connecticare Sets The Stage For Fun In 2010

PRLog (Press Release) – May 25, 2010 – Inspired by timeless adages such as “Laughter is the Best Medicine” and “An Active Mind is a Healthy Mind,” ConnectiCare has created the 2010 “Setting the Stage” program for its VIP Medicare members. The program will provide free admission to events such as trivia game shows, dance classes, museums, movies, comedy shows and more to give members incentive to stay active and healthy. “Our ‘Setting the Stage’ program will provide free admission to a number of fun events around the state for our VIP Medicare members. It’s a great way to help keep our members feeling vital, fit and always smiling,,” says Tony Tedeschi, Director of Medicare Program Management with ConnectiCare. “Additionally, we are hosting four trivia competitions at locations around the state to see who knows the most about the 1950s through the 1980s. The top three contestants will advance to a final challenge in September in Cromwell hosted by Scot Haney of WFSB TV 3 and Better Connecticut, where the top finisher will be crowned the ‘Know it by Heart’ trivia king or queen. It should be lots of fun and an event-filled summer for all of our members.” Details about all of the ConnectiCare VIP Member exclusive events can be found on ConnectiCare’
Source: prlog.org

Hartford Healthcare, ConnectiCare ink new deal

“Reaching a new contract with ConnectiCare brings us one step closer to reaching our goal of a solid financial foundation and is an important step in ensuring we can continue to meet the healthcare needs of our community now and in the future,” said Jim Blazar, executive vice president and chief strategy officer, of Hartford Healthcare.
Source: hartfordbusiness.com

Medicare Advantage Plans Connecticut

[…] AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 aetna Medicare Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Donut Hole High Deductible F supplement how to choose a Medicare Advantage plan How to choose a Medicare plan how to choose a plan How to choose a supplement how to enroll in a medicare plan MAPD Med Advantage Medicare Medicare Advantage Medicare Advantage plans Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare part B Medicare part D Medicare plan Medicare prescription drug plans Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 Original Medicare Part D united healthcare United Healthcare AARP United medicare complete United Medicare complete 2013Source: croweandassociates.com […]
Source: croweandassociates.com

Insurer Teams With Medical Group To Improve Patient Care

The second part of the program involves end-of-life care, a term that invokes stigmas after debate about federal health care reform. In this instance, the term means that patients will meet with their doctors and health insurer to talk about treatment options before it’s a last-minute decision in an intensive-care unit, said Dr. Paul Bluestein, ConnectiCare’s chief medical officer.
Source: courant.com

Workable Solutions Partners with ConnectiCare on Innovative New Product Combining Flexible Employers Contributions and Choice of Plans for Employees

Weve listened to our customers and as a result ConnectiCare Benefit addresses three of our clients highest priorities managing charges, providing program alternatives that meet the person requirements of their personnel, and streamlining the rewards administration process, says David Gordon, VP Product and Product Development for ConnectiCare. In addition, the flexibility we have with our Workable Solutions partnership will allow us to continue to add products and services, ensuring we are in a position to meet the evolving requirements of our consumers.
Source: true-wellbeing.com

Medicare Advantage, Medicare « Insurance News from Crowe & Associates

Medicare Advantage plan designs are set for 2010.  The general trend was that everyone lowered benefits and raised premiums.  Some of the change can be attributed to the cut in funding for Advantage programs (approximate 4% decrease in funding vs. the traditional 4%-6% increase in funding) but some of it most surely be due to utilization and frequency.
Source: croweandassociates.com

Emdeon Current: New Payer Transactions

Claims Management Services, Payer ID: 39141 Clarian Health Plans Inc., Payer ID: 95444 Connecticare – Medicare, Payer ID: 78375 CoreSource Little Rock, Payer ID: 75136 DiaTri LLC, Payer ID: 36439 Employee Benefit Systems, Payer ID: 42149 Fallon Community Health Plan, Payer ID: 22254 GHI – Medicare Private Fee for Service, Payer ID: 22937 GHI – New York (Group Health Inc.), Payer ID: 13551 GHI HMO, Payer ID: 25531 Geisinger Health Plan, Payer ID: 75273 Group Health Cooperative of South Central Wisconsin, Payer ID: 39167 Group Health Inc., Payer ID: 22937 HIP – Health Insurance Plan of Greater New York, Payer ID: 55247 Harrington Health-Kansas (formerly known as Fiserv Health-Kansas), Payer ID: 62061 Harvard Pilgrim Health Care, Payer ID: 4271 ISLAND HOME INSURANCE COMPANY, Payer ID: IU Medical Group Primary Care, Payer ID: SX172 Integra Group, Payer ID: 31127 LIFE Pittsburgh, Payer ID: 25181 Landmark Healthcare Inc, Payer ID: LNDMK MED PAY, Payer ID: 88058 MEDICA HEALTH CARE PLAN INC., Payer ID: 78857 March Vision Care Inc., Payer ID: Call Meritain Health / Agency Services, Payer ID: 64158 Meritain Health/North American Administrators, Payer ID: 64157 Metropolitan Health Plan, Payer ID: 10850 Montefiore Contract Management Organization, Payer ID: 13174 Network Health, Payer ID: 4332 Network Health Insurance Corp-Medicare, Payer ID: 77076 North American Administrators Inc., Payer ID: 64157 North American Health Plan, Payer ID: 64157 North American Preferred, Payer ID: 64157 Northstar Advantage, Payer ID: 60058 ODS Health Plan, Payer ID: 13350 PacificSource Health Plans, Payer ID: 93029 Paragon Benefits Inc., Payer ID: 58174 Prism-First Health, Payer ID: 37303 Screen Actors Guild, Payer ID: 99289 Touchstone Health PSO, Payer ID: 23856 Trellis Health Partners, Payer ID: 36397 Vytra Healthcare, Payer ID: 22264 Weyco Inc., Payer ID: 38232 Wisconsin Department of Corrections, Payer ID: 74101 Anthem Blue Cross, Payer ID: 47198 Associated Benefits, Payer ID: 50266 Blue Cross Blue Shield of New Mexico, Payer ID: SB790 Blue Cross Blue Shield of Oklahoma, Payer ID: SB840 Illinois Medicaid, Payer ID: SKIL0 Nebraska Medicaid, Payer ID: SKNE0 New Hampshire Medicaid, Payer ID: SKNH0 Eligibility Inquiry and Response Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Medical Mutual of Ohio, Payer ID: 211 Medical Mutual of Ohio, Payer ID: MMO00211 Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 ameritas, Payer ID: AMTAS00425 Blue Cross Blue Shield of Pennsylvania (Highmark), Payer ID: BCPAC Blue Cross Blue Shield of Pennsylvania – Highmark, Payer ID: 440 Mountain State, Payer ID: MTNST Affinity Health Plan, Payer ID: AFNTY New Jersey Medicaid, Payer ID: AID19 New Jersy Medicaid, Payer ID: NJ South Dakota Medicaid, Payer ID: AID28 South Dakota Medicaid, Payer ID: SD Claim Status And Response: Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 For all payers, visit https://access.emdeon.com/PayerLists/
Source: blogspot.com

