Mid North Coast Greens: Bring Dental Care under Medicare

Posted by:  :  Category: Medicare

The Greens have released a fully costed plan to bring dental care under Medicare. This will mean that dentists can bulk-bill dental services the same way doctors do. Read more about our plan to help people afford dental care.
Source: blogspot.com

Video: Does Medicare Cover Dental Services?

Medicare – Should You Become a Provider?

Even though Medicare has traditionally not covered routine dentistry, it does cover biopsies, which a number of practices do, and it may cover procedures needed prior to jaw surgery along with a few other unique dental-related situations.  If your practice provides any of those procedures, you must be enrolled as a participating or non-participating provider for Medicare in order for your patients to receive Medicare benefits.
Source: fluenceportland.com

Why Doesn’t Medicare Cover Glasses or Dental? » Toni Says

There are 2 different types of dental plans: 1) Traditional or indemnity dental insurance plans which is generally higher in premium and the preventive services are usually covered at 100%, basic restorative is generally covered up to 80% and major procedures at 50%. Many of the traditional/indemnity dental plans may have a wait for services such as fillings, root canals, bridges, crowns, etc. 2) Discount dental plans are generally less expensive than traditional dental plans.
Source: tonisays.com

Medicare coverage has gaps

A: Medigap plans are sold by private insurance companies, but the plans have to follow state and federal rules. Medigap plans come in several standard varieties, which helps consumers compare plans. They cover some of Medicare’s cost-sharing, including deductibles and co-insurance, but they do not pay for services that Medicare does not cover. Medigap plans are popular because they rarely change from year to year, and they allow you to see any health care provider that accepts Medicare. But Medigap plans can have high premiums that increase annually, and policyholders usually must also buy separate Part D prescription drug plans. If you have a Medigap plan, think twice before dropping it for some other coverage because you may not be able to get it back later.
Source: seniordigestnews.com

5 Services Medicare Won’t Pay For

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Medical services not covered by Medicare.Dental exams are not included.

Medicare Part C, often referred to as Medicare Advantage, are plans offered by private companies that the government has approved to provide medical care services.  HMO’s and PPO’s are part of Medicare Part C.  These Advantage Plans can be selected as a substitute for Original Medicare (Part A and Part B).  Part C must provide at least the same benefits as Original Medicare but can vary the degree of coverage and use a different cost structure. Several Medicare Advantage plans do cover some basic eye, ear, and dental practices and procedures but beware; these procedures are often very basic and might include high deductibles or copayments.
Source: joannaleefer.com

Prioritize Dental Hygiene for Nursing Home Residents

Quoted in the Times, Dr. Sarah J. Dirks, a San Antonio dentist who cares for nursing home residents, says dental hygiene in such facilities is ‘almost universally overlooked.’ Indeed, there are currently no national assessments of dental hygiene in nursing homes. Some states have conducted evaluations since 2011 using surveys from the Association of State and Dental Directors. One Kansas survey reports that the occasional filling notwithstanding, nearly 1/3 of 540 residents in 20 long-term care facilities exhibit untreated tooth decay.
Source: forcechange.com

Michigan Doctor Accused of Cheating the Government $35 Million in Fake Medicare Claims : News : Counsel & Heal

Posted by:  :  Category: Medicare

Medicare was set up by the government to provide good medical care and treatment for people who cannot afford it. This health care insurance system gives millions of Americans the opportunity to see doctors without worrying about the large medical bills later on. Even though Medicare is set up to help patients, for one particular doctor, Medicare might have made him $35 millions richer. Dr. Farid Fata, a 48-year-old oncologist from Oakland Township, MI was accused of filing fake Medicare claims that sent millions of dollars straight to his bank account.
Source: counselheal.com

Video: medicare.gov

What Medicare plan & supplemental protects best for fewest out

spncity, I am almost certain he has a Medicare Advantage plan called Secure Horizons by United Health Care. This plan has the AARP nametag but has nothing to do with the plan. United pays a fee to AARP to use their name and make everything sound better. I was with this United Advantage plan for two years and it treated us good. No problems. In 2012 they increased their copays and deductibles so I switched us to BCBS Medicare Advantage. With both of these plans, along with others, there is no premium in addition to your Medicare insurance premium ($105/mo??). All of the plans available are listed on the medicare.gov website. Regarding the idea of going back to Medicare: I checked on this and found out that you can go back to plain old Medicare anytime; however, you may not be able to purchase a supplemental plan. That would be up to the issuer of the supplemental plan. My BIL has researched this for years and rechecks all the time. He says that all the supplemental plans have letter designations (such as Plan F) and each supplemental plan must provide the same coverage across the country. The only difference is the price. EX: He has regular Medicare and supplemental Plan F. So he shops for the best price on Plan F. For 2013 the best price was Mutual of Omaha, so that’s what he bought. I think he said it was $105/mo. About going back and forth: I probably couldn’t go back as most likely an insurance company wouldn’t sell me a supplemental plan because of preexisting conditions. That may change with Obamacare as they aren’t supposed to hold that against you. I’ll believe that when I see it. I may not change back regardless, but it would be nice to have that option. Hope this helps and if anyone has more information I’d like for you to post also as this is a big concern for everyone. The more information the better. Edited to add that prescription drugs are covered by most Advantage Plans but price per drug changes every year. Some of mine are even free for a 90 day supply. The Advantage Plans are "advantageous" and that is why they are always targeted for cuts by the government. A lot of older people have those plans and that is why the government treads lightly.
Source: early-retirement.org

