Help fight Medicare fraud

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Source: medicare.gov

How to Report Fraud and Suspected Fraud

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Source: cms.gov

Avoid and Report Medicare Fraud and Abuse

Medicare billing fraud means knowingly billing Medicare — possibly over and over again — for products and services that were not medically necessary, accurately coded, or for an actual beneficiary. You can help detect Medicare billing fraud by carefully reviewing your payment notice. This is the notice you get whenever a doctor or health care provider bills Medicare or your insurance company for a health care product or service. The notice identifies the product or service and lists the total amount billed, the amount Medicare or your insurance company paid to the provider, and the amount you owe.
Source: ehealthmedicare.com

Medicare Fraud Reporting Center

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

What’s Medicare Supplement Insurance (Medigap)?

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Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

How to compare Medigap policies

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Source: medicare.gov

Boomer Benefits Medicare Supplements

Our caring agents provide lifetime claims service for your Medicare insurance policy. This means when claims occur, you are not alone. You will have our experts on hand to help you sort through your statements, and even assist with appeals if necessary.
Source: boomerbenefits.com

Help fight Medicare fraud

Posted by:  :  Category: Medicare

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Source: medicare.gov

National Medicare Fraud Takedown Results in Charges Against 243 Individuals for Approximately $712 Million in False Billing

“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement,” said Attorney General Lynch.  “The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others.  They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.  In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives.  We are prepared – and I am personally determined – to continue working with our federal, state, and local partners to bring about the vital progress that all Americans deserve.”
Source: justice.gov

Medicare Fraud Reporting Center

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

Biggest healthcare frauds in 2015: Running list

Two Southern California residents, Theresa Fisher, 45, and Lindsay Hardgraves, 30, were both found guilty of mail fraud for submitting bills for more than $71 million for medically unnecessary procedures performed on insurance beneficiaries who received free or discounted cosmetic surgeries. Members of the scheme lured insured patients to a surgery center in Orange with promises that they could use their union or PPO health insurance plans to pay for cosmetic surgeries, which are generally not covered by insurance. The surgery center was known at various times as Princess Cosmetic Surgery, Vista Surgical Center, and Empire Surgical Center. The women told patients they could receive free or discounted cosmetic surgeries if they underwent medical procedures covered by their insurance such as endoscopies, colonoscopies and cystoscopies. Once the health care benefit program paid the claims, the patients were given free or discounted cosmetic surgeries, including “tummy tucks,” breast augmentations and liposuction. In some cases, the surgery center simply billed cosmetic procedures as if they were medically necessary procedures such as hernia surgeries.
Source: healthcarefinancenews.com

Criminal and Civil Enforcement

New York City Pharmacy Owner Arrested For $8.5 Million Fraud As Part Of Largest National Medicare Fraud Takedown In History Preet Bharara, the United States Attorney for the Southern District of New York, Diego Rodriguez, the Assistant Director-in-Charge of the New York Office of the Federal Bureau of Investigation (“FBI”), and Scott J. Lampert, the Special Agent-in-Charge of the New York Office of the Department of Health and Human Services, announced today that SAJID JAVED was charged with participating in a health care fraud scheme that used nine pharmacies in Brooklyn and Queens, New York, through which JAVED submitted more than $8.5 million in fraudulent claims to Medicaid and Medicare. JAVED’s arrest is part of an unprecedented nationwide sweep led by the Medicare Fraud Strike Force, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses, or other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (“CMS”) also suspended a number of providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in the history of the Medicare Fraud Strike Force, both in terms of the number of defendants charged and loss amount.
Source: hhs.gov

Doctors and nurses busted for $712 million Medicare fraud

A Los Angeles doctor is charged for allegedly billing $23 million for 1,000 power wheelchairs and home health services that were not medically necessary and often not provided. And in a Florida case, a health care provider received $1.6 million from Medicare for prescription drugs that were never purchased and never dispensed, said Lynch.
Source: cnn.com

State Health Benefit Plan (SHBP)

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A Qualifying Event (QE) or life event change is defined as a personal change in status that may allow you to change your benefit elections.  Examples of a QE are a change in marital status, number of dependents, employment status or eligibility for health coverage. The QE rules that apply to you will depend on whether you are an active employee, former employee continuing coverage, or a surviving spouse or surviving child. These rules are set forth in your SPD.
Source: georgia.gov