CT Medicare Advantage, Medicare Supplement, Prescription Drug Plans

Our agency is expanding! Shortly we will be Medicare Advantage and Medicare Supplement brokers. (We will continue to help Connecticut residents buy medical insurance.) We will be offering Zero Premium Policies (that right, some of the policies require none of your money be sent to the insurance company!) as well as other policies with premiums and enhanced benefits.
Source: 1800insurancect.com

Virginia is Approved to Begin Offering Coordinated Healthcare for Medicare

Posted by:  :  Category: Medicare

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Secretary of Health and Human Resources, William A. Hazel, MD. said, “For many years, the Commonwealth has been working toward this significant reform opportunity. We view this achievement as a testament to the willingness of Virginia’s Medicaid providers and interested health plans to work collaboratively with the department to implement innovative models of care. DMAS is always working towards the development of more effective and efficient service delivery opportunities. This program has the potential to be one of the most significant to date. I am grateful for the governor’s consistent push to ensure that Medicaid operates more efficiently and am proud of the leadership of the department in developing and obtaining federal approval for this demonstration. I am confident that participants in this demonstration will have better health outcomes while the state will achieve associated cost savings.”
Source: chrispeace.com

Video: Terry McAuliffe: Expanding Medicare In Virginia ‘Right Thing To Do’

Virginia starts pilot Medicare/Medicaid program

Boston Marathon Caroline County Celebrate Virginia Live Chancellorsville 150 City Council Civil War Colonial Beach crime Culpeper Culpeper County Dahlgren Daniel Harmon–Wright Dominion Raceway earthquake Falmouth intersection fatal fire Fredericksburg Fredericksburg Va. Getting There Health Care Historic Half Hurricane Sandy Interstate 95 King George King George County Natatia Bledsoe National Slavery Museum Orange County outage Patricia Cook power outage Rappahannock River Spotsylvania Spotsylvania County Stafford Stafford County storm transportation UMW University of Mary Washington VDOT VRE weather Westmoreland County
Source: fredericksburg.com

Medicaid Expansion Popular In Southern States, Despite Govs’ Opposition

Tampa Bay Times: Tampa Chamber: Businesses Concerned By Legislature’s Inaction On Medicaid Expansion For Tallahassee, refusing additional federal funds to expand Medicaid may turn out to have been the easy part. It will take longer, a half-dozen Hillsborough legislators acknowledged Tuesday, to come up with an alternative to provide health care coverage to an estimated 1 million uninsured Floridians. … Some Tampa businesses, (Greater Tampa Chamber of Commerce Chairman Gregory Celestan told local legislators), are “very concerned about significant additional health insurance costs” because of the Legislature’s “refusal to expand Medicaid.” “We will be at a competitive disadvantage when recruiting new businesses or adding jobs,” Celestan added. “How would you respond?” (Danielson, 5/21).
Source: kaiserhealthnews.org

Medicaid Expansion: A false promise to poor Virginians

Another concern, unrelated to the program itself, is how do we pay for it? The federal government has promised to cover all the costs of expansion. The nation is $16 trillion in debt. Our Congress hasn’t passed a budget in four years. Advocates for expansion claim “free federal money” will pay for expansion, but the truth is the federal government cannot afford to pay for Medicaid expansion without adding hundreds of billions of dollars in debt that will burden our children and grandchildren. In short, Medicaid is an expensive, broken program. And Virginia taxpayers will eventually get stuck with the tab. You don’t fix a broken program by putting more people in it. And you certainly don’t help poor Virginians by putting them in a broken program. Enrolling low-income Virginians in a broken program that we cannot afford is a false promise and a fool’s paradise.
Source: bearingdrift.com

West Virginia Blue:: Capito Alone Votes for Partisan Cuts Slashing Medicare, Hurting WV

I have nothing personal against Congresswoman Capito.  She is a nice lady.  On a slim sliver of issues, I think she is relatively moderate (she is Pro Choice for example).  She is also an establishment Republican that has in the past rebuked the Tea Party.  Now that the radicals control the GOP, however, she feels she needs to keep pace.  She is a calculating politician above all else and such strategic maneuvering in Washington often leaves West Virginia out in the cold.  Don’t take my word for it, just ask her Republican colleague from West Virginia’s First Congressional District.
Source: wvablue.com

Survey on Social Security, Medicare, Virginia

"The share of the budget going to entitlements has to slow down. Everybody has to give a little bit, the sooner the better, to go after the problem," said retired foreign service officer Stephen Brundage, 61, of Arlington, expressing a view shared by many Virginians.
Source: aarp.org

Seniors should tell Obama to prevent Medicare Advantage cuts

Posted by:  :  Category: Medicare

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When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

Video: Senior Advantage Medicare

Obama Cuts Medicare – Again!