Four who ran Hollywood, Fla. psychiatric hospital found guilty of Medicare fraud

Posted by:  :  Category: Medicare

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The taxpayer-funded healthcare program was duped into paying almost $40 million to Hollywood Pavilion, whose chief executive officer and others covered up the “sham” by falsifying patient records and marketing contracts with “dirty” patient recruiters, according to Justice Department prosecutors. The recruiters, many convicted felons, were paid more than $1 million for the patient referrals, prosecutors said.
Source: cchrint.org

Video: Medicare International Coverage

Immigrants Contribute More To Medicare Than They Take Out, Study Finds

Between 2002 and 2009, immigrants generated a cumulative surplus of $115 billion for the trust fund, the study found. Most of the surplus contribution came from noncitizens. The immigrants created a net gain primarily because of demographics: There are 6.5 immigrants of working age for every one elderly immigrant, but only 4.7 working-age native citizens for every one retiree. Although that ratio could change in the future, the report notes that the Census Bureau projects that the share of immigrants in the United States will increase for the next 18 years.
Source: bioethicsinternational.org

More doctors opting out of Medicare

One big part of the problem is the fact that Medicare payments rates have not kept pace with inflation, and Medicare reimbursements could be slashed by 25 percent next year unless Congress delays the cuts. In addition, the amount of paperwork and information required from doctors and providers is massive.
Source: wordpress.com

Doctors Fleeing Medicare? Not So Fast, Feds Say

No consolation for the folks at the American Medical Association, who point to financial pressure on doctors who take part in Medicare. “While Medicare physician payment rates have remained flat since 2001, practice costs have increased by more than 20 percent due to inflation, leaving physicians with a huge gap between what Medicare pays and what it costs to care for seniors,” AMA President Dr. Ardis Hoven told Forbes.
Source: kcur.org

The Patient Protection and Affordable Care Act (ACA): US Health Reform to Slash Medicare, Leaving Millions Uninsured

www.globalresearch.ca contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available to our readers under the provisions of “fair use” in an effort to advance a better understanding of political, economic and social issues. The material on this site is distributed without profit to those who have expressed a prior interest in receiving it for research and educational purposes. If you wish to use copyrighted material for purposes other than “fair use” you must request permission from the copyright owner.
Source: globalresearch.ca

Congress: Don’t make shortsighted cuts to Medicare and Medicaid

Irresponsible cuts to Medicare and Medicaid could be right around the corner in the next budget deal. We can’t let the well-being of millions of our nation’s seniors be undermined for the sake of continuing tax breaks for the 1% of Americans and Big Oil.
Source: seiu.org

Career Opportunity at International Medicare Limited

Manager, IT: M.Sc/B.Sc. in computer science. Having 10 to 12 years experience as team leader or in managerial position. Linux proxy and mail server windows server 2008 administration. VPN, MIRRORING, Mikrotik OS, Large scale LAN, WLAN, Wireless Router, Radio & Fiber Connectivity. IT Enabled Service and webhosting.
Source: bdchakri.com

UnitedHealth Group Reports Strong Earnings On TRICARE, International Growth

While the company saw a drop in revenue from employer-based and individual health insurance plans, UnitedHealthcare had an increase in its municipal and state health plans, its Medicare and retirement plans, and a huge jump in international business. Revenue at UnitedHealthcare International grew to $1.6 billion from $38 million a year before.
Source: courantblogs.com

Shakopee, MN Tax Expert Guides You Through The New World of Medicare Decisions

Medicare Ratings System To assist consumers, Medicare now rates Medicare Advantage programs using a star system. Using member satisfaction surveys and plan evaluations, plans are rated between one and five stars. In fact, at any time, you can switch into a five-star Medicare Advantage plan, but only if one is available in your region (only a few states have a five-star plan). Even if your area does not offer a top-rated plan, every state offers at least a four-star plan.
Source: mendenaccounting.com

CMS Proposes to Significantly Increase Reward for Reporting Medicare Fraud

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CMS noted that it expects its proposed enhancement to the IRP reward to encourage more people to come forward with information, leading to an increase in the recuperation of health care fraud funds. This expectation is based on the success of an Internal Revenue Service (IRS) program that pays individuals for reporting IRS tax code violations. The IRS reward program—which pays whistleblowers 15–30% of the amount collected by the IRS for all claims filed after July 1, 2010 and pays 15% of the amount collected for claims under $2 million filed before July 2010—has both paid out more rewards and collected more money than the IRP. Since its inception in 1998, the IRP has paid out only 18 rewards, totaling $16,000 in reward payments and less than $3.5 million in collected funds. The IRS program, on the other hand, paid out approximately $193 million in rewards and collected almost $1.6 billion from 2007–2012. CMS did not comment on whether it believes there is a comparable level of Medicare and tax code fraud.
Source: upenn.edu

Video: How to report 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 $223 Million Medicare Fraud Schemes

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

HHS Proposes $9.9M Reward for Reporting Medicare Fraud

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

Report: Inaccurate Payments to Medicare Advantage Programs Continue to Cost Government Billions