Contact Information and Websites of Organizations for Medicare

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Source: medicare.gov

Health Insurance Programs

Report of the Commissioner of Health and Insurance Superintendent to Governor David A. Paterson on the Partnership for Coverage Initiative on the Release of the Urban Institute Report, July 17, 2009 (PDF, 90KB)
Source: ny.gov

Florida Department of Health

Zika Fever is a mild febrile illness caused by a mosquito-borne virus. It has been identified in several countries in Central and South America, Mexico, and the Caribbean. Zika fever has also been reported in travelers returning to the U.S. and Florida. The Centers for Disease Control and Prevention Travel Advisory to impacted countries can be found here. Take protect yourself and your loved ones: Drain standing water, no matter how seemingly small, cover your skin with mosquito repellent or protective clothing and keep windows and doors covered with screens.
Source: floridahealth.gov

How to Qualify For Medicaid and CHIP Health Care Coverage

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If your state has not expanded Medicaid: You may qualify based on your state’s existing rules. These vary from state to state and may take into account income, household size, family status (like pregnancy or caring for young children), disability, age, and other factors. Because each state and each family situation is different, there’s no way to find out if you qualify without filling out an application.
Source: healthcare.gov

10 health care benefits covered in the Health Insurance Marketplace

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Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans. When you fill out your application and compare plans, you’ll see the specific health care benefits each plan offers.
Source: healthcare.gov

Health Insurance, Medical Insurance, Free Online Insurance Quotes, Affordable Individual, Group, Family Plans

HealthInsurance.com offers a wide variety of health plans including individual and family health insurance, group health insurance, HMOs, PPOs, POS, Indemnity plans, short-term health insurance plans, dental health insurance, and international travel health insurance. Popular health insurance companies such as Blue Cross and Blue Shield, Anthem, Aetna, Humana, Golden Rule Insurance Company, HealthNet, Assurant, Celtic, Unicare, Kaiser and PacifiCare Life and Health Insurance Company offer the plans we feature.
Source: healthinsurance.com

Find out what Marketplace health insurance plans cover

It depends. Large employers who “self-insure” — meaning they pay employees’ health care costs directly — don’t have to provide essential health benefits. But many do. Check with your employer to find out if it’s self-insured and what services are covered.
Source: healthcare.gov

Florida Medicare Supplemental Insurance

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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

What’s Medicare Supplement Insurance (Medigap)?

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

Medicare Supplement Rates

To find sample plans and premium rates, click the �Search Medicare Supplement Rates� link below. The pages on this website are printer friendly. Search results may be exported to Microsoft Excel compatible format. If you need assistance with this website, please click the �Contact Us� link.
Source: fldfs.com

Medicare Supplement Insurance in Florida

In Florida, HealthMarkets Insurance Agency offers several Medicare Supplement insurance options to help you cover the out-of-pocket costs with Original Medicare coverage. These types of plans are also known as Medigap Plans. When added to your Original Medicare coverage, Medicare Supplement insurance plans help cover out-of-pocket medical expenses. To ensure that your Medicare Supplement insurance plan covers your medical costs, contact HealthMarkets Insurance Agency for a free consultation.
Source: healthmarkets.com

2017 Florida Medicare Supplement Insurance Plans

The key to finding the perfect plan is to have all of the information in front of you so you can compare plans. Keep in mind, there are significant differences between lettered plans and it makes sense to review everything to ensure you’re making the best choice. Some plans provide coverage if you travel outside the United States, others do not. At Secure Health Options, we can help you locate these options with Florida Blue so you can have all the information you need to make the right decision, easily and conveniently.
Source: myfloridamedicareplan.com