 The combined impact of these administrative actions will force millions of seniors into the government run Medicare they already chose to reject. According to the CMS’ own numbers, enrollment in Medicare Advantage fell for several years after the program was faced with significant cuts in the Balanced Budget Act of 1997. And between December 2001 and December 2002, enrollment dropped by more than 900,000. Those who stayed in the program saw higher premiums and reduced benefits and coverage.
Source: townhall.com

MEDICARE ADVANTAGE: Growth Projections Are Stunning.

Based on this eye-opening news article today, UnitedHealth, Humana May See Surge in Medicare Advantage – Bloomberg I’m now going to get certified to sell Medicare Advantage plans with 2, or perhaps 3, good carriers. I looked at one from Humana last year for my dad in Michigan, but the out-of-pocket expenditures for medical care were stunningly high, compared to Standard Medicare mated with a Plan "F" MedSupp. But if Medicare Advantage participation is going to grow a whopping 50% over the next 10 years, I’d be a fool not to at least have it in my portfolio of offerings. Who’s driving the growth of these Medicare Advantage plans the most.. Is it Well-To-Do Seniors who don’t mind paying the high out-of-pocket costs? Or is it Seniors on very limited income who are attracted by the lower overall premium cost? Other some other demographic? -Allen
Source: insurance-forums.net

Hawaii ranks 6th for senior health

“United Health Foundation’s America’s Health Rankings Senior Report is a highly valuable tool to help gain a greater understanding of the health challenges faced by Hawaii’s seniors,” said Ron Fujimoto, M.D., chief medical officer, UnitedHealthcare’s Community Plan for Hawaii. “Hawaii’s growing senior population points to the urgency of identifying key opportunities for improving senior health and pursuing effective solutions at the national, state, community and family levels.”
Source: hawaii247.com

Worst Medicare Advice You’ll Ever Get from an Insurance Agent

Part C Medicare Advantage health plans will NEVER make paying for any kind of health care service "more expensive" than paying for that same service simply using Original Medicare Parts A and B. Part C Medicare Advantage health plans are not right for every senior (which is why the "Medicare and You, 2013" booklet shows options on page 15–see illustration above) but Part C plans are always better for seniors than Original Medicare. Almost no senior citizen in the United States depends on Original Medicare. Original Medicare charges an unlimited number of $1165 deductibles per year for admitted-inpatient hospital visits and 20% for all other services (even more if the doctor involved does not "accept assignment"). Original Medicare has lifetime limits that can potentially bankrupt seniors. Unlike Original Medicare, all Part C Medicare Advantage health plans have annual out of pocket (OOP) limits and typically nominal $20-$40 copays for doctor visits (but every Part C plan is different so you need to do the math).
Source: typepad.com

Firm Perspectives on the Medicare Advantage Market

Based on interviews with senior executives at 14 large firms, the issue brief finds that insurers anticipate continuing to offer Medicare Advantage plans in 2012, in part because of a Medicare demonstration project that will award bonus payments to plans based on their quality standards.
Source: kff.org

The Ins and Outs of Medicare Supplemental Insurance

Yes! So how does this relate to Medicare’s coverage? There is a general rule of thumb that is called the “80/20 rule.” Outside of some of the preventative items like mammograms, colorectal screenings, and some psychiatric care, Medicare covers the first 80 percent of medical bills, leaving you to cover the last 20 percent. Medicare will also cover certain medically-necessary pieces of equipment like seat lift mechanisms and diabetic shoes (fitted by a specialist, of course). It doesn’t seem so bad at first, especially if you’re a healthy individual, but if something happens that requires you to need urgent medical care or even an operation, you may have to spend tens- to hundreds-of-thousands of dollars. A June 2011 report from the Kaiser Family Foundation predicted that by the year 2020 the median out-of-pocket spending for seniors with Medicare is projected to reach 26 percent of all income, with the most money being spent in the last five years of their life. This is why supplemental Medicare insurance is a necessity for every senior. Not only do you really need Medicare supplemental insurance, you need it before something happens to you, and you likely won’t use it much until the last 5 years of life. So two points to keep in mind 1) If you wait until a procedure is needed or something unexpected happens to you, you’ve waited too long, and 2) Don’t make the mistake of cancelling your Medicare supplement policy because you’ve’ paid in more than you use. It’s health insurance and in this case it works best if it’s held to its natural end point.
Source: insideeldercare.com

Medicare Advantage Cuts and Coverage Update

The Centers for Medicare and Medicaid Services report applications are up almost fifty percent from last year for requests from private insurers vying for a position in the Medicare market. Large national insurance companies continue to see a large part of their business profitability and growth projections being met with Medicare Advantage. Private insurance companies believe that the growing baby boomer market will bring exponential enrollment numbers to the senior insurance market. Proponents of Medicare worry that the viability of the Medicare Advantage model may become threatened with the Obama Administration’s proposals to cut Medicare Advantage payments by up to eight percent in 2014.
Source: medicarebenefits.com

89 Charged with Medicare Fraud After Busts in 8 Cities

Posted by:  :  Category: Medicare

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If you have first-hand knowledge of government fraud occurring at your place of employment or your doctor’s office, including Medicare fraud, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicaid and Medicare fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today.803.252.4800
Source: stromlawnursinghomeabuse.com

Video: Miami: Medicare Fraud Summit Remarks (HHS Secretary & Attorney General)

Social Security Questions: Bridging the Medicare Gap

Of course, what all of this still fails to address is the fact that COBRA is incredibly expensive. Many people are surprised to find themselves paying for plans that cost $500 per month—or more. And if you manage to get COBRA extended beyond the original 18 months, your insurer is allowed to charge you 150% of the premium during this time. COBRA may be a solution but it can’t be the only one for a lot of people, because too many just can’t afford it.
Source: disabilitydenials.com

Medicare fraud accusations hit Houston

Medicare fraud has developed into complicated and sophisticated schemes. The ways people attempt to defraud the government can involve multiple people in multiple cities. On the other hand, individuals may make innocent mistakes with regard to Medicare claims or practices. If an individual is charged with Medicare fraud, it is important that they have competent representation to defend the oftentimes complex charges. Medicare fraud is a federal offense and carries stiff penalties with it. These penalties can vary from heavy fines to major prison time.
Source: houstonfederalcriminaldefenseblog.com

Medicare Liens Including Medicare Set Asides Apply to Medical Damages Only!