A report by the U.S. Government Accountability Office (GAO) suggests the Medicare Trust Fund could save billions if the Centers for Medicare and Medicaid Services (CMS) would adjust payments for Medicare Advantage plans to more accurately reflect the health of those enrollees. The problem, according to the report, is Medicare pays Medicare Advantage plans a predetermined amount for each beneficiary based on risk scores, which are adjusted for health status. The methodology CMS uses to come up with the risk scores has led to overpayments to these plans. CMS has been working to correct the problem, but not enough. By more accurately paying for beneficiaries, the Medicare program would have saved between $3.2 to $5.1 billion in Medicare Advantage plan payments from 2010 to 2012, according to the GOA report. While Congress took action through the Affordable Care Act in 2010 to reduce excessive payments to private plans, CMS continues to use the risk score adjustment of 3.4 percent it used in 2010, ’11 and ’12. CMS officials have said they may revisit their methodology in the future. Recently, Energy and Commerce Ranking Member Henry A. Waxman, along with Ways and Means Ranking Member, Sander Levin, released an update to the GAO report. Waxman and Levin point out interesting inconsistencies in what the plans report. They say documented evidence shows that Medicare Advantage plans tend to report higher patient severity than is supported by medical records. The evidence also shows reported patient severity increases faster than for comparable patients in traditional fee-for-service Medicare. More information for Medicare fraud is located at the Nolan Auerbach & White website.
Source: medicare-fraud.net

Stories from the Field: Medicare Fraud in South Florida

The agency’s purpose is to enroll Medicare beneficiaries in their fraudulent health care program, cancelling their current Medicare plans and leaving them without the ability to receive crucial benefits. In order to carry out this scam, the agency takes advantage of the economic insecurity that many Hispanic older adults face. A recent report showed that 70.1% of Hispanic older adults live of the verge of poverty – the highest of any racial/ethnic group in the U.S. Aware of this fact, the scammers offer the beneficiaries much needed money to enroll in fraudulent health care plans. Since many live in poverty and are forced to choose between food, medication or housing, this extra money can be the difference between going to bed hungry and eating a filling dinner. In addition to this “signing bonus,” the agency attracts new clients by offering access to its beauty salon and gym.
Source: nhcoa.org

Utah Medicare Supplements

Posted by:  :  Category: Medicare

A Utah Medigap (also called Utah Medicare Supplement Insurance) policy is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (gaps) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you are in Original Medicare and you have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. (Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.)
Source: utahseniorservices.com

Video: AARP Medicare Supplement Plan F

Medicare Supplement Plan F

Medicare Supplemental Plan F is the most popular supplemental plan because it provides the most robust coverage, and the premiums are not much higher when the benefits are compared to the plans offering less coverage. A patient with Plan F can in many situations pay nothing additional out of pocket for doctor and hospital services. People eligible for a Medicare Supplemental Plan should compare the benefits and premiums of the plans and purchase the best coverage they can afford. For many patients, that is Plan F.
Source: wastedenergy.net

Seniors See Value in Medicare Supplement Plan G

Why would an insurance company charge a consumer $500 to cover a $147 expense? The better question might be; why would anyone pay it? The answer to the first question is two-fold, first of all, because they can and secondly, because of Federal laws which require Medicare supplement companies to accept without underwriting individuals losing group insurance and/or leaving a Medicare Advantage plan, companies incur greater claims losses since they can’t weed out the sick individuals. This law does not apply to Medicare Supplement Plan G. Now to answer the question, why would anyone pay so much to cover such a little difference? The answer is simply because they don’t know any better. Whose fault is it that they don’t know any better? That blames rests on the consumer themselves for not doing adequate research, the insurance agent who is not knowledgeable or unscrupulous, the insurance company which is profit driven and the Medicare system for not providing proper education.
Source: askmedicareblog.com

What Medicare Supplemental Plan F Covers

Health Plans Heath Plans Mediacre Insurance Policy Medicare Medicare Advantage Plans Medicare Effective Dates Medicare Health Plans Medicare Insurace Plans Medicare Insurance Medicare Insurance Plan Medicare Part A Medicare Part A and B Medicare Part B Medicare Part D medicare plan Medicare Plan D Medicare Plans Medicare Plans for your State Medicare Policy Medicare supplement Medicare Supplemental Insurance medicare supplemental insurance plans medicare supplemental insurance quotes medicare supplemental insurance rates Medicare Supplement Insurace Medicare supplement insurance Medicare Supplement Insurance Plan F Medicare Supplement Plan MEDICARE SUPPLEMENT PLAN G Medicare Supplements Plan Medigap Medigap Advantage Plans Medigap insurance company Medigap Insurance Plans Medigap Plan Medigap Plans Medigap Plans for your State Medigap Policy medigap quotes medigap rates Medigap Supplemental Plans Meidcare Plans Part D Prescription Plan Threat to Medigap Urgent Issue for Medigap
Source: medigap4seniors.com

More Seniors Finding a Better Value with Plan G

As the years passed, and enrollment in Plan F grew, so did the number of claims being filed by individuals. This growth would take a bigger toll on policy reserves than expected, requiring insurance companies to raise the premium of a Plan F at a higher percentage rate than Plan G. Over the years this higher rate of increased premium has resulted in widening in cost difference. In most instances that gap has grown to represent a cost difference to the consumer to the tune of several hundreds of dollars in yearly premiums. Couple that with a more cost conscious consumer, who isn’t trying to hold onto every dollar these days and you have people saying to themselves:
Source: jcgnewmedia.com

