Medicare Whistleblower Center

Posted by:  :  Category: Medicare

Help save American taxpayers money by reporting Medicare fraud. The False Claims Act is one of the most critical and effective tools used by the government to identify fraud and return billions of dollars to government-funded programs. Since January 2009, the government has recovered almost $20 billion through the False Claims Act for healthcare fraud and has paid hundreds of millions of dollars in rewards to whistleblowers. If you are aware of Medicare fraud, contact us for a free case evaluation. You may be entitled to 15-30% of the amount the government recovers.
Source: medicarewhistleblowercenter.com

Whistleblower suit alleges UnitedHealth defrauded Medicare

Ingenix, which is now called OptumInsight, is UnitedHealth’s business for health care data analytics. Through the subsidiary, UnitedHealth “engaged in systematic fraud by assisting and causing [Medicare Advantage] organizations … to submit fraudulent risk adjustment claims,” the lawsuit states. “Through this fraudulent scheme, defendants have defrauded the United States of hundreds of millions — and likely billions — of dollars.”
Source: startribune.com

How to report Medicare fraud or Medicaid fraud and receive a whistleblower reward

The False Claims Act pays whistleblowers a reward of between 15 and 25 percent of what the government collects based on your report of Medicare fraud (or Medicaid fraud). To receive a whistleblower reward, you must actually hire an attorney (which is on a contingency basis) to file a lawsuit against the hospital or healthcare provider that is committing Medicare fraud or Medicaid fraud. To convince the government to take a Medicare fraud case requires detailed and specific evidence that the healthcare provider was committing fraud against Medicare or Medicaid. It is not enough to report fraud to a hotline or have a general knowledge of Medicare or Medicaid fraud. Usually, rewards are paid to whistleblowers who worked for the hospital or healthcare provider who committed the fraud because they have knowledge of the fraud scheme, and receive a reward even if they were asked to participate in defrauding Medicare or Medicaid. The government pays huge monetary rewards when the whistleblower has inside information that proves the Medicare or Medicaid fraud. Example of reporting Medicare fraud and receiving a whistleblower reward Suppose a hospital wants to defraud Medicare and Medicaid. One common ways to defraud Medicare or Medicaid is upcoding, which means bill at a higher code than allowed, such as billing for treating pneumonia when the person had a cold. Another common way to defraud Medicare or Medicaid is to bill for services that are not necessary or provided, such s way order unnecessary tests or to bill for tests not actually done. Hospitals cheat insurance companies in similar ways, but the reward program only pays rewards for reporting fraud against Medicare of Medicaid or other government programs. Therefore, if a hospital is upcoding for most of its patients, the reward program would only look at the fraud against Medicare or Medicaid or other government programs. Because Medicare and Medicaid often are a large part of a hospital’s practice, the amount of fraud gets high pretty fast.
Source: howtoreportfraud.com

Report Medicare Fraud and Medicaid Fraud and get a whistleblower reward

The largest area of fraud against the government today is against Medicare fraud and Medicaid fraud. Approximately 10% of all Medicare/Medicaid bills are inflated or fraudulent. That helps explain why the Department of Justice pays such large whistleblower rewards for reporting Medicare fraud.
Source: howtoreportfraud.com

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by “Hundreds of Millions”

The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit, United States of America ex rel Benjamin Poehling v. Unitedhealth Group Inc., No. 16-08697 (Cent. Dist. Cal. Sep. 17, 2010), ECF No. 79, against UnitedHealth Group (United) and its subsidiary, UnitedHealthcare Medicare & Retirement—the nation’s largest provider of Medicare Advantage (MA) plans. The suit accuses United of operating an “up-coding” scheme to receive higher payments under MA’s risk adjustment program called the HCC-RAF Program (see below). The complaint alleges that United fraudulently collected “hundreds of millions—and likely billions—of dollars” by claiming patients were sicker than they really were. The suit was originally filed in 2011 by a former United finance director under the False Claims Act (FCA), which allows private citizens to sue those that commit fraud against government programs. Pursuant to the FCA, the case was sealed for five years while the DOJ investigated the claims.
Source: sheppardhealthlaw.com

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by “Hundreds of Millions”

The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit, United States of America ex rel Benjamin Poehling v. Unitedhealth Group Inc., No. 16-08697 (Cent. Dist. Cal. Sep. 17, 2010), ECF No. 79, against UnitedHealth Group (United) and its subsidiary, UnitedHealthcare Medicare & Retirement—the nation’s largest provider of Medicare Advantage (MA) plans. The suit accuses United of operating an “up-coding” scheme to receive higher payments under MA’s risk adjustment program called the HCC-RAF Program (see below). The complaint alleges that United fraudulently collected “hundreds of millions—and likely billions—of dollars” by claiming patients were sicker than they really were. The suit was originally filed in 2011 by a former United finance director under the False Claims Act (FCA), which allows private citizens to sue those that commit fraud against government programs. Pursuant to the FCA, the case was sealed for five years while the DOJ investigated the claims.
Source: natlawreview.com