This is not that uncommon in cases of very serious injuries where significant and sometimes permanent medical treatment is required. However, there are numerous potential areas for negotiation with Medicare’s over inclusive liens. For instance, in cases of serious personal injury, there are often very significant recoverable damages unrelated to medical expenses, either past of future. Medicare is not entitled to claim liens against settlement amounts that are unrelated to medical expenses paid or to be paid by Medicare.
Source: newmexicoinjuryattorneyblog.com

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

Medicare Advantage for Veterans

If you are a veteran and obtain your health care from the VA, you may think there is no need for Medicare.  However if you qualify for Medicare, by age or disability, then you should obtain your Medicare card and use it to supplement your VA care.
Source: legalhelpforveterans.com

RIVERSIDE: Animal activist attorney Charlotte Spadaro disbarred

The San Bernardino County case is a single count.  Its next court date is June 14. The Riverside County case has 16 counts stemming from investigation of a kennel on 1.5 acres of property in the 3500 block of Myers Street in Riverside.  Spadaro does not own the property. It is currently scheduled for a June 10 trial date.
Source: pe.com

Medicare Part D oversight works against Iowa patients

The study demonstrated that physicians have administered elderly dementia patients extremely dangerous antipsychotic drugs in clear disregard of government warnings. Other doctors used pharmaceuticals in ways that medical experts claim have little scientific basis and may be harmful. In 2010, drugs that had been pulled from other markets years earlier were still being given to elderly patients en masse, even though professional organizations knew that seniors should not be taking them. In the past, nursing home abuse of this nature has resulted in deaths and multimillion-dollar court judgements against care providers.
Source: iowa-injury.com

New Hope for Those Denied Medicare Benefits?

There is a re-review process for certain Medicare beneficiaries who were denied benefits for rehabilitative services. The denial must have become final and appealable after January 18, 2011. A further appeal need not have been filed. The re-review process only applies to services that were actually received by the Medicare beneficiary.  In other words, if Medicare denied benefits and no further rehabilitative services were received the Jimmo settlement will not help you.  Medicare can only pay for services received. If skilled care was stopped because Medicare wouldn’t cover, you may be able to get it restarted under this new standard.  First, you’ll need your doctor to explain in writing why skilled care or therapy is necessary.  Keep in mind that all the normal Medicare requirements still apply.  For example, skilled nursing care requires the 3 day hospital stay first.
Source: estateplanandassetprotection.com

Texas Personal Injury Attorneys, Commercial Litigation, Lawyer

Big rigs, semis, and tractor trailers are all names for large trucks. The Fatality Analysis Reporting System (FARS) defines a large truck as a truck weighing over 10,000 pounds. The fact is that many large trucks reach up to 80,000 pounds when fully loaded. Because truck crashes are often devastating, resulting in serious injuries and fatalities, the government heavily regulates the trucking industry. The Federal Motor Carrier Safety Administration (FMCSA) has numerous rules and regulations that strictly monitor hours and service, maintenance, cargo loading, drug testing, insurance coverage, and licensing.
Source: wpklawfirm.com

Immigrants Help Medicare Stay Solvent, Study Finds

Posted by:  :  Category: Medicare

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The New York Times: For Medicare, Immigrants Offer Surplus, Study Finds Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending. The study, led by researchers at Harvard Medical School, measured immigrants’ contributions to the part of Medicare that pays for hospital care, a trust fund that accounts for nearly half of the federal program’s revenue. It found that immigrants generated surpluses totaling $115 billion from 2002 to 2009. In comparison, the American-born population incurred a deficit of $28 billion over the same period (Tavernise, 5/29).
Source: kaiserhealthnews.org

Video: New York and Medicare Supplements

The Best that Medicare Can Buy: Staten Island Native Bought Bentley, Louis Vuitton Bathrobe With Embezzled Medicare Funds

Mr. Shelikhov, along with his colleagues at Bay Medical Care, amassed their money by bribing numerous Medicare patients into faking needs for medical services—ranging from physical therapy to ambiguous “nerve” treatments—in exchange for cash kickbacks from the program, according to court transcripts obtained by The Observer. Most Bay Medical Care employees humbly respected their newfound fortunes, storing them in multiple accounts at JP Morgan and Bank of America, while Mr. Shelikhov instead flaunted Louis Vuitton bathrobes, black velvet Ferragamo loafers, and Dolce & Gabbana cufflinks. (YOLO, right?)
Source: observer.com

CMS crackdown doubles Medicare removals

A compliance expert cautioned long-term care providers about CMS’ new Fraud Prevention System in a recent McKnight’s Super Tuesday webcast. While technology can catch bad actors, it’s also a crucial way to maintain compliance, advised Alliance Training Center Executive Director Leah Klusch, RN, BSN, FACHCA. She advocated for programs that electronically compare Minimum Data Set and billing data so administrators can catch problems early.
Source: mcknights.com

Study: Immigrants Pay More Into Medicare Than They Receive in Benefits

The authors also noted that many immigrants pay taxes that help fund the program but are not eligible for its benefits. For example, many undocumented immigrants use fake Social Security numbers to work, which means they and their employers pay Social Security and Medicare taxes. However, such residents are ineligible for either program. The Affordable Care Act also prohibits undocumented immigrants from obtaining other health benefits, such as the insurance subsidies intended to help U.S. residents purchase coverage through the health insurance exchanges that launch next year (“Politics Now,” Los Angeles Times, 5/29).
Source: californiahealthline.org