Medicare Supplement Plan F

Purchasing a Supplemental Plan F policy should prevent any out-of- pocket costs for the recipient. One of the benefits covered by Supplemental Plan F is hospitalization for up to 365 days after Medicare coverage ends. The plan will cover up to 20 percent of all Medicare approved expenses. If blood is required three pints of blood each year are covered under the plan. The plan also covers the expense of a stay in a skilled nursing care facility. One of the greatest benefits is that Supplemental Plan F covers any emergency medical assistance that may be required while traveling abroad.
Source: edvox.org

Mutual of Omaha has Announced a Rate Increase on Medicare Supplement Plans in Indiana

Robert Bache aka MedicareBob owns and operates Senior Healthcare Direct. Senior Healthcare Direct is a National Telephonic Insurance Agency that represents over 26 Medicare Insurance Companies. It is our job to make sure that you always have the best price for your Medicare Supplement Plan.
Source: srhealthcaredirect.com

Compare Medicare Supplement Plans

Absolutely yes!  Medigap plans follow Federal and state laws for your protection and must be identified clearly as “Medicare Supplement Insurance”.  Medicare Supplement plans in most states are able to sell only “standardized” plans A through N.  Each standardized Medigap plan has to offer the same basic benefits, regardless which insurance company sells it.  Cost is typically the only difference between Medicare Supplement policies with the same letter sold by different companies.
Source: medicarehealthplans.com

What are Medicare Supplements?

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Source: medicarechoicesofarizona.com

Report Medicare Fraud and get a rewards

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Here’s why the new Medicare whistleblower reward program works. The incentive is large enough to make it worth the effort. In fact, the average whistleblower reward is $1 million and the largest rewards top $100 million. So far, whistleblowers have received $2.9 billion in rewards for helping the government collect back $18.5 billion in fraudulent billings. This is one of the best returns on investment the government has ever done. By paying whistleblower rewards of roughly 16% of what it would not have otherwise recovered, the Medicare program netted over $15 billion!
Source: howtoreportfraud.com

Video: Medicare Fraud Case

Short On Funds, HHS Failed To Investigate 1,200 Fraud Cases Last Year

Fiscal Times: 1,200 Medicare Fraud And Abuse Cases Went Unchecked In 2012 The watchdog agency for the behemoth Department of Health and Human Services is stretched so thin that it was unable to investigate at least 1,200 cases of Medicare and Medicaid fraud and abuse last year, leaving the agency vulnerable to losing out on millions of dollars, Gary Cantrell, deputy inspector general for Health and Human Services said at a congressional hearing last week. Cantrell’s announcement comes just as the auditing agency prepares to cut 400 workers nationwide from its 1,800-person workforce. Cantrell warned that with continued budget cuts and a huge reduction in staff, the agency will likely fail to investigate even more cases in the coming year (Ehley, 7/2).
Source: kaiserhealthnews.org

Medicare Fraud Horror: Cancer Doctor Indicted for Billing Unnecessary Chemo

The oncologist told the FBI of one patient who received chemotherapy under Fata’s care, even though the patient was in remission. The oncologist advised the patient to get a second opinion and he or she never returned to see Fata. The oncologist also told the FBI that Fata ordered chemotherapy for all of his end-of-life patients, even if the treatment would not improve or extend their lives. The oncologist told the FBI, “no other physician would do this and would let the patient die in peace.” The oncologist also said Fata sometimes issued patients life-long prescriptions of drug treatment for low platelet conditions, without informing patients that surgery was a treatment alternative to years of drug therapy. The oncologist also told the FBI that many of Fata’s patients received intravenous immunoglobulin therapy even though they did not need it. A nurse practitioner who worked for Fata examined charts for 40 patients undergoing this treatment and found that 38 did not need it at all.
Source: tacticalminc.com

Psychiatry company settles Medicare fraud allegations for $1 million

The Department of Justice alleged Park Avenue Medical Associates billed for psychiatry services for patients whose dementia or cognitive disorders actually made them unable to benefit from psychotherapy. Authorities also charged the company with billing for services where there was no documentation. PAMA billed for nearly 91,000 exams that “were duplicative, failed to comply with Medicare rules and reflected a lack of coordination of care both among PAMA’s own psychiatrist, psychologists and nurses, and between PAMA”s employees and staff at the facilities at which PAMA performed services,” according to the complaint.
Source: mcknights.com

Medicare fraud outrunning enforcement efforts

The Department of Health and Human Services Office of Inspector General is set to lose a total of 400 staffers that are deployed nationwide as a primary defense against health care fraud and abuse. Though agency officials have yet to decide which investigations will be shelved as staff dwindles, the existing staff is already stretched so thin that the agency has failed to act on 1,200 complaints over the past year alleging wrongdoing — and expects that number to rise. The OIG began shedding staff at the beginning of the year.
Source: publicintegrity.org

Michigan: Doctor charged in $35M Medicare fraud giving chemo to those who didn’t need it

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Source: wordpress.com

Settlement reached in Medicare fraud case involving Williston Rescue Squad

The U.S. Attorney’s Office says the employees who helped with the transports created false records, some saying patients were put on a stretcher to get into the ambulance when they walked to it instead.
Source: wrdw.com

Son Reports Dad’s Company for Medicare Fraud, Park Avenue Medical Assoc.

