Posts Tagged ‘medicare’

Feds Announce Largest Healthcare Fraud Takedown Ever

July 19th, 2010 by Iris | Comments Off | Filed in health insurance, insurance fraud, insurance news, medicare

Anyone who is, or has a parent who is, covered by medicare knows that healthcare fraud is a tangible risk. Some good news, then, on this Monday, is that Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced last Friday at a healthcare fraud summit in Miami, that the feds are in the process of the largest fraud takedown ever, with 94 defendants charged in five different cities (Baton Rouge, LA, Detroit, MI, Houston, TX, Miami FL, and New York, NY)

Also in conjunction with the Miami summit, which gathered together insurance providers, consumer advocates, and patients as well as federal, state, and local authorities, came the announcement from HHS that the state of Florida has been granted a Medicaid waiver which will help fund a program allowing the state’s Medicaid Fraid Control Unit to scan insurance claims for patterns that are red flags for insurance scams. Currently, Federal law prohibits federal matching funds from being used in such fraud control efforts.

As of Friday morning, 36 alleged participants had been arrested in connections with schemes involving over $250 million in fraudulent claims, according to the Justice Department. The suspects include insurance company owners, medical assistants, and doctors, and the allegations against them fit the profile of the kind of healthcare fraud typical of South Florida over the last several years – fraud that is now spreading across the country, with scammers filing false claims for HIV infusion services, home healthcare, durable medical equipment, and physical therapy, and beneficiaries getting monetary kickbacks for their Medicare numbers.

There are plans for additional, similar healthcare fraud summits to be held in Boston, Detroit, Las Vegas, Los Angeles, New York, and Philadelphia.

Source: Modern Healthcare

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Senate Approves COBRA Extension Bill

March 12th, 2010 by Iris | Comments Off | Filed in cobra insurance, health insurance

Modern Healthcare reported on Wednesday that the United States Senate voted 62-36 to approve a $138 billion bill that temporarily halts cuts in Medicare payments to doctors, and also extends COBRA premium subsidies and Medicaid assistance.

Senate Majority Leader Harry Reid (D – NV) said in a statement to the press, “This week’s bill helps those who have been hit the hardest. Among other things, we’re going to extend unemployment benefits to those looking for work, cut taxes for families and businesses, and protect Medicaid so low-income families can afford healthcare.”

Specifically this new bill will postpone a 21% cut in Medicare physician payments until October 1, 2010, though physician groups are still hoping that Congress will offer a more permanent solution to Medicare’s sustainable growth-rate (SGR) formula, which is based on the health of the economy at any given moment. Payment cuts to doctors have been looming since 2003. This SGR measure is likely to cost almost $7.5 billion between now and 2020.

In addition, the bill contains a six-month extension of additional federal financial aid to the state Medicaid programs, and extends COBRA and unemployment insurance benefits through the end of this year.

The bill is not unopposed. Naysayers argue that it isn’t fully offset, and will add more than $100 billion to the federal deficit over the next ten years. Senator George LeMieux (R – FL) said during floor debate that while some of the programs in question may be good for the states in the immediate future, “…at some point a senator has to stand up and say … no more bankrupting the country.”

With Senate approval, the bill has now been sent back to the House of Representatives, which already passed an earlier version of it. As of close of business on Wednesday, it was still uncertain whether there would be a conference between the Senate and House, or if the House would simply vote on the bill as altered by the Senate, before passing it along to the President.

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Planning for Retirement? Pay Attention to Health Care

February 2nd, 2010 by admin | Comments Off | Filed in advice and how-tos, health insurance, medicare

If you’re planning for retirement pay close attention to your health care options. Why? Because according to financial journal MarketWatch, this is likely to be one of the biggest costs you’ll have to absorb once you leave the workplace, even with the federal Medicare program providing your basic coverage.

Why is health care so expensive for seniors? There are several reasons, including:

  • You must often pay substantial out-of-pocket fees and costs
  • Medicare doesn’t cover long-term care, beyond a brief transition period
  • There are multiple parts to the Medicare plan that cover different aspects of care (hospital stays, regular doctor visits, prescription drugs)
  • Even above the three main parts to Medicare, you’ll have to make many, many choices about which benefits to choose and when they should begin, which is especially difficult if you have continuing health coverage from your union or employment when you enter retirement.

So what should you do to help keep your financial future easy to navigate? Charles Ellis, co-author of The Elements of Investing advises that simplicity is the key.

While keeping it simple may be wise, the advice is a bit vague. Here’s some that isn’t: you should know that you have the option of choosing to buy Medigap or a Medicare Advantage plan – both are supplemental policies that extend your health coverage. As well, you can choose to purchase private long-term-care insurance, in case you ever need ongoing nursing home care, or home health care, later on in life.

But how do you know what’s essential to saving money on health care in retirement, and how do you know what you can live without, and what must be purchased immediately? For that matter, how do you even know when the window for Medicare eligibility even begins?

One invaluable source is the Medicare Rights Center, they’re a non-profit consumer advocacy group with a mission to help senior citizens and those nearing retirement age in understanding how Medicare works, how to apply, and what changes may be occurring as health care reform moves closer to actuality.

Health care may be one of the biggest expenses of retirement, but it doesn’t have to be the most confusing. Get informed now, so you can be confident in your coverage later.

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Health Plan Tax Resolved?

February 1st, 2010 by admin | 1 Comment | Filed in health insurance, insurance news

Consumers worried about the rumor of taxes on high-value health insurance plans, the so-called “Cadillac” plans, can rest easy. Why? Because the White House and union leaders reached an accord two weeks ago which changed the cost threshold and added an eight-year exemption for collectively bargained plans.

According to a report in Modern Healthcare, the deal, which was cemented in mid-January, removed one of the major issues causing friction between the House and Senate.

The final bargain raises cost levels to $8,900 from $8,500 for individuals and to $24,000 from $23,000 for families. Union plans would have an exemption from the tax until 2018. Additionally, dental and vision benefits would be excluded from being part of the total cost beginning in 2005, and the threshold would be adjusted to account for age and gender.

“It’s subject to the final bill,” said Richard Trumka, president of the AFL-CIO, who added that the concessions were tough-won. He also felt that they would move the unions toward an official endorsement of a merged health reform bill.

The move does come at a price, however. The original Senate proposal would have raised almost $150 billion over ten years. With the negotiated changes, the measure will only raise $90 billion, making it necessary for lawmakers to find other sources of revenue to make up for that loss. One idea is an extension of the Medicare tax to include capital gains earnings.

House Democrats have always maintained that they were wary of the Senate’s measure, saying that middle-class workers would be affected, but wealthier ones would not.

Rep. Joe Courtney (D-Conn.) has always been very critical of the tax, and has not yet endorsed the deal, telling reporters only, “It’s too soon to say.”

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