Medicare Solutions BlogCrackdown on Medicare Fraud
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NPR did an interesting story looking at Medicare frauds growing numbers, and how the government is working to crack down on those abusing the system.
Medicare fraud is among the most common types of health care fraud. The Obama administration has requested a funding increase in an effort to cut down the Medicare fraud. These efforts have been successful in the Miami area, which has the highest rates of both Medicare fraud and prosecutions.
Recently, the fraud teams have been set up in cities like Detroit and Brooklyn, area’s where Medicare fraud was starting to turn up more. Many of those cases were developed by the same Miami criminals who were looking to move to an area where there was less crackdown and scrutiny.
The schemes are constantly changing, however, making catching those involved difficult. One of the first popular scams was based on durable medical equipment like wheelchairs and walkers. Then HIV infusion clinics and home health care were targeted. The enforcement teams are often left simply trying to play catch up with the constantly changing schemes and locations.
It is very important to make sure you are using a legitimate carrier for your health plan and a reliable source for your health care needs. This is why choosing a plan is such an important decision. By going though MedicareSolutions.com you know you can trust your plan, we only represent the best rated carriers. You can be sure that any plan you buy through us is a genuine plan. You can call our representatives at 800-328-7305.
NPR – Miami Serves As Model In Medicare Fraud Crackdown
Cigna PFFS plan to close
Effective February 1, 2010, Cigna is closing their CIGNA Medicare Access PFFS plans to OEP enrollments.
CIGNA will still accept clients enrolling during their individual election period (those aging in to Medicare or newly eligible to Medicare) and those with a Special Enrollment Period. Current clients who have CIGNA Medicare Access PFFS will not see a change in their 2010 benefits. They will continue to have coverage for the entire year. There will be no changes in benefits due to this decision.
Please note this does not effect plans such as CIGNA Medicare Rx, CIGNA Medicare Select Plus Rx, or any of CIGNA’s other medical or pharmacy plans.
CMS and MIPPA rules
After going through another Medicare Annual Enrollment season, it is hard to believe just how many rules are listed an enforced by CMS. You can read the rules on CMS’s website, but below is a taste for some of these rules:
The following are considered “unsolicited contacts and in violation of MIPPA:”
- Generally, use of old lists or consents to satisfy the new MIPPA rules regarding unsolicited contacts
- Referrals of beneficiaries and/or their contact information resulting in an unsolicited contact are prohibited by the new guidance.
- Members who are voluntarily disenrolling from a plan should not be contacted for sales purposes or be asked to consent in any formant to further sales contacts
Provider Marketing
It is “inappropriate for providers to be involved in any of the following actions”:
- offering sales/appointment forms,
- mailing marketing materials on behalf of plans,
- making phone calls or steering beneficiaries, in any way, to a limited number of plans
Avoiding Medicare Insolvency in 2016
The recent Senate bill entitled “The Patient Protection and Affordable Care Act” is intended to bring insurance to many uninsured Americans and to help the Medicare program avoid insolvency, which is projected to happen in 6 years. Unfortunately, the bill will probably have just the opposite effect.
In addition to making draconian cuts to the Medicare Advantage program, the bill largely increases the number and cost of beneficiaries in Medicare. For example, both the House and Senate bills reduce the coverage gap, or “doughnut hole” in Part D coverage by $500 beginning in 2010. Other additions include increased benefits for dual Medicare-Medicaid eligible and eliminating cost-sharing for preventative services (beneficiaries will not have to pay for any of the cost). Such great cost reduction is certainly an enormous benefit for any senior, but puts a new strain on the need for more Medicare funds.
Additionally, the Senate bill plans to tax companies receiving prescription drug subsidies. Since 2003, companies that continued to provide their own prescription drug benefits qualified for a 28% tax-free subsidy (about $600 per year per retiree). The advantage for companies was the ability to list the subsidy as a reduction to their retiree health liability. The Senate bill will tax the subsidy, thus increasing companies’ tax liabilities and companies will be required to register the change as a loss in earnings.
The response expected from these companies will be to no long provide prescription drug benefits on their own. Thus, the cost falls back on Medicare who will see a dramatic increase in Part D beneficiaries. Increasing the number of Medicare eligibles will only add fuel to the fire: these change merely bring the day of reckoning for Medicare closer than 2016.
Senator Baucus and CMS slam Humana
In light of the recent letters sent out to their Medicare Advantage beneficiaries, insurance company Humana now faces the possibility of heavy fines and may even be kicked out of the Medicare Advantage market by federal healthcare agency, CMS. This seems like a pretty harsh penalty for a one page letter informing seniors that “health reform proposals being considered in Washington, D.C., this summer include billions in Medicare Advantage funding cuts” and that “millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable.” So why is CMS so up in arms?
At the urging of Senate Finance chairman Max Baucus who describes Humana’s letters as “mislead[ing] seniors regarding the subject,” CMS ordered Humana to stop sending out such letters. Both Baucus and CMS have put a warning to Humana and any other insurer that might get mixed up in health care reform politics, Baucus stating “it is wholly unacceptable for insurance companies to mislead seniors,” but, as the Wall Street Journal points out, “Humana merely made the mistake of trying to tell seniors the truth about what will happen to their coverage.”
CMS does not currently have a model for how insurance companies should respond to health care politics but, clearly, attempting to inform your current customers is not allowed. It should be noted that Humana has been extremely supportive of health care reform, save these changes to Medicare Advantage, despite all the fingers pointed at the insurance companies and their growing reputation as the “bad guys.” Finally, Humana attempts to defend itself through these letters, pointing out that if benefits were to be cut, it is not a consequence of Humana’s actions, but of the government. But Humana gets slammed.