The whistleblower in the case, Zachary Wolfson, is not only a former employee of Park Avenue Medical Associates, but also the son of Mitchell Wolfson, a founding partner of the company, and its chief medical officer. The son accused the firm, which provides health care services to residents of nursing homes and assisted living facilities in the Northeast, of repeatedly billing Medicare for services that weren’t medically necessary or didn’t comply with Medicare rules.
Source: aarp.org

CMS Proposes to Significantly Increase Reward for Reporting Medicare Fraud

CMS noted that it expects its proposed enhancement to the IRP reward to encourage more people to come forward with information, leading to an increase in the recuperation of health care fraud funds. This expectation is based on the success of an Internal Revenue Service (IRS) program that pays individuals for reporting IRS tax code violations. The IRS reward program—which pays whistleblowers 15–30% of the amount collected by the IRS for all claims filed after July 1, 2010 and pays 15% of the amount collected for claims under $2 million filed before July 2010—has both paid out more rewards and collected more money than the IRP. Since its inception in 1998, the IRP has paid out only 18 rewards, totaling $16,000 in reward payments and less than $3.5 million in collected funds. The IRS program, on the other hand, paid out approximately $193 million in rewards and collected almost $1.6 billion from 2007–2012. CMS did not comment on whether it believes there is a comparable level of Medicare and tax code fraud.
Source: upenn.edu

Feds Get Tough On Medicare Fraud: Moratorium Bans New Healthcare Agencies In Miami, Chicago, And Houston

In 2012, 662 home health agencies were operating in Miami-Dade county, making its home healthcare agency to Medicare beneficiary ratio 1,960 percent greater than other counties. South Florida is notorious for being a hot-bed for Medicare fraud, in part because of several high-profile cases. In February, owners and operators of 2 Miami home health agencies were found guilty of participating in $48 million Medicare fraud scheme.
Source: medicaldaily.com

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August 25, 2013

Medicare for Dummies: The ABC of Medicare

Posted by:  :  Category: Medicare

In 2011, Part D includes a monthly premium of $30. On the initial stage, you will need to pay the total cost of your prescriptions until you reach $310—which is your deductible amount. After reaching the amount of your deductible, the drug plan pays the 75% of the prescription drugs until the total costs amounts to $2,840. Once it has reached the said amount, the stage of non-coverage, known as the “donut hole” begins. Beneficiaries pay 100% (with the exemption of 50% discount on certain brand name prescription drugs) the for the prescription drugs until it reaches $4550. After reaching said amount, the drug plan picks up most of the drug cost with minimal co-pay.
Source: medicarebase.com

Video: Medicare for Dummies

Medicare for “Dummies”

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Source: wordpress.com

Michigan: Doctor charged in $35M Medicare fraud giving chemo to those who didn’t need it

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Source: wordpress.com

Obamacare For Dummies: The "Affordable Care Act" In One Chart

The only way to kill this behemoth tumor is to starve it. More and more healthcare providers need to opt out of Medicare and insurance and turn into cash for service. Two weeks ago I had a large adhesion removed from my left abdomen causing me sharp pain to bend over. My insurance would not pay because I was not disabled so it was considered cosmetic. I went to a plastic surgeon and he quoted me a price that covered everything. I couldn’t afford it and asked if he’d take payments. No. Only cash or credit card ( he would take gold but I wouldn’t part with it). In fact, it was to be paid it full 3 weeks before the procedure. So I saved for 3 years to pay for it. I think he like me for my diligence and tenacity because he knocked off $1000 off his price when I returned 3 years later. Though he is world renouned, his office was simple and efficiently run with just basic paperwork. What a contrast to our modern Sickcare model!
Source: zerohedge.com

Medicare liens for dummies

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

Medicare Expert Patricia Barry, Ask Ms. Medicare

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

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August 25, 2013

Health Insurance Navigator Groups Announced

Posted by:  :  Category: Medicare

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Aug. 16, 2013 — The Department of Health and Human Services (HHS) has awarded $67 million in grants to 105 organizations that will help people buy health insurance and understand their options in the new health insurance Marketplaces. The grants will go to health care providers, nonprofit organizations, and business groups in 34 states to train insurance “navigators” as part of the Affordable Care Act. The grants are for states where the federal government will run the Marketplace and for states that are partnering with the feds. States that run their own Marketplaces have separate navigator programs.  
Source: webmd.com

Video: No Cost Enrollment Strategy for State Health Insurance Exchanges

Idaho’s poorest fare worst in state’s health care reform

After Idaho reveals the rates insurance companies plan to charge, and after the insurance-buying website begins running for Idaho at a subsection of www.healthcare.gov, any Idaho resident can find out exactly what the options are. By entering their income and some information about their age and family size, users will find either that they qualify for Medicaid or can choose among several private insurance plans, each with several levels of coverage. Or, the news might be bad: They could be too poor to get assistance with the cost of coverage.
Source: spokesman.com

State Health Insurance Marketplaces Progress With Fits And Starts

The Associated Press: Blue Cross Reaches Out Over Insurance Law Changes Just down from the Target and Gander Mountain big-box stores and between a nail salon and dental office, North Carolina’s largest health insurer opened its first retail store. It has some exercise offerings — step aerobics classes and stationary bike workouts — but for now, its main product is providing in-person information about changes coming in October with the health insurance overhaul law. Blue Cross and Blue Shield of North Carolina is opening half a dozen of these offices in strip malls statewide to first educate and then, starting in October, enroll consumers shopping for coverage because of the federal Affordable Care Act, also known as “Obamacare.” Blue Cross affiliates in Florida and Pennsylvania have had similar stores open for years (Dalesio, 8/10).
Source: kaiserhealthnews.org