CarePlus Health Plans (Florida Medicare) Doctors: Book Online By Insurance, Reviews & ZIP

Posted by:  :  Category: Medicare

“Dr. Chakote is exactly what the reviews say he is. He doesn’t care at all about the patient. All he asked is what i was there for…. listened to my heart beat then sent me on my way. I had to do a follow up and booked an appt at his other location and when I showed up he wasn’t even the doctor in office. He gave no advanced notice that he would be having me see someone else. His nurse practitioner is amazing though. Her name was Norma and she was very professional and knowledgeable.”
Source: zocdoc.com

First Choice VIP Care Plus (Medicare

First Choice VIP Care Plus, a Healthy Connections Prime (Medicare-Medicaid Plan), is designed for South Carolinians who are on both Medicare and Healthy Connections Medicaid. Here, you will get all the services you need, plus extra benefits. There are no monthly payments, and no costs for doctor visits or hospital care. Get more and get better.
Source: firstchoicevipcareplus.com

Medicare Open Enrollment Questions and Answers

Posted by:  :  Category: Medicare

A good question. First, if you end up needing a medication such as an antibiotic and you didn’t have coverage, you would pay 100 percent of the cost. Second, and more important, every month that you don’t have creditable prescription drug coverage, you face a late enrollment penalty when you eventually do  get a plan. In 2017, that penalty will be $0.35 for every month you didn’t have drug coverage. Go two years without drug coverage and you’ll pay an extra $4.20 every month. That doesn’t sound like much, but the penalty amount increases every year and it will follow you for life.
Source: nextavenue.org

Medical Billing and Coding

Posted by:  :  Category: Medicare

P.O. Box 1051 Augusta, GA 30903-1051 Usually Medicare does not accept primary paper claim so please find out the payor id and submit the claims electronically. Here is the updated list of Medicare all state phone number and payor id, Its usually change to different clearing house hence double confirm before doing any setup.
Source: whatismedicalinsurancebilling.org

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

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Claim Status Request and Response

The electronic 276/277 process is recommended since many providers are able to automatically generate and submit 276 queries as needed, eliminating the need for manual entry of individual queries or calls to a contractor to obtain this information. Submission of 276 queries and issuance of 276 responses should be less expensive for both providers and for Medicare. In addition, the 277 response is designed to enable automatic posting of the status information to patient accounts, again eliminating the need for manual data entry by provider staff members. If unsure whether your software is able to automatically generate 276 queries or to automatically post 277 responses, you should contact your software vendor or billing service.
Source: cms.gov

Coventry Medicare: Advantra (HMO/PPO)

Posted by:  :  Category: Medicare

Whether you are an employer, health care provider, someone interested in enrolling, or already a current member, our goal is to provide you with valuable and convenient online resources and information. Come explore the ways in which we can help you take charge of your Medicare Advantage coverage.
Source: coventryhealthcare.com

Welcome to medicareappeals.com

ATTENTION MEDICARE HEALTH PLANS: Updated Medicare Advantage Process Manual, PACE Process Manual, Appendix, Reconsideration Background Data Form, and Dismissal Case File Data Form are now available under the ‘Health Plans’ section.
Source: medicareappeals.com

Federal Withholding Tax Table

Update your payroll tax rates with these useful tables from IRS Publication 15, (Circular E), Employer’s Tax Guide. The charts include federal withholding (income tax), FICA tax, Medicare tax and FUTA taxes.
Source: suburbancomputer.com

Learn About Medicare Starting With The Basics

Posted by:  :  Category: Medicare

From parts and plans and cost-sharing, to formularies, tiers and coverage gaps, we break Medicare down into bite-size chunks that you can understand. And with that knowledge under your belt, you’ll be prepared to explore topics like Enrolling in Medicare and Choosing a Plan.
Source: medicaremadeclear.com

Medicare News and Updates

A Medicare Medical Savings Account plan (MSA) is a special type of Medicare Advantage plan (Part C). This type of plan may offer the freedom of choice for people who want more control over their health care dollars and decisions. And along with the freedom come some responsibilities.
Source: medicaremadeclear.com

Medicare Plans for Different Needs

Posted by:  :  Category: Medicare

When it comes to Medicare, one size definitely does not fit all. What works for your neighbor may not be the best bet for you. Which is why it’s great to have choices. To find plans that may be a good fit for you, enter your ZIP code in the field below and click the "Find plans" button.
Source: uhcmedicaresolutions.com

