Medicare Fraud Reporting Center

Posted by:  :  Category: Medicare

Medicare Whistleblowers are typically healthcare professionals who are aware of hospitals, clinics, pharmacies, Nursing Homes, Hospices, long term care and other health care facilities that routinely overcharge or seek reimbursement from government programs for medical services not rendered, drugs not used, beds not slept in and ambulance rides not taken. If you have information about a person or a company that is cheating the Medicare program (or any other government run healthcare program), you may be able to collect a large financial reward for reporting it here.
Source: medicarefraudcenter.org

Fraud Case Casts Spotlight On Medicare Advantage Plans : Shots

The Center for Public Integrity has previously reported on several whistleblower lawsuits, including one filed by a Miami doctor against Humana, that allege upcoding. In that case, Olivia Graves alleges that a Humana medical center had diagnosed abnormally high numbers of patients with diseases such as diabetes with complications that boosted Medicare payments — diagnoses that “were not supported by medical records.” Graves alleges that Humana knew about the overcharges but took no action to stop them, which Humana denies.
Source: npr.org

Fraud case puts spotlight on Medicare Advantage plans

The Center for Public Integrity has previously reported on several of the whistleblower lawsuits, including one filed by a Miami doctor against Humana, that allege upcoding. In that case, Olivia Graves alleges that a Humana medical center had diagnosed abnormally high numbers of patients with diseases such as diabetes with complications that boosted Medicare payments — diagnoses that “were not supported by medical records.” Graves alleges that Humana knew about the overcharges but took no action to stop them. Humana has denied the allegations in the civil suit.
Source: publicintegrity.org

Medicare For Dummies: Patricia Barry: 9781118532782: Amazon.com: Books

Posted by:  :  Category: Medicare

Enter your mobile number or email address below and we’ll send you a link to download the free Kindle Reading App. Then you can start reading Kindle books on your smartphone, tablet, or computer – no Kindle device required.
Source: amazon.com

Medicare For Dummies Cheat Sheet

Special enrollment period (SEP): You qualify for this SEP if you’re beyond 65, have group health insurance from an employer for whom you or your spouse actively works, and the employer has 20 or more employees. If you meet these conditions, you can delay Medicare enrollment after turning 65. The SEP lasts throughout the time you have this coverage and extends for eight months after it ends or the employment ends — whichever comes first. For example, if you stop work at the end of February, you can enroll in Medicare without risking late penalties until your SEP ends on October 31 — but to avoid a gap in coverage, you’d probably want to enroll in February so that your Medicare benefits begin March 1.
Source: dummies.com

Medicare Health Insurance Options for People over 65

Prior to retirement, you’re likely covered by your employer’s health insurance plan. However, what do you do for health insurance after retirement? Many people postpone retirement until age 65 merely because they need to wait to retire until they qualify for the government’s healthcare program, Medicare. You’re eligible for Medicare if you or your spouse worked for at least ten years in Medicare-covered employment, and you’re age 65 or older and a citizen or permanent resident of the United States. If you’re not yet age 65, you may qualify for coverage if you have a disability.
Source: dummies.com

Wiley: Medicare For Dummies

To apply for permission please send your request to permissions@wiley.com with specific details of your requirements. This should include, the Wiley title(s), and the specific portion of the content you wish to re-use (e.g figure, table, text extract, chapter, page numbers etc), the way in which you wish to re-use it, the circulation/print run/number of people who will have access to the content and whether this is for commercial or academic purposes. If this is a republication request please include details of the new work in which the Wiley content will appear.
Source: wiley.com

Medicare For Dummies by Patricia Barry

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Source: barnesandnoble.com

Health Care Reform for Dummies: What You Need to Know

If you are over 65 you’ve probably got Medicare. And that’s not going to change. But if you have a bundled Medicare Advantage plan — essentially a privately-administered Medicare HMO — you might lose some of the additional perks you get. These can range from dental and vision coverage to gym memberships. Taxpayers pay up to 14 percent more per person for these bundled plans. Both the House and Senate health reform bills use this overpayment as one way to help fund coverage for people who currently don’t have it.
Source: go.com