Rather than arguing over words, Senator Baucus should set reimbursement levels for Humana and other managed care providers, so that they perform the way they were intended to! Save the government and taxpayers money, while offering high quality health plans. Humana should stop the clumsy PR campaign and defend their program with how they help taxpayers and beneficiaries—not simply scaring their members—be their claims true or not.
A cup of coffee a day keeps the Alzheimer’s away
Alzheimer’s is one of the most feared human diseases. It robs your memory and then your life. As many as 2.3 to 4.5 million Americans have Alzheimer’s, according to the National Institute on Aging (NIA). These numbers are likely to increase as more baby boomers find themselves entering old age and becoming more prone to getting Alzheimer’s. To date there haven’t been many promising strategies to reduce or reverse Alzheimer’s, despite a healthy lifestyle and mental stimulation, which are supposed to delay and decrease the chances of getting the disease. However, research has recently shown that caffeine may be able to fight and even reverse the effects of Alzheimer’s, so perhaps coffee is good for you after all.
A team of University of South Florida researchers experimented with 55 lab mice which were bred to develop Alzheimer’s symptoms by giving aged mice caffeine equivalent to five cups of coffee a day and discovered that the mice’s memory impairment was reversed. In medical terms, this happened because the caffeine substantially decreased the abnormal levels of beta amyloid, a protein that is linked to Alzheimer’s, in both the blood and brain of the mice.
These findings suggest that caffeine may be an effective form of not only prevention, but also treatment for Alzheimer’s disease. So maybe all it takes to prevent, or even reverse Alzheimer’s is your daily dose of coffee.
American Spending on Alternative Medicine
The National Institutes of Health (NIH) recently announced that Americans spent $33.9 billion on complementary and alternative medicines in 2007. These results come from a study which surveyed more than 70,000 across America and inquired into 36 forms of alternative medicine. These findings suggest that Americans spend more than 10% of their out-of-pocket health care dollars on alternative medicines and services which include chiropractors, acupuncturists, massage therapists and herbal remedies.
The usefulness and effectiveness of these alternative medicines isn’t always evident. Some of them are promising, but others could be more harmful than helpful to your health. About half of the people who used alternative medicine do so because they cannot afford conventional care. This includes a significant amount of senior citizens who chose to turn to alternative medicine once they hit the Medicare gap and can no longer afford conventional alternatives. One report found that over one-third of adults use some form of alternative medicine.
The main reason behind why people tried alternative therapies like chiropractic care and massages was for pain. The most popular supplements used were glucosamine (which is supposed to reduce joint pain) and fish oil (which is supposed to reduce the risk of heart disease).
Although not all alternative medicine is covered by health insurance, it was found that about 43 percent of alternative medicine in 2007 was paid for by private insurance and about 31 percent was paid for by public insurance. The remainder was paid by the patients.
Workers delaying retirement
Many workers aged 65 and older are delaying retirement due to the economic state of our country, approximately 430,000 to be exact. This is a 45% increase from last year according to the Bureau of Labor statistics. Severe market losses are among one of the main reasons why seniors are continuing to work well into their 60s. Many seniors’ retirement accounts have suffered a huge hit over the past year.
And if seniors aren’t already working, some who had retired early are finding themselves forced back to work. Due to high unemployment rates, it is an extremely challenging time to find a job or get back into the work force. Unemployment rates for seniors looking for work jumped from 6.1% in May to 6.8% in June.
“A lot of people who thought their funds would carry them into their golden years are being forced to work,” said Ford Myers, President of Career Potential, LLC, a career consulting firm based in Pennsylvania.
Nearly 10% of the country’s population is unemployed. Issues like age discrimination resume gaps, and out of date skills can keep seniors from finding jobs or keeping their jobs. Cynthia Shapiro, a career coach, suggests going back to school and obtaining a higher degree such as a master’s degree. Another option is to show that your years of experience can make you a good mentor or put you into a position of higher responsibility.
Increased Risk of Skin Cancer for Men over 50
Recent studies have found that men are almost twice more likely to develop skin cancer than women. Skin cancer is actually more prominent than prostate, lung and colon cancer in men over fifty years old. In fact, the majority of people diagnosed with skin cancer are white males over the age of 50.
The American Society for Dermatological Surgery (ASDS) claims that men are more prone to developing skin cancer because they are less likely to take protective measures like wearing sunscreen and protective clothing and they are more likely to work outdoors. Additionally, many men wait too long before they visit a doctor to have their moles checked out. This decreases the chances of early detection of melanoma, which has a percent survival rate if detected early enough.
In order to avoid getting skin cancer, older and younger men alike must take better precautionary measures against the harmful rays of the sun. Wearing protective clothing, sunscreen with a high SPF and visiting a dermatologist yearly to check moles will help prevent and detect any signs of melanoma.
Proposal Suggests Formation of A New Agency To Set Medicare Pay Rates
The White House has recently been circulating draft legislation that would create an executive agency for the purpose of overseeing Medicare reimbursement rates and policy changes. Under the proposal, there would be a paid five-member Independent Medicare Advisory Council whose members would serve five-year terms. They would be nominated by the president and subject to approval by the Senate. In all likelihood, the members of the council would be doctors, or other people who are highly skilled in health policy.
The members of the council would be given the authority to make broad recommendations about Medicare, but they would focus on setting appropriate payment rates for Medicare Part A and Part B. The council would give two annual recommendation reports: the one due by October 1st of each year would deal with Medicare Part A and the one due by December 31st of each year would address Part B. These recommendations would be sent to the White House for the president’s approval before being brought before Congress. This legislation, if enacted will go into effect after Obama’s first term as president on September 15, 2014.
Other proposals are also being given consideration with respect to Medicare. In particular, the Obama administration wants to give the Medicare Payment Advisory Commission (MedPAC) the authority to determine cuts and makes other changes to Medicare.