Daily Kos: Missouri legislator wants to opt out of contraception in state health care plan

I just don’t understand these people.  If they don’t want to use coverage, so they might pay less, then fine.  At some point, however, you have to accept the logic that you have to have some bundling of service together to provide a price point upon which to set your insurance.  As others have pointed out, there’s no choosing not to have various other services that may or many not be needed by you, and yet they have to be paid for and the only way to make them affordable is to spread the cost over the whole risk pool.  For example – I don’t expect to need coverage for which Viagra is mentioned above, yet that will still be (and probably has been – I have no idea) covered in my insurance.  I’m paying for it, but can’t decline it and be cheaper.  I may have other needs, but I am getting subsidies from other subscribers who won’t have those needs, because we all pay into a pool and draw out the help for what we do need.
Source: dailykos.com

Affordable Care Act and State Health Insurance Marketplaces

Health Insurance Navigators and Enrollment Assisters. Federal grants from HHS will be made to entities in states with Federally Facilitated and State Partnership Marketplaces to fund Health Insurance Navigators. These Navigators will help people enroll in health insurance. States with State Operated Marketplaces will fund Enrollment Assisters to perform a similar function. It will be exceptionally important for us to work with the navigators and assisters so that uninsured persons with behavioral health and ID/DD conditions are not overlooked in the outreach process. Peers should play a very large and important role in this process.
Source: behavioral.net

Alaska Health Care Leader Examines Arkansas ‘Private Option’

Arkansas wants to use Medicaid expansion money under the federal health care law to enroll people in private plans on its health insurance exchange. Instead of enrolling low-income, uninsured people in Medicaid, Arkansas would buy them insurance plans on that state’s health insurance exchange, APRN reported.
Source: arkansasbusiness.com

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August 25, 2013

Medicaid Expansion, As Proposed In Obamacare, Shows Potential To Improve Health And Decrease Costs When Tested In Wisconsin

Posted by:  :  Category: Medicare

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“What’s special about this is that studies of expanding insurance coverage typically find increases in usage across the board,” Dague explains. “Typically you would think about two effects: a price effect, through which access to insurance lowers the out-of-pocket price of care, leading people to get more care, and a preventive effect, in which getting folks consistent access to care, they can perhaps manage chronic illness better resulting in better health (and hence needing less intensive health care). The price effect almost always dominates. But we show that in certain populations − very low-income, high incidence of chronic illness, adults without dependent children − it’s possible for the preventive effect to dominate.”
Source: tamu.edu

Video: Insurance Information : Does Medicaid Cover Mental Health Care?

Amid Health Law Expansion, Some States Trim Medicaid Rolls

About 10,000 childless adults in the state, a little less than a third of those losing Medicaid coverage, won’t qualify for those federal subsidies because they have incomes below the poverty level, $11,490 for an individual. The health law makes those subsidies available only to people with incomes between the poverty level and four times that amount. The law was written that way because it was assumed all states would expand Medicaid eligibility to cover everyone with incomes up to 138 percent of the poverty level, but the Supreme Court last year made that provision optional. Only about half the states are expanding Medicaid for 2014. Many states led by Republicans have balked at expanding Medicaid, citing how spending for the program has outpaced inflation and even a modest increase in spending over the next decade could be difficult.
Source: webmd.com

Smoking Cessation Coverage for Pregnant Women in Medicaid and Health Insurance Exchanges

The Affordable Care Act (ACA) coverage expansions to childless adults, through Medicaid and Health Insurance Exchanges, could have broad effects on public health. A recent study gives us one good example of that by showing that pregnant women in Medicaid with tobacco cessation coverage were less likely to smoke during pregnancy, but only if they had such coverage before becoming pregnant, as childless adults. Since the ACA’s Essential Health Benefits package includes tobacco cessation services, the law could help many more future mothers to quit smoking during or (ideally) before pregnancy.
Source: piperreport.com

The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State

This analysis uses the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to provide national as well as state-by-state estimates of the impact of ACA on federal and state Medicaid costs, Medicaid enrollment, and the number of uninsured. The analysis shows that the impact of the ACA Medicaid expansion will vary across states based on current coverage levels and the number of uninsured. This analysis shows that by implementing the Medicaid expansion with other provisions of the ACA, states could significantly reduce the number of uninsured. Overall state costs of implementing the Medicaid expansion would be modest compared to increases in federal funds, and some states are likely to see small net budget savings.
Source: kff.org

Medicaid recipients losing coverage to get letter

Those losing BadgerCare Medicaid coverage under Walker’s budget are those who earn between 100 percent and 200 percent of the federal poverty level. Walker rejected federal money that would have paid to keep those earning up to 138 percent of poverty enrolled in Medicaid.
Source: channel3000.com

Zooming in on Health Reform: Understanding the Potential Impact of the ACA on Medicaid and the Uninsured at the Local Level