Personal Finance For Seniors For Dummies: Eric Tyson, Robert C. Carlson: 9780470548769: Amazon.com: Books

Enter your mobile number or email address below and we’ll send you a link to download the free Kindle Reading App. Then you can start reading Kindle books on your smartphone, tablet, or computer – no Kindle device required.
Source: amazon.com

Insurance Providers for Overseas Coverage

Posted by:  :  Category: Medicare

The Department of State assumes no responsibility or liability for the professional ability or reputation of, or the quality of services provided by, the insurance coverage providers whose names appear on the following lists.  Inclusion on this list is in no way an endorsement by the Department.  Names are listed alphabetically, and the order in which they appear has no other significance.  The information on the list is provided directly by the insurance coverage providers; the Department is not in a position to vouch for such information.  You may receive additional information about insurance coverage providers by contacting local associations or licensing authorities.
Source: state.gov

Paul Ryan Urges State Lawmakers Not to Set Up Health

“Oh God, no…The last thing anybody in my opinion would want to do, even if you are not a conservative, is consign your state to this law,” the Wisconsin Republican told state legislators Thursday during a conference call organized by the…
Source: wsj.com

New York State Department of Health

The New York State Department of Health (DOH) is hosting its first-ever Cancer Prevention Summit in New York City on Wednesday, May 20. The New York State Cancer Prevention Summit: Transforming the Cancer Agenda for the Next Generation will be held at the New York Hilton Midtown, 1335 Avenue of the Americas in Manhattan from 8:30 a.m.- 4:15 p.m. Given that nearly half of all cancer deaths are preventable, the Summit calls for a renewed focus on cancer prevention. State and national cancer prevention researchers, medical and public health practitioners, health organizations, business and government leaders, and other stakeholders will be brought together to demonstrate concrete ways different sectors can work together to recognize the prevention of cancer as an urgent public health priority
Source: ny.gov

Medicaid Dental Insurance Plan Coverage Detail

Posted by:  :  Category: Medicare

Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist. A direct dental referral is required for every child in accordance with the periodicity schedule set by the state. The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. Under the Medicaid program, the state determines medical necessity.
Source: echealthinsurance.com

Health Insurance Made Simple

Posted by:  :  Category: Medicare

Our licensed Product Advisors can help you find a health plan that meets your needs and budget. You have a limited time to apply for Open Enrollment. Don’t delay! Open Enrollment begins November 15, 2014 Apply by December 15, 2014, to start coverage January 1, 2015 Open Enrollment ends February 15, 2015
Source: goldenrule.com

Fargo VA Health Care System

Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.
Source: va.gov

Florida Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

If you live in Florida and have basic Medicare health coverage, you may find that you have to pay more for your health care costs than you can afford. Because there are certain health needs that Medicare does not cover, private insurance companies are able to offer two different customized options that Medicare users can purchase to help lower the cost of health care. Medigap insurance pays some additional costs, such as co-pays and deductibles, and may also cover services not covered or fully covered by Medicare. Medicare Advantage are totally custom and cover as much or as little of your costs as you choose. You must have Medicare in order to qualify for Medigap.
Source: medicaresupplementalinsurance.com

Medicare Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

Medicare Supplemental Insurance & Medigap

Learn how a Mutual of Omaha Medicare supplement insurance plan can reduce your out-of-pocket health care costs. Review Medicare supplement insurance basics, determine which Medicare supplement insurance policy is best for you, or get a Medicare supplement insurance quote.
Source: mutualofomaha.com

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Your Medicare Supplemental Insurance Information – MedicareSupplemental.com

There are exceptions to the standardization if you live in certain states, such as Massachusetts, Minnesota, and Wisconsin. Depending on your state, you may be able to buy another type of Medigap policy called Medicare SELECT (a Medigap policy that requires you to use specific hospitals and in some cases specific doctors to get full benefits). Who Provides Medicare Supplemental Insurance? Medicare supplemental insurance is provided by private insurance companies such as AARP, BlueCross BlueShield, Globe Life, Humana, Mutual of Omaha, Transamerica Life, United American, UnitedHealthcare and many others. Remember from above that Medigap insurance companies can sell you only a “standardized” Medigap policy. All Medigap policies must have specific benefits so you can compare them easily on the basis of price.
Source: medicaresupplemental.com

