Medicare Fraud Continues to Skyrocket but Obama Administration Arresting Them All -- Anti-Fraud Law Coming to the Rescue!

I am always amazed by the amount of Medicare Fraud that continues to happen every year. Every time the Feds have a large bust, they say it is the largest fraud ever. In 2010, we have had four of the "Largest Medicare Fraud ever!" headlines.


March 2010 - "The largest Medicare fraud ever in the nursing home industry"
Medicare fraud by California-based nursing home company North American Health Care (NAHC), which operates 35 nursing homes in four states. NAHC may be falsifying patient records and overcharging Medicare by tens of millions of dollars each year. Indeed, a number of former NAHC employees have testified to repeated orders to alter and falsify patient records. NAHC appears to be an industry leader in "upcoding" services provided to Medicare patients and charging Medicare the highest possible rates for resident care.


July 2010 - "Brooklyn Arrests Are Part of "Largest Medicare Fraud Bust Ever"
The FBI has arrested three doctors and doctors "professional patients" in Brooklyn for allegedly submitting thousands of bogus medical claims to Medicare and Medicaid. Prosecutors said the doctors and their clinics stole more than $80 million from taxpayers. The local arrests are part of the largest Medicare fraud bust ever. Dozens of suspects accused in scams totaling $251 million were busted in five states, authorities said. In one Brooklyn office, the doctors had set up a "cash kickback room" to pay patients for allowing them to submit false bills to the government health programs. The so-called "kickback" room had a poster on the wall resembling Soviet-era propaganda, showing a woman with a finger to her lips and two messages in Russian: "Don't Gossip" and "Be on the lookout: In these days, the walls talk."


October 13, 2010 - "44 Charged in Huge Medicare Fraud Scheme" An Armenian-American crime syndicate stole the identities of doctors and thousands of patients and used them and more than a hundred spurious clinics in 25 states to bill Medicare for more than $100 million for treatments no doctor ever performed and no patient ever received, the federal authorities announced on Wednesday.


October 21, 2010 - 4 arrested in alleged $200 million Medicare fraud case 
Federal agents arrested four Miami-Dade health care operators Thursday in one of the nation's biggest Medicare fraud cases, charging them with scheming to fleece $200 million from the taxpayer-funded program by billing for bogus mental health services. Lawrence S. Duran, 48, of North Miami, and his company, American Therapeutic Corp., were charged along with other employees in a conspiracy indictment. The Miami-based company's chief executive officer, Marianella Valera, 39, was also among the defendants named in the indictment.
=================================================
This fraud has been going on for years. The good news is, the Obama Administration is catching up to them and filing charges against them. Additionally, for decades, Medicare and its contractors have relied upon a largely antiquated policy of reimbursing health care claims quickly without verifying them. The brisk payments, typically made within 14 days, keep the healthcare system going but also fuel corruption.


In September, President Barack Obama signed an anti-fraud law that will require the behemoth Medicare bureaucracy to act more like a credit card company in flagging suspicious claims that could save taxpayers billions of dollars a year in wasteful government healthcare spending. The anti-fraud provision, tucked into the Small Business Lending Act, will force Medicare and its claims contractors to adopt new billing software with "predictive modeling" for the 10 worst states by next year.


No wonder many in the Healthcare Industry, including Doctors, want to make sure President Obama does not win re-election in 2012.

Why are people afraid of Obamacare and not afraid of those wanting to eliminate social security and medicare?

I spoke with someone today about "Obamacare." Why is it so many people believe Universal Healthcare will negatively impact medicare? Why do they demonize the new bill without even knowing its content? Universal Healthcare protects seniors and will allow Medicare to continue. Each year, starting in 2011, we will see a continued reduction of the donut hole until it finally closes in 2020.

There are many politicians in the Republican party that wish to eliminate social security and privatize social security. Why aren't people afraid of their agenda?

The Government PAYS the Healthcare Providers to Manage the Plans!