The data represents the anticipated changes in Medicaid enrollment and the uninsured before and after the ACA, based on a micro-simulation model. The micro-simulation model assesses the relative desirability of the health insurance options available to each individual and family under reform and takes into account a number of factors such as premiums and out-of-pocket health care costs for available insurance products, health care risk, whether or not the individual mandate would apply to them, and family disposable income. As with all projections of ACA coverage impacts, there is uncertainty of actual outcomes due to difficulties associated with predicting take-up of different types of coverage under the ACA and other behavioral responses as well as with respect to federal and state actions that could affect a number of implementation issues. Most importantly, these results assume state participation in the ACA Medicaid expansion.
Source: kff.org

Insurance Department Makes Case For Medicaid Expansion

“If the people who would be qualified for an expanded Medicaid enroll in Medicaid, they are not in our commercial market, and it is reasonable to believe that people that are left in our commercial market are going to be healthier, which may translate into lower premiums,” says Brannen.
Source: nhpr.org

Qualifying for health insurance subsidies in states that don’t expand Medicaid carries risk

But if an individual projects their income up to 10 percent higher than shown in electronically available data such as a prior tax return, there will be no questions asked. If there is more than a 10 percent discrepancy, the exchanges will ask for more information, such as a pay stub. If an applicant is unable to provide such data, the regulations allow the exchanges in 2014 to rely on the individual’s “self-attestation” to determine the subsidy. This applies only when someone overestimates their income, according to a spokeswoman for Health and Human Services.
Source: medcitynews.com

Health Insurance Marketplace No Substitute for Medicaid Expansion

Lack of health coverage is a huge problem in this state, as nearly 1.9 million people, including more than one in four Georgians between the ages of 19 and 64, were without health coverage in 2011. These figures rank Georgia among the worst in the nation for access to health insurance. But Gov. Nathan Deal and other state officials maintain Georgia should turn down more than $33 billion in new federal money over the next decade, dollars that could be used to extend health coverage to hundreds of thousands of uninsured Georgia residents. Failing to expand Medicaid ensures Georgians will continue to lack coverage at higher rates than the national average and will exacerbate shortages in Georgia’s health care delivery system.
Source: gbpi.org

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August 25, 2013

Viewpoints: Did Sen. Cruz Get Early Benefits From Canadian Health Care?; Medicaid Expansion Won’t Work If Doctors Don’t Accept Patients

Posted by:  :  Category: Medicare

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The Washington Post: Wonkbook: Newt Gingrich Explains How The GOP’s Obamacare Tactics Backfired The opening session of the Republican National Committee’s Boston confab featured ex-speaker Newt Gingrich scolding his fellow Republicans on their failure to come through on the “replace” side of “repeal-and-replace.” … That’s a task Republicans have clearly failed at. One of the more interesting polling wrinkles of the past few years is that the persistent unpopularity of the Democrats’ signature health-care initiative hasn’t helped the GOP take the lead on the broader issue. A recent poll by the Morning Consult found a 10 percent edge for Democrats on health care. Even the conservative polling group Rasmussen continues to find a Democratic edge. The public doesn’t like what the Democrats did. But they really don’t like what they think the Republicans will do (Ezra Klein and Evan Soltas, 8/20).
Source: kaiserhealthnews.org

Video: Health Insurance Benefits Philippines

Daily Kos: UPS cutting health care for 15,000 spouses, blaming Obamacare

paradise50, JML9999, millwood, jeff in nyc, HappyinNM, MKinTN, annieli, allergywoman, Mostel26, TDDVandy, Sylv, miracle11, Russ Jarmusch, leathersmith, IndieGuy, More Questions Than Answers, newinfluence, Gooserock, twigg, ZappoDave, FloridaSNMOM, kevinpdx, wintergreen8694, remembrance, roses, gchaucer2, Matt Z, deben, Yosef 52, ItsSimpleSimon, Lujane, ColoTim, arizonablue, Mannie, enhydra lutris, duhban, fb, irate, hotdamn, MartyM, eeff, gramofsam1, vzfk3s, mconvente, Curt Matlock, NYFM, devis1, Buckeye Nut Schell, pat bunny, VirginiaBlue, Habitat Vic, Involuntary Exile, offred, hoof32, Turbonerd, skybluewater, mookins, emal, trumpeter, slowbutsure, filkertom, BlueSue, catly, MRA NY, countwebb, pickandshovel, madgranny, kerflooey, artr2, snazzzybird, mungley, wxorknot, OregonWetDog, thomask, TracieLynn, dsteffen, Oaktown Girl, bbctooman, marina, Josiah Bartlett, ladybug53, BeninSC, PrahaPartizan, prettygirlxoxoxo, rmx2630, HCKAD, kaliope, RightHeaded, Larsstephens, Dodgerdog1, VTCC73, lorell, hungeski, Lilyvt, Dirtandiron, veinbulge2000, mooshter, Tunk, scyellowdogdem, RadGal70, Says Who, RUNDOWN, yoduuuh do or do not, Drunkard, jedennis, diggerspop, ichibon, Alfred E Newman, splashy, 1Nic Ven
Source: dailykos.com

President's message explains health care benefits changes at Penn State

The recently announced initiative meets the objectives outlined in the University’s strategic plan.  Our strategy is a deliberate and aggressive attempt to reduce the rate of health care cost increases—something that we have been unable to do previously.  Despite several million dollars in University expenditures over the past decade in support of voluntary programs for health and wellness, only a very small percentage of faculty and staff have participated.  If we can improve the health of our participants through increased awareness and engagement in their own health, the rates of our health insurance can be maintained at current levels or even reduced. This opportunity is too great to ignore, and we know from the experience of our employees at the Hershey Medical Center that substantial reductions in the rate of cost increases have been achieved with a similar program over the past eight years. The modest investment we are making in employee engagement to help mitigate their own health risks will ensure the long-term stability of our ongoing benefits plan.
Source: psu.edu