Tom Harkin Holds Up Medicare Nominee

Then Senator Tom Harkin, an Iowa Democrat who chairs a key Senate health committee, put a hold on the nomination. At least it was not a secret hold, a pernicious practice that allows senators to block a nominee without revealing who they are or why they are doing it. In this case, Mr. Harkin told reporters what he was doing and why. He raised no issues about her competence; instead he complained that the Administration has been raiding a fund established by the health care reform law to pay for prevention and public health programs, and using the money for other purposes.
Source: nytimes.com

New York Medicaid and Medicare Part D: Working Together

Any individual currently receiving or about to begin receiving New York State Medicaid must join a Medicare prescription drug plan, or they will lose their Medicaid benefits. When an individual becomes eligible for both Medicare and Medicaid, he or she will automatically be assigned to a Medicare Prescription Drug Plan in order to not miss even one day of coverage. Though a prescription drug plan is mandatory, enrollment in Medicare Part D is not; enrollment in another plan which better meets prescription drug needs is allowed. Patients are able to switch to another plan at any time.
Source: elderlawnewyork.com

Medicare’s Health and Well

On the other hand, immigrants currently make substantial financial contributions to the system, even though a large segment may not be able to use any public benefits in return. A new study conducted by researchers at Harvard Medical School and the City University of New York shows that immigrants are already disproportionately subsidizing Medicare, the national social insurance program that guarantees access to health insurance to people aged 65 and older, as well as younger people with disabilities. Between 2002 and 2009 immigrants generated surpluses of between $11.1 and $17.2 billion per year, which amounted to $115.2 billion in the entire period. Most of the surplus from immigrants, moreover, came from noncitizens who are largely working-age taxpayers.  Conversely, in 2009 alone, U.S.-born people accounted for a $30.9 billion deficit.  As the study asserts, “immigrants generate a surplus for Medicare primarily because so many of them are working-age adults and the group has a higher labor force participation rate, a combination that generates large payroll tax payments.”
Source: immigrationimpact.com

Medicare fund insolvency date a bit further away than last year

Then where was their plan before. Dumb azzes, think, my insurance goes up every year because all of the people without insurance still get sick and go to the doctor. ProBusiness you dumb azz, do you know what bad debt expense is????? Give you a hint, it is an expense and they charge my insurance which then raises their rates. It is all a matter of efficiency, how do you provide some limited insurance for all because we already are paying for it. The Healthcare industry spends over $5 billion every year on lobbying, to put that into perspective, the defense industry spends $1.6. Your congressman and women are bought and paid for two bit whores. We pay more per capita than any country in the world. You don’t like Obama care then what is your plan??? Fat people should lose weight, smokers should pay more and the billing should be transparent and competitiive. Just ripping things down is a sign of ignorance. People keep ripping the illegals, saw something last night driving home through the bad part of town. All the blacks are sitting out on their porches and this one little hispanic guy is pushing his little cart down the street selling whatever he is selling. The low skilled jobs are going to be taken over by the hispanics you watch. I know I am racist now. The trash that makes up the tea party from the right and the left are destroying this country and yes I said too, the extreme left is no dam different than the extreme right.
Source: nbcnews.com

New York Medicaid and Medicare Part D: Working Together

Typically, as part of Medicare Plan D, the patient must pay a nominal amount, like a copayment, for the medication. Individuals who have full coverage from Medicaid while living in a residential home, an adult living or assisted living facility will likely be required to pay a small medication copayment for each medication. If an individual has full Medicaid coverage and resides in a nursing home, they will not be required to pay anything for covered prescription drugs.
Source: lawfirmnewswire.com

Nearly half of seniors, including a majority of elderly blacks and Hispanics, are on the cusp of poverty, a new Economic Policy Institute report finds.

Because lower-income elderly households depend heavily on social programs such as Social Security and Medicare, changes to these programs should be viewed through the lens of how they would affect economically vulnerable seniors. Proposals to shift additional health costs onto seniors, such as House Budget Committee Chairman Paul Ryan’s plan to convert Medicare into a voucher system, would drive more seniors into poverty. The new EPI report found that under Ryan’s proposed Medicare changes, the predicted increase in seniors’ out-of-pocket health costs would raise the share of economically vulnerable elderly from 48.0 percent to 56.4 percent, an increase of almost 3.5 million vulnerable seniors. Similarly, proposals to change the calculation of Social Security cost-of-living adjustments (COLAs) to a chained consumer price index would result in 132,000 more economically vulnerable seniors.
Source: fiscalpolicy.org

For Medicare, Immigrants Offer Surplus, Study Finds

The study, which was published on the Web site of the journal Health Affairs on Wednesday, comes as Congress considers legislation that would eventually give legal status to the country’s 11 million unauthorized immigrants. The legislation has sparked a vigorous debate about whether immigrants ultimately contribute more than they receive from the federal budget. One of the sticking points has been whether immigrants should be eligible for government programs, including health benefits, before they qualify for citizenship, but while they are on the path to getting it.
Source: nalacc.org

Medicare Needs Fixing, but Not Right Now (The New York Times) 

In a story about the future of Medicare and how the government will pay for the care of older Americans, Elliott Fisher, a professor of medicine at The Dartmouth Institute for Health Policy and Clinical Practice (TDI), a professor of community and family medicine at the Geisel School of Medicine, and director of the Center for Population Health at TDI, tells The New York Times that Medicare spending per person varies widely throughout the United States regardless of the quality of the care. Bringing the entire country in synch with the prevailing hospital-stay lengths of Medicare enrollees in Oregon and Washington would result in a dramatic savings, Fisher tells the Times.
Source: dartmouth.edu

Medicare, Medicaid Allowed as Defendants in Suit

Posted by:  :  Category: Medicare

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The ruling was reported Friday in the Lexington Herald-Leader. It came in response to ARH’s motion, filed in January in U.S. District Court in Lexington, that said the federal agency’s failure to scrutinize the Cabinet for Health and Family Services, has resulted in an unstable managed-care system heading toward collapse.
Source: wbko.com