Medicare Supplemental Health Insurance Information and Medicare Supplement Insurance Plans

Unlessyou buy a Medicare SELECT policy, you may go to any doctor or hospitalfor treatment. The Medicare supplemental insurance policy pays for itsshare of the expenses and your Medicare policy covers its share. Thelevel of benefits you receive will depend on which plan you choose. Youwill pay for your Medicare supplemental insurance and pay the Medigap insurancecompany on a separate invoice. You will receive a Medicare Summary oncea month by mail and your Medigap insurance company will also send you Medicare health insurance planinformation on what has been paid. A Medicare supplemental health insurance policy doesnot replace your original Medicare coverage. It simply provides additional benefits to help cover themedical expenses that are not paid for by the original Medicare policy.You may also want to join a Medicare Advantage Health Plan that willhelp with drug costs and coinsurance deductibles.
Source: healthinsurancefinders.com

Compare Medicare Supplement Insurance Plans & Medigap Plans and Rates for
2011. See Plan Chart for AL, AR, AZ, CO, FL, GA, IA, ID, KS, KY, LA, MD, MI, MO, MN, MS,
NC, NE, NM, OH, OK, SC, TN, TX, VA & WV. Medigap Insurance Plans including the
Popular Plan F & G

Year after year we have found Medicare Supplement Plan F or Medicare Supplement Plan G to be the best value for the dollar. The new Plan N is a great alternative to a Medicare Advantage plan.  Plan N might be recommended depending on which state you live in and how much the supplement cost in relation to available Medicare Advantage plans. A plan N will provide more coverage and a very reasonable premium. In Florida we have the lowest rate for plan F & plan N. See the Medicare Supplement Plan chart below. In general, the higher you go up in the plan chart the more Gaps the plan fills. Medicare Supplement Plan F is the most comprehensive supplement plan and there is not a better plan than F. Most people will select a Plan F. However, depending on your personal situation there may be a more cost efficient choice.
Source: themedicarechannel.com

Get Medicare Supplemental Insurance Plan Quotes

Ms. Tuesday N. was very well versed and knowledgeable regarding my mother’s situation; her service skills are outstanding. I was very pleased, and she kept my mother interested in what she had to say, which is very difficult for me at times. Thank you, Tuesday, for the incredible service. You’re amazing and ONE OF A KIND. I will be in touch to continue with my mother’s application and receive more of your excellent services. Thank you again.
Source: ehealthmedicare.com

Does Medicare pay for the Shingles vaccine?

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You are probably wondering, since the shingles virus comes from the same virus as chickenpox, are the symptoms the same as chickenpox? Shingles usually starts with a headache and then a rash on a band or section of skin, typically on one side of the face or body. Symptoms can also include general achiness and fatigue, fever and chills. The rash then turns into clusters of blisters, which fill with fluid and crust over. Itching can also be a symptom. Shingles can be very painful. The virus travels along nerve pathways, causing inflammation and damage. The pain tends to be more severe and last longer in older people. In the worst cases, the shingles virus can cause blindness, if it infects the eyes or the area around your eyes, as well as hearing problems, brain inflammation (encephalitis) or death. Mild scarring usually occurs where shingles appear on the skin. If you believe you may have shingles you should seek medical attention promptly.
Source: medicarepathways.com

Shingles Vaccine Medicare Coverage and Cost Information

Shingles, or Herpes zoster, is caused by the same virus (varicella zoster, VZV) that causes chickenpox. It is characterized by pain, red rash, and painful fluid filled blisters. The virus is never eliminated from the body, but instead lives in a dormant stage in the nervous system. The virus can be reactivated when the person is subject to prolonged stress, or through the treatment certain illnesses such as cancer. Getting vaccinated with Zostavax, a chickenpox booster, can help prevent it’s painful occurrence, as well as reduce the risk of complications such as posterherpetic neuralgia.
Source: clivir.com

Shingles Vaccine Protects Seniors and Is Covered by Medicare 

Shingles Overview Shingles, also known as herpes zoster, is a burning, blistering, often excruciating skin rash that affects about 1 million Americans each year. The same virus that causes chickenpox causes it. What happens is the chickenpox virus that most people get as kids never leaves the body. It hides in the nerve cells near the spinal cord and, for some people, emerges later in the form of shingles.
Source: huffingtonpost.com

Does Medicare cover the shingles vaccine?