Here’s Why Employers Need to Keep Offering Health Care Benefits

Retail, fast food, and hospitality firms are likely to be hit hard — In these industries, because the employee skill set required is similar, it is relatively easy for unhappy employees to move between companies, locations, and industries. Because workers in these industries may frequently interact outside of work with workers in these industries, your employees will likely hear quickly about other hourly jobs that offer health care. As a result of these two factors, I estimate that individual outlets in this industry that do not offer health care benefits will over a year will lose up to 25 percent of their employees to similar firms that have nothing superior to offer beyond health care benefits. With similar hours, pay, location, and working conditions, health care benefits may become the significant differentiator.
Source: tlnt.com

Obamacare call center employees not offered health care benefits

(NaturalNews) News reports of late have declared that, despite it being passed nearly three years ago, Americans are “still confused” over Obamacare and its myriad of regulations, requirements and provisions. Confused yes, but increasingly angry as well. Why? Because as the time draws near for most of the law’s remaining provisions to kick in, the roaches who created this monstrosity are scurrying for the darkness in a bid to distance themselves from the law they helped draft and pass. Their actions are creating an unprecedented environment of utter hypocrisy that would make even the most cynical, seasoned political observer wince. Hypocrisy, surrounded by irony and submerged in obfuscation and denial To wit: — Remember a few months back when reports surfaced that members of Congress were negotiating in secret to develop a way to exempt themselves and their aides from the ravages of Obamacare? Politico broke the story: The talks – which involve Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner (R-Ohio), the Obama administration and other top lawmakers – are extraordinarily sensitive, with both sides acutely aware of the potential for political fallout from giving carve-outs from the hugely controversial law to 535 lawmakers and thousands of their aides. Discussions have stretched out for months, sources said. Lawmakers quickly backed away from those revelations, but they never refuted the crux of the story and, in fact, defended efforts to exempt themselves and their staffs. — One of the most daunting provisions of Obamacare is that enforcement of its various penalties and sanctions will be carried out in large part by the hated Internal Revenue Service – to the point where the law requires adding 16,000 new agents to the IRS to ensure your compliance. Only, as reports in recent days have revealed, that agency’s own union announced it wanted no part of the law either. Per The Washington Examiner: National Treasury Employees Union officials are urging members to write their congressional representatives in opposition to receiving coverage through President Obama’s health care law. The union leaders are providing members with a form letter to send to the congressmen that says “I am very concerned about legislation that has been introduced by Congressman Dave Camp to push federal employees out of the Federal Employees Health Benefits Program and into the insurance exchanges established under the Affordable Care Act.” That IRS union members, whose ranks would be charged with Obamacare enforcement, want out is the pinnacle of irony. — The president and his supporters have all regularly denied reports that Obamacare is a job killer and is affecting full-time employment especially. But recent polls of businesses have confirmed as much. “We were startled because we know that employers were concerned about the Affordable Care Act and the effects it would have on their business, but we didn’t realize the extent they were concerned, or that the businesses were being proactive to make sure the effects of the ACA actually were minimized,” said attorney Steven Friedman of Littler Mendelson, in an interview with CNBC, commenting on the results of a survey his firm commissioned through Gallup. “If the small businesses’ fears are reasonable, then it could mean that the small business sector grows slower than what economic conditions otherwise would indicate. And small businesses have been a growth engine in the economy,” he said. Not full time and you’ll, um, need to pay for your own health insurance Now we find that even call centers set up to handle questions about the complex law are are hiring largely part-time employees and will offer them no health insurance benefits. Per the Contra Costa Times in California: Earlier this year, Contra Costa County won the right to run a health care call center, where workers will answer questions to help implement the president’s Affordable Care Act. Area politicians called the 200-plus jobs it would bring to the region an economic coup. Now, with two months to go before the Concord operation opens to serve the public, information has surfaced that about half the jobs are part-time, with no health benefits — a stinging disappointment to workers and local politicians who believed the positions would be full-time. That’s because, according to the paper, when the jobs were first posted they were posted as full-time positions. One worker, who talked to the newspaper on condition of anonymity, summed up the hypocrisy thusly: “What’s really ironic is working for a call center and trying to help people get health care, but we can’t afford it ourselves.” To add insult to injury, workers who were initially employed under the guise of being full-time were later told after they were re-designated as part timers that they would have to come up with the money to pay for their own health insurance: $600 to $1,200 a month for a single worker and between $1,400 to $2,900 a month for an employee with a family. The employees will make between $15.33 and $18.63 an hour. Sources: http://www.nationalreview.com http://www.politico.com http://www.cnbc.com/id/100825782 http://www.contracostatimes.com/rss/ci_23733819
Source: naturalnews.com

Will employers drop health insurance benefits?

We continue our series on the Affordable Care Act with Marty Anderson of Security Health Plan in Wisconsin. In previous weeks, Anderson has talked about some of the things you need to consider when selecting a health insurer: make sure the doctor you want is covered, choose a plan that best fits your needs and budget. He notes all plans have the same basic coverage and you can pick-and-choose beyond that.
Source: brownfieldagnews.com

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