Video: Medigap Supplements in Kentucky by Medicare Pathways

Kentucky Appalachian Transition Services awarded funds by Centers for Medicare & Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) has announced that the Kentucky Appalachian Transition Services (KATS) was selected to participate in the Community-based Care Transitions Program (CCTP). KATS will implement a transitional care program to improve medical treatment for people with Medicare. The program goal is to reduce readmissions by 20 percent among the partner hospitals over two years while improving the quality of transitional care and services to Medicare beneficiaries.
Source: medicalnews.md

Medicaid Expansion Popular In Southern States, Despite Govs’ Opposition

Tampa Bay Times: Tampa Chamber: Businesses Concerned By Legislature’s Inaction On Medicaid Expansion For Tallahassee, refusing additional federal funds to expand Medicaid may turn out to have been the easy part. It will take longer, a half-dozen Hillsborough legislators acknowledged Tuesday, to come up with an alternative to provide health care coverage to an estimated 1 million uninsured Floridians. … Some Tampa businesses, (Greater Tampa Chamber of Commerce Chairman Gregory Celestan told local legislators), are “very concerned about significant additional health insurance costs” because of the Legislature’s “refusal to expand Medicaid.” “We will be at a competitive disadvantage when recruiting new businesses or adding jobs,” Celestan added. “How would you respond?” (Danielson, 5/21).
Source: kaiserhealthnews.org

State Mutual Insurance Company Announces Sale of Medicare Supplement Insurance in Kentucky

We are pleased to announce the availability of lower cost Medicare Supplement Insurance in Kentucky. The Kentucky Department of Insurance approved Medicare Supplement Insurance plans from State Mutual Insurance Company and made it possible for us to offer extremely competitive Medicare Supplement Insurance rates for qualifying Kentucky seniors.
Source: statemutualinsurance.com

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June 08, 2013

Florida Blue Is New Name for BCBS of Florida

Posted by:  :  Category: Medicare

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

Video: Florida Blue CEO Patrick Geraghty Talks Medicare on Bloomberg TV

Electronic Medical Billing Software

1. Direct Electronic Claims Medisoft direct electronic claims module is a productivity and revenue enhancement program. It saves time by allowing you to send literally hundreds of claims electronically at the touch of a button, and decreases the waiting time for receiving payments which translates to a lower overall Accounts Receivable balance. Medisoft Direct Electronic Claim modules require Medisoft Advanced Patient Accounting in order to work. The Direct Electronic Claim module is an "ADD-ON" to Medisoft, and not a replacement or substitute. ERA – Electronic Remittance Advice, allows you to automatically download and retrieve your Medicare EOB electronically, AND post all Medicare Payments, with the touch of a button. This is a REAL TIME and PRODUCTIVITY saver!!! This is only available if used in conjunction WITH Medisoft Direct Electronic claims module or NDC Clearinghouse.  
Source: medicalbillingsoftware.com

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June 08, 2013

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

Posted by:  :  Category: Medicare

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

Video: Keystone 65 BlueCross

Columna: Medicare Philadelphia and my tale about them

Living in the Philly Pennsyvania area, there are lots of great alternatives when looking for an inexpensive Medicare Prepare. Generally, Medicare health insurance Edge Programs give a very economical high quality, using top quality coverage. Based on the insurer, monthly installments can vary through $0/month for you to $90/month. Exactly why the real difference inside payments? 1 business may possibly supply a big circle associated with medical professionals as well as medical centers, while yet another carrier might have a lot smaller sized provider record to choose from. There could be also a tremendous improvement in co-pays, derived from one of intend to one more. Last but not least, 1 program may offer accessories including eyeglasses as well as dental, even though yet another plan doesn’t.In Philly, the biggest health care insurance company is Freedom Azure Mix. They have got revamped their particular Medicare health insurance Edge Ideas now supplies a program that, in an exceedingly limited time, has grown to be a very well-liked choice for Medicare health insurance heirs. If you live throughout Chicago, Money, Chester, De or even Medicare Philadelphia county, so if you are upon Treatment Medicare part a and also Part B, you can get this particular Medicare insurance Edge strategy, called Keystone Sixty five Decide on The hmo.Why is this important regarding inhabitants associated with Philly and its instant suburbs? Keystone 65 Decide on The hmo delivers excellent protection together with rates starting as low as $15/month! This is the Medical Simply Plan. If you’re searching for an agenda together with prescription medications, Keystone Sixty five Pick The hmo provides which covered at the same time. The Keystone Over 60 Select The hmo which include prescriptions is merely $42.10/month! First and foremost, this can be complete insurance, which has a company you could rely on. This specific brand-new Keystone 65 Choose HMO strategy covers several preventative services with no copay in any respect. Primary care physician appointments tend to be engrossed in a new $20 copay, expert sessions use a $45 copay, inpatient stay in hospital includes a $215 every day copay for the days 1-8 without having copays after that. Testimonials and referrals are required for many particular solutions, and also you ought to make use of program vendors except in urgent situation as well as critical care situations.Ab muscles well-known Sterling silver Athletic shoes is actually immediately included in the Keystone 65 Select HMO strategy and offers users a simple gym account with no extra charge! A lot more than 2 hundred fitness gyms have fun playing the increased Philly place with lots of of such health clubs supplying specific physical fitness lessons simply for Silver Tennis shoes associates. In addition, the Keystone Select HMO prepare offers the Choice Software, for the next $10/month. Excessive Software gives precautionary dentistry, an eyewear profit as well as a assistive hearing aid device benefit.If you reside from the increased Chicago region, there are a few famous brands which are close to along with precious to be able to us- Tastykake, Gino’s, Difficult, The Mummers, and yes, Self-sufficiency Blue Combination. Freedom Azure Cross is an extraordinary medical health insurance firm using a extended tradition associated with giving the top quality medical health insurance for the members. Independence Azure Mix provides presented Medicare insurance products because the inception of Medicare throughout 1966, and today handles more than 170,500 Medicare beneficiaries. The system regarding doctors and nursing homes is actually extensive, with well over 50,Thousand doctors as well as 100 nursing homes in circle. Numerous elements might be of interest when evaluating choices for Medicare health insurance coverage, which include: company, community service, company availability, cost, advantages and also, of course, particular person wellbeing requirements.
Source: lamula.pe