Medicare Part D and Medicare Advantage plans that provide drug coverage are required to cover all commercially available vaccinations. These plans will cover the vaccination medication and the administration of the shot by your doctor or physician. There is no set cost for this vaccination; rather, the copayment or coinsurance amount varies depending on the plan you have. Make sure to follow your plan’s guidelines for this vaccination to be covered.
Source: ehealthmedicare.com

Ask Ms. Medicare: Coverage for the Shingles Vaccine

Have a question about Medicare? There’s a good chance Ms. Medicare has already provided the answer you need. Check out the Q&As featured in the Ask Ms. Medicare Archive. If the information you’re looking for isn’t there, email your query to msmed@aarp.org. Be sure to include your name, age, state and ZIP code. Your name will not be published.
Source: aarp.org

Shingles Vaccine Information, Side Effects, and More

Nerve pain can be a symptom of many different conditions, and is caused when the brain receives a pain signal where there is no immediate cause. Symptoms include burning, tingling, numbness and loss of reflexes. Usually, nerve pain results from damage from a physical injury or diseases like cancer, diabetes or HIV. Often, treatment of the latter conditions causes the nerve pain. Diagnosis is made in some cases by CT scans, MRIs and skin biopsies. Treatment will vary from over-the-counter topical treatments to anticonvulsants and antidepressants to painkillers to electrical stimulation. Follow the links below to find WebMD’s comprehensive coverage about nerve pain, its causes, how it is diagnosed, treated, and much more.
Source: webmd.com

Medicare Benefits Schedule (MBS)

Posted by:  :  Category: Medicare

MBS service statistics broken down by Commonwealth Electoral Division (CED) are available in the PDF files below. File 1 details Medicare Safety Net statistics for the 2010 calendar year of service by CED and File 2 details Medicare Bulk Billing statistics for the 2010 – 11 financial year of processing by CED. It is important that you read all notes on these files.
Source: gov.au

WellCare of Ohio, Inc : Home

Posted by:  :  Category: Medicare

WellCare of Ohio members will have access to covered benefits through June 30, 2013 or through their disenrollment date if earlier. Providers should continue to bill for covered services rendered for eligible dates of service. Claims will be accepted through June 30, 2014.
Source: wellcare.com

WellCare Health Plans, Inc : Home

WellCare Gives $2,500 to Hope House to Provide Telepsychiatric Behavioral Health Care for Women and Children in Augusta, Georgia Read more » WellCare Donates $10,000 to the Partnership Against Domestic Violence In Georgia Read more »
Source: wellcare.com

WellCare Health Plans, Inc : Medicaid

At WellCare, we understand that different people have different healthcare needs, and we are committed to helping you find a health plan that works for you. The WellCare Group of Companies provides eligible children and adults with comprehensive benefits packages.
Source: wellcare.com