Health Insurance Plans for Individuals & Families, Employers, Medicare

UnitedHealthcare offers health insurance plans to meet the needs of individuals and employers. Plus we offer dental, vision and many other insurance plans to help keep you and your family healthy. 
Source: uhc.com

Medicare Supplement Plans & Medigap Plans

Posted by:  :  Category: Medicare

A Medicare Supplement plan (also called a Medigap policy) is private health insurance designed to supplement Original Medicare coverage. Medicare Supplement insurance helps pay some of the health care costs (or “gaps”) that are not covered by Original Medicare, such as copays, coinsurance, and deductibles. All Medicare Supplement plans must follow federal and state laws. The standardized policies that can be offered by Medicare Supplement insurance companies are identified by the letters A through N. Medicare Supplement plans do not replace Original Medicare; they only work to supplement Original Medicare benefits. Medicare supplement plans typically do not cover long-term care, vision, dental, hearing aids, eyeglasses, or private nursing.
Source: healthnet.com

Which Medicare Supplement Plans are the Best?

Introduced in 1965, Medicare was designed to provide affordable and reliable health care services to senior citizens and people with disabilities. Individuals who were eligible for Medicare faced significant financial struggles in paying for health insurance through the private sector. Medicare Part A does not include a monthly premium, which does provide some relief for seniors and people with disabilities. However, Part A has limited coverage for hospital expenses and skilled nursing facility care.
Source: medigapplansguide.com

AARP® Medicare Supplemental Insurance by United Healthcare

Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. If you’re considering a Medicare supplement plan, talking to an agent/producer may offer the direct assistance you’re looking for.
Source: aarpmedicaresupplement.com

Compare Medicare Supplement Plans

People come to us confused about which insurance company they should pick for their Medicare supplement. Perhaps you may be confused too. We have helped many seniors compare Medicare supplement plans to choose the right company for their needs… …but there is something you must consider before you compare Medicare supplement plans. You need to thoroughly […] Read More
Source: clearmedicaresolutions.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 Supplemental Insurance Policies at Mutual of Omaha

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as Medicare supplement insurance. Medigap insurance companies can only sell you a standardized Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies sold by different insurance companies
Source: mutualofomaha.com

Get Medicare Supplemental Insurance Plan Quotes

As long as you enroll during this six-month Medigap Open Enrollment Period, the insurance company cannot refuse to sell you a Medigap policy, charge you more because you have health problems, or make you wait for coverage to begin. However, you may have to wait up to six months for coverage of a pre-existing condition. Original Medicare will still cover that health problem even if your Medicare Supplement plan doesn’t cover your out-of-pocket costs.
Source: ehealthmedicare.com

TRICARE Help Military People Find News and Information

Posted by:  :  Category: Medicare

Although this is more flexible than the aforementioned plan, it also comes at a slightly higher cost. Veterans usually do not need to register for this plan in advance if they are otherwise eligible to utilize the TRICARE system; enrollment takes place automatically when a veteran first goes to receive health care upon presenting the military/dependent ID as insurance. This is also flexible in terms of the fact that veterans may avail health care from any clinic or hospital that is a TRICARE network provider; all they need to do first is show their ID cards. It is more costly because a deductible is paid on an annual basis. Furthermore, any medical expenses are also split in an 80-20 method, whereby TRICARE is accountable for eighty percent of the total expenses, but the veteran would be required to cover the remaining twenty percent. As with TRICARE Prime, veterans do not need to concern themselves with the paperwork for reimbursements as the provider covers this as well.
Source: tricare.com

Defense Enrollment Eligibility Reporting System

(DEERS) A database of information on uniformed services members (sponsors), U.S.-sponsored foreign military, DoD and uniformed services civilians, other personnel as directed by the DoD, and their family members. You need to register in DEERS to get TRICARE.
Source: tricare.mil

Dental Insurance for Seniors on Medicare

Posted by:  :  Category: Medicare

Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment. Note-not all plans and offers available in all markets. Special promotions including, but not limited to, additional months free are not available to California residents.
Source: medicarewire.com

Dental Insurance, Individual Vision Plan, Senior, Medicare Supplement

MWG Insurance Mall is the premier health insurance site online. Here, you’ll find great support in your search for Medicare supplemental insurance, dental insurance, and many other types of coverage. We strive to make our site as accessible as possible. Find a solution for your health insurance needs by relying on us to find the perfect senior life insurance plan, vision plan, or dental coverage. If you require further guidance, reach out to us.
Source: mwginsurancemall.com

Health Insurance, Medicare Insurance and Dental Insurance

At Humana, we go beyond insurance. We help provide a roadmap to a healthier you. By taking a personalized look at your life and your health, we can help you find the perfect plan and achieve your goals. Start becoming your best you. Start with healthy.
Source: humana.com