70% Back Keystone Jobs Project

American workers and employers have rallied in support of Keystone, calling the project an “economic engine” that will create thousands of jobs and provide “a lifeline” to out-of-work Americans, particularly in the hard-hit construction industry.  That’s why it’s a key part of the GOP Plan for Economic Growth & Jobs, along with several other bills that will increase American energy production to help address gas prices, create jobs, revitalize American manufacturing and fuel economic growth.
Source: speaker.gov

Increasing Medicare Age Increases American Health Care Spending

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

Blue Cross Keystone 65 is best for the aged people

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

Blue Cross Keystone 65 among the very best plans for you

Other added advantages of the program All of the members of this plan can access anytime its services by just producing a call. The potential members too as common members can call seven days per week from 8am to 8pm on their offered numbers. Nevertheless the enrollment of a membership in any program is becoming performed only throughout precise times of a year. All the members are being offered an enhanced way of accessing the network of pharmacies for any form of prescription related query. There is an added assist offered for the persons that have limited income sources to pay for their requires. If qualified the medicare takes up the responsibility to pay up to seventy five percent with the drug fees that incorporate each of the prescription premiums, co insurance and annual deductibles.
Source: panicawayr.net

Medicare Open Enrollment Information Session

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

You Don’t Need To Become 65 to become Entitled to Medicare

If you be eligible for a Medicare insurance due to a impairment and therefore are beneath Sixty five years of age, your own preliminary registration period can come directly into perform if you wish to sign up for any Medicare health insurance Advantage program, or Medicare health insurance Component D prescription coverage. If you opt to sign up for both strategy, understand that Twenty-five may be the wonder number. Initial, figure out once the 25th thirty day period of one’s incapacity may occur. Your Preliminary Enrollment Time period (IEP) is a seven-month period encompassing in which date:
Source: superarticledirectory.com

Effective Communication Solutions

ECS requires a 6 hour minimum cancellation notice for all appointments. Sessions cancelled in less than 6 hours are subject to a $25 cancellation fee per session. It is important that families commit to the therapeutic process by bringing children to appointments on a regular basis. Cancellation in excess of 3 in a 12 week period may be terms for discharge.
Source: ecstherapy.com

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June 08, 2013

Schneiderman catches top NYC hospital overbilling Medicare and Medicaid

Posted by:  :  Category: Medicare

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According to the Complaints and Settlements filed in this case, the hospital double-dipped by billing New York and the federal government for psychiatric services provided by its physicians.  St. Luke’s-Roosevelt billed out-patient psychiatric services to Medicaid as a rate-based service, which included the care provided by the physician and all other related costs. At the same time, SLR billed the state and federal governments on a fee-for-service basis for the same care provided by the physician. Also, St. Luke’s-Roosevelt sought and received reimbursement from Medicare for non-reimbursable costs for outpatient psychiatric visits. As a result, the Hospital received Medicare and Medicaid payments that it was not entitled to receive.
Source: seniorlivingcare.com

Video: medicaid centers nyc

Can A New York Medical Provider Bill Medicare For Providing Medical Supplies For Beneficiaries Under A Medicare Certified Office For A Pending Certification Office?

Long Island Federal Defense Attorneys Long Island Federal Corporate Fraud Long Island Federal Bank Fraud Long Island Federal Healthcare Fraud Long Island Federal Medicaid Fraud Long Island Federal Insurance Fraud Long Island Federal Money Laundering Long Island Federal Bankruptcy Fraud Long Island Federal Mortgage Fraud Long Island Long Island Federal Mail and Wire Fraud Long Island Federal Computer Crimes Long Island Federal Tax Fraud Long Island Federal Drug Crimes Long Island Federal Sex Crimes Long Island Federal Weapons Charges International Extradition Long Island Federal White Collar Crimes Guide New York City Criminal Attorney
Source: jpcriminaldefense.com

Grappling With Details of Medicare Proposals

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

A.G. Schneiderman Announces Arrest Of NYC Psychiatrist Who Stole More Than $230k From Medicaid

The prosecution is being handled by the Medicaid Fraud Control Unit’s New York City Regional Office by Special Assistant Attorney General Mark P. Cannon, under the supervision of Deputy Regional Director Christopher Shaw. The investigation was conducted by Special Investigators Thomas Dowd and Steven Broomer and Senior Special Auditor Investigator Shoma Howard, under the supervision of Principal Special Auditor Investigator Paul Erhardt and New York City Chief Audit Investigator Thomasina Smith. The Medicaid Fraud Control Unit is directed by Special Deputy Attorney General Monica Hickey-Martin under the supervision of Executive Deputy Attorney General for Criminal Justice Kelly Donovan.
Source: ny.gov

NY AG ARRESTS ROCKLAND PHARMACIST FOR MEDICAID FRAUD

In 2011, Attorney General Schneiderman launched an initiative to bolster his office’s Medicaid Fraud Control Unit (MFCU) and create a Taxpayer Protection Bureau to crack down on fraud. At no cost to taxpayers, Schneiderman added dozens of additional prosecutors, investigators and auditors to the team charged with investigating, penalizing, and prosecuting individuals and companies responsible for improper or fraudulent Medicaid billing schemes. The MFCU utilizes a team-based approach to identify and investigate frauds committed by hospitals, nursing homes, pharmacies, doctors, dentists, nurses, and other health care entities billing the Medicaid Program. In the last two years, MFCU has charged dozens of health care professionals and corporations, including doctors, pharmacists and nurses, with defrauding the Medicaid program and recovered more than $478 million in money stolen from New Yorkers.
Source: rocklandtimes.com