WellCare Careers and Employment

and other services. WellCare Health Plans administers its Medicaid plans under various brands such as Staywell and HealthEase in Florida; WellCare in Ohio (ending in 2013), Georgia, Kentucky, and New York; Harmony in Illinois; and ‘Ohana in Hawaii. The company’s Medicare prescription-drug and Medicare Advantage plans operate primarily under the WellCare brand. Operations WellCare serves some 2.6 million members nationwide. About 1.5 million customers are Medicaid members (including SCHIP members), and more than 1.1 million of those are recipients of Temporary Assistance to Needy Families (TANF) benefits. The Medicare customers include about 1 million prescription members throughout the US, while its 135,000 Medicare Advantage customers are largely enrolled in HMO coordinated care plans (CCPs) in about a dozen states. Financial Analysis After several years of reporting decreased earnings (due to troubles including legal and regulatory issues), in 2011 WellCare was able to increase both its revenues and net income levels. The firm reported a 12% increase in sales to $6.1 billion and a return to profitability with a $264 million net income figure that year, largely attributed to growth in the core Medicare and Medicaid markets, as well as decreased legal expenses and successfully implemented cost control efforts. Strategy The company seeks growth by expanding Medicaid coverage in the states where it already has a presence, as well as the occasional entrance into new states where conditions are attractive. For instance, in 2011 it gained Medicaid TANF contracts in Hawaii and entered the new Medicaid territory of Kentucky, giving its annual Medicaid enrollment levels a 12% boost. However, as a provider of services to federal and state Centers for Medicare & Medicaid Services (CMS) entities, WellCare is also subject to the loss of contracts when they are awarded to different providers. For instance, in 2012 the firm’s Medicaid contracts in Missouri and Ohio expired and were not renewed for 2013; the state of Ohio, however, extended its contract for a transitional period (possibly through mid-2013) during which WellCare may provide services to its Medicaid members until they transfer to other plans. WellCare successfully added more members to its Medicare plans in 2011, doubling the membership level of its Medicare Advantage programs (especially in special needs plans for members who qualify for both Medicare and Medicaid coverage) and increasing Part D enrollment by 27%. Like the Medicaid programs, covered territories for Medicare Advantage plans can shift each year: WellCare added Hawaii to its territory roster in 2010, but exited the Indiana market the following year.  WellCare decided to exit the less-profitable Medicare Advantage private-fee-for-service (PFFS) market in 2010 after CMS changed how the plans were regulated. The move affected about 110,000 customers in some 40 states and caused a dip in Medicare enrollment that year. Mergers and Acquisitions In 2012 WellCare agreed to acquire the South Carolina Medicaid business of UnitedHealth. The purchase adds some 65,000 members throughout most of South Carolina and gives WellCare further opportunities for growth in the region. Company Background Though it successfully rejuvinated its finances in 2011, WellCare spent several years prior to 2011 cleaning up a rash of regulatory and legal difficulties. The company’s troubles started with a raid on its headquarters in late 2007 and a subsequent federal investigation into possible Medicaid fraud in the Florida market (which also led to a management shakeup and the restatement of the company’s finances for several previous years). WellCare settled the fraud allegations by paying some $80 million to the US Attorney’s Office through an agreement reached in 2009. As part of the agreement, WellCare agreed to operate under the supervision of an independent monitor to avoid facing formal criminal charges; the three-year supervision term was successfully completed in 2012. In addition, the company agreed to pay some $138 million to settle a handful of civil whistleblower suits in 2011; that settlement was finalized in 2012. Other related settlements include a $10 million payout in 2009 to resolve charges leveled by the SEC that it failed to refund money due a Florida health care administration agency, and a 2011 shareholder class action settlement for misrepresentation that cost WellCare some $200 million in cash and bonds. Personal criminal charges for three former officers are still pending. – less
Source: indeed.com

New Whistleblower Charges at WellCare

The publicly traded company is still being monitored for compliance with federal law under the terms of a five-year “Corporate Integrity Agreement” it signed in 2011 with the Office of Inspector General of the Department of Health and Human Services.  It calls for WellCare to train staff on the legal requirements, assign responsibility for compliance in each division, file reports regularly and hire an independent review organization to conduct evaluations.
Source: usf.edu

Benefits for People with Disabilities

Posted by:  :  Category: Medicare

The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program.
Source: ssa.gov

Social Security Administration

For some claimants, this program is harder to receive than funds from RSDI. To warrant a processing time of anything more than a day and an immediate denial, certain specific criteria must be met, including citizenship status, having less than $2,000.00 in countable financial resources, or having countable income of less than $718.00 per month from any source. Disposal of a financial resource (i.e., a deliberate spend-down to fall under SSI resource ceilings) can prevent a person from receiving SSI benefits for a period up to 36 months. Every person with or without a Social Security Number is eligible to apply. But if a person does not meet any of the above criteria or is not a documented resident of the United States, his or her claim can only be taken on paper and will be immediately denied. Even documented residents with legal permanent resident status after August 1996 are immediately denied unless they meet some or all of the SSI criteria listed above.
Source: wikipedia.org