Medicare.gov: the official U.S. government site for Medicare

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Source: medicare.gov

Florida Medicare Supplements

Medigap Companies: Admiral Life Insurance Aetna Life Insurance American Continental Insurance American National Life Insurance Anthem Life American Pioneer Life Insurance American Republic Insurance Bankers Fidelity Life Insurance Blue Cross and Blue Shield Central Reserve Life Insurance Christian Fidelity Life Insurance Combined Insurance Company Conseco Insurance Company Continental General Insurance Continental Life Insurance Company Equitable Life and Casualty Insurance Family Life Insurance Company Forethought Insurance Company Genworth Life Insurance Company Gerber Life Insurance Company Globe Life and Accident Insurance Golden Rule Insurance Company Great American Life Insurance Guarantee Trust Life Insurance Humana Insurance Company Lincoln Heritage Life Insurance Loyal American Life Insurance Marquette National Life Insurance Mutual of Omaha Insurance Company National States Insurance Company New Era Life Insurance Company Old Surety Life Insurance Company Pacificare Life Assurance Company Pennsylvania Life Insurance Company Philadelphia American Life Insurance Physician’s Life Insurance Company Provident American Life & Health Reserve National Insurance Company Royal Neighbors of America Sierra Health and Life Insurance Southwest Service Life Insurance Standard Life and Accident Insurance State Mutual Insurance Company Sterling Investors Life Insurance Sterling Life Insurance Company Unicare United American Insurance Company United Commercial Travelers (UCT) United National Life Insurance United of Omaha Life Insurance United Teacher Associates United World World Corp Insurance Company
Source: medigap360.com

Medicare Supplement Plans

To be eligible to enroll in a Medicare Supplement plan, you must be enrolled in both Medicare Part A and Part B. A good time to enroll in a plan is generally during the Medigap Open Enrollment Period, which begins on the first day of the month that you are both age 65 or older and enrolled in Part B, and lasts for six months. During this period, you have the guaranteed-issue right to join any Medicare Supplement plan available where you live. You may not be denied coverage based on any pre-existing conditions during this enrollment period (although a waiting period may apply). If you miss this enrollment period and attempt to enroll in the future, you may be denied coverage or charged a higher premium based on your medical history.
Source: ehealthinsurance.com

Shingles vaccine: Should I get it?

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The shingles vaccine (Zostavax) is recommended for adults age 60 and older, whether they’ve already had shingles or not. Although the vaccine is approved for people age 50 and older, the Centers for Disease Control and Prevention isn’t recommending it until you reach age 60.
Source: mayoclinic.org

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

Shingles Vaccine Information, Side Effects, and More

Some people who get the vaccine still get shingles. But they’re more likely to have shorter periods of shingles-related nerve pain called postherpetic neuralgia, which is very painful and can last weeks, months, or even years after the rash goes away.
Source: webmd.com

Shingles Shots and Treatment under Medicare Part D

Most stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans provide coverage for the shingles vaccine; however, coverage can vary depending on your chosen plan and the pharmacy or physician that administers the vaccine. Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans are offered by private insurance companies contracted with Medicare to provide Medicare Part D prescription drug coverage. A stand-alone Medicare Part D Prescription Drug Plan works in conjunction with your Original Medicare Part A (hospital insurance) and/or Part B (medical insurance) coverage. Medicare Advantage Prescription Drug plans, on the other hand, combine health and prescription drug coverage, providing at least the same level of health coverage as available in Part A and Part B (except hospice care, which continues to be covered by Part A). If you are not currently enrolled in a Medicare plan offering prescription drug coverage you may do so at various times, including the Initial Enrollment Period, when you first become eligible for Medicare, the Annual Election Period, occurring October 15 – December 7 each year when you may sign up for a Medicare Advantage plan or a Medicare Part D Prescription Drug Plan, change plans, or return to Original Medicare, the General Enrollment Period, which occurs between January 1 and March 31, if you did not enroll in Medicare during the Initial Enrollment Period, and in some cases during a Special Enrollment Period.
Source: planprescriber.com

Medicare.gov: the official U.S. government site for Medicare

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Source: medicare.gov

Medicare Information, Help, and Plan Enrollment

Humana is a Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. [Benefits, premiums and/or member cost-share] may change on January 1 of each year. The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.
Source: medicare.com

Get a Free Medicare Advantage Kit

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If you are turning 65 soon and/or are eligible for a Special Needs plan (including Medicaid eligibility), you may qualify for a WellCare Medicare Advantage Plan today! Now you can manage your health and enjoy life, just like Gloria.
Source: wellcarenow.com