For Medicare, We Must Cut Costs, Not Shift Them

In the Wyden-Ryan proposal, the government would give each older citizen a certain amount of money — basically, a voucher — with which to buy a health insurance policy. The recipients would decide which policy to buy, based on whatever combination of benefits and price they found most appealing. If they chose a plan that cost more than the voucher, they would have to pay the difference. An earlier premium support plan by Mr. Ryan would have totally replaced traditional Medicare. This latest one would preserve Medicare as an option — although, critically, it would not guarantee that the voucher was enough to make Medicare affordable or ensure that private plans could not design a benefits package to attract only the healthiest patients. If this doesn’t sound like the kind of sweeping reform that will save us … it’s because it isn’t.
Source: nytimes.com

Alarmed at Mandated Cuts Coming to Medicare and Medicaid – Let’s Make A Difference

We are very proud of the Chapter’s demonstration in support of Occupy Wall Street. It is an accurate and important crystallization of basic social work values. Senator Bernard Sanders in a recent comment captured those ideas. “In the long term, we need to have the courage to take on the drug companies, insurance companies, and other powerful and well-funded special interests which make billions of dollars off of human illness. Simply stated, we need to move toward a national health care program that guarantees health care to all as a right, not a privilege. When we do that, and end the greed and profiteering in the current system, studies show that we can provide quality care for all Americans without spending a nickel more than we currently spend. “
Source: wordpress.com

Law Firm Decides to Collect Medicare at Silverstein’s 120 Wall

“Like what, the horse and buggy? The carrier pigeon?” said Peter James Johnson Jr., now a managing member of the firm, who has been coming to the office with his father since he was 8 years old. “No, Jesus, no, no. The truth is, we’ve always had an excellent relationship with the Silversteins. First Larry, now Roger. They’re very responsive to tenants. We like them personally. We think they were desirous of continuing the relationship. And I think they realized we were a signature tenant for them in the building.”
Source: observer.com

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June 08, 2013

Do I Need Medicare If I Have Other Health Insurance?

Posted by:  :  Category: Medicare

Most people don’t pay a premium for Medicare Part A, which helps cover hospital stays. There’s usually no reason not to sign up for this coverage as soon as you’re eligible. With Part B, which covers doctor visits and other outpatient care, you’ll pay a monthly premium. If you like your current plan, it may make sense to keep it and wait to sign up for Part B when you retire.
Source: allsup.com

Video: How Medicare Works With Social Security Disability

What is Medicare Disability Insurance and Who Qualifies?

Disability is something that you hear about, but not something that you actually think will happen to you. SSA.gov reports that a 20-year-old worker has a 3-in-10 chance of becoming disabled before reaching retirement age. Most of us spend a lot of time working, but are not prepared whether we may become disabled. Well now is the time to change that and Ahlbum Insurance Group are the ones to help you! Jon Ahlbum created the Ahlbum Insurance Group in 1992 and has molded the agency into one of the top general agency’s nationwide, providing quality insurance solutions. In 2004, Jon qualified for the Medicare Supplement Accredited Advisor designation and is a member of the National Association of Medicare Supplement Advisors.
Source: ahlbumgroup.com

2013 Medicare Trustees’ Report Gives the HI Trust Fund 2 More Years

Social Security projections, however, remained the same as predicted in 2012, which anticipates a 2033 depletion. Social Security disability insurance also remains the same with a predicted 2016 depletion. SSDI applications have grown from fewer than 300,000 in 1990 to 850,000 today. The applications have increased by 30% since just 2007 and SSDI has become the unemployment alternative for middle age males in a soft job market. Due to this increased volume of applications, ALJs reviewing those applications on behalf of CMS feel as if they do not have adequate time to review the applications that typically contain over 500 pages of medical records, notes form doctors and evidence provided by experts and are approving questionable claims they otherwise would have denied if given adequate time to investigate. In a federal lawsuit filed by the ALJ union in April, over 1400 judges allege that CMS expects them to decide over 700 claims per year causing them to rush evaluations to the detriment of the taxpayers. The alleged productivity goal is outlined in the agency directive and the suit alleges that directive violates both the Social Security Act and the Administrative Procedures Act.
Source: medval.com

Social Security Questions: Bridging the Medicare Gap

Of course, what all of this still fails to address is the fact that COBRA is incredibly expensive. Many people are surprised to find themselves paying for plans that cost $500 per month—or more. And if you manage to get COBRA extended beyond the original 18 months, your insurer is allowed to charge you 150% of the premium during this time. COBRA may be a solution but it can’t be the only one for a lot of people, because too many just can’t afford it.
Source: disabilitydenials.com

Does Medicare or Medicaid Come with Disability?

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

Medicare Advantage for Veterans

If you are a veteran and obtain your health care from the VA, you may think there is no need for Medicare.  However if you qualify for Medicare, by age or disability, then you should obtain your Medicare card and use it to supplement your VA care.
Source: legalhelpforveterans.com

Chances For Deficit Deal Diminish As Medicare’s Outlook Improves

The Associated Press: A Respite For Medicare; Social Security No Worse Medicare’s long-term health is starting to look a little better, the government said Friday, but both Social Security and Medicare are still wobbling toward insolvency within two decades if Congress and the president don’t find a way to shore up the trust funds established to take care of older Americans. Medicare’s giant fund for inpatient care will be exhausted in 2026, two years later than estimated last year, while Social Security’s projected insolvency in 2033 remains unchanged, the government reported (Alonso-Zaldivar, 5/31).
Source: kaiserhealthnews.org

Social Security Disability Insurance and Medicare

: Once the applicant qualifies as disabled, the recent work test and duration of work tests are administered. The recent work test is based on age; according to the Social Security administration, the age of the applicant at the time of the disability determines how long the applicant needs to have worked in order to qualify. The duration of work test is meant to prove that the applicant worked under Social Security (and paid Social Security taxes) for long enough to qualify. SSDI eligibility is based on “work quarters”, or three month periods during which the applicant needs to have worked.  Please click here to view the specific guidelines that the Social Security administration has outlined in regards to the duration of work and the recent work test.
Source: specialneedsplanning.net

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