Being new to what my friend Dee calls "The Blogosphere," I feel like such a novice. However, getting past that, there is so much I want to share with readers of my blog. There is so much happening in the Health Care industry that is impacting all of us, especially those of us who are getting older, approaching the age of 65.

At 65, we in the U.S. are eligible for Medicare. Back in 1965, when Congress passed the Social Security Act, they passed Part A for Hospital coverage and Part B for Doctors/Medical coverage. Many seniors felt this coverage was not sufficient. Many who could afford it bought supplements to fill the gaps Medicare didn't cover. Then, in 1997, Congress passed the Balanced Budget Act (sponsored by a Republican) which allowed Medicare beneficiaries the option to receive their Medicare benefits through private Health Insurance companies. They sell "Medicare Advantage (MA) Plans." Then in 2003 (sponsored by a Republican), with the "Medicare Prescription Drug, Improvement and Modernization Act," Medicare benificiaries could now purchase prescription drug plans (PDP) and Medicare Advantage with Prescription Drugs (MAPD) through private Health Insurers. These two acts (1997 and 2003 -- bills sponsored by Republicans) opened the door for private health companies (Big Business) to virtually take over Medicare. It is a gold mine for them and for Pharmaceutical companies. How? Healthcare providers make these MAPD plans so attractive to seniors that they are are now addicted to them. These plans weave together Hospitalization, Doctor/Medical benefits and Prescription Drug Plans for a Premium of $0. Yes. Zero Dollars.  These plans are so attractive, they are a signficant improvement vs government offered Medicare. These plans charge less for hospitalization, very low co-pay for doctor visits ($10 - $20), flexibility to go in and out of network, very low co-pay for generic drugs and significantly lower co-pay for Branded and higher Tier drugs. Additionally many plans include membership to fitness clubs, low cost dental, vision and hearing coverage as well as Wellness programs, all for $0 Premiums.
Many people ask, "How can Health Care providers offer these plans at $0 premiums? Where do you make your money?" The answer is, the government. The government pays the Healthcare providers to manage the plans.

Now, to the issue:
1. How can Healthcare providers provide such LOW Cost plans (which include PDP)?
(Because these Big Business Providers receive so much profit!)
2. Who sponsored these bills? (As my friend Dee would say: Republicans! More to come)
3. Democrats in Congress are wise to this and have protested, however the MESSAGE has not filtered down to every day American.
Note: So much more to come! More revelations with each Blog Post!
Note 2: Here is an article about the Dems in Congress addressing this issue in 2007!

Good News About "ObamaCare!"

News reports are always quick to announce the negative aspects of "ObamaCare." There are at least two positive aspects that will help seniors on Medicare.

ObamaCare (OC) Medicare Initiatives:

• Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
• Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs.

Anyone on medicare and who takes a large amount of Prescription Drugs knows that the Donut Hole arrives quickly and is very costly. Starting in 2011, the OC Medicare initiatives will begin to close the hole. Seniors in the gap will not only receive a 50 percent discount on Brand named drugs, but they will only have to pay 93% (vs 100%) of the cost for generic drugs. The even better news is that by 2020, the Hole will be gone!

Understanding Medicare Plans: One Easy Picture

Part A: Hospital Insurance is automatically available to those qualified at no premium. Part A helps cover inpatient hospital and skilled nursing home costs, hospice care and limited home health benefits. There is a large deductible for hospital stays. In 2010, the deductible = $1068 for days 1 - 60 and more for additional days.

Part B: Medical Insurance is a voluntary program that requires a monthly premium. In 2010, this monthly premium was approximately $110. Most Part B recipients have this premium automatically deducted from their monthly social security checks. Part B members pay 20% copay for each doctor visit and medical coverage.

Part D: Prescription Drug Plans offered by private insurance companies that contract with the Federal government to provide these optional plans to medicare recipients for a monthly premium plus copays for each drug's monthly prescription. There is also a large coverage gap once Total Drug Costs reach $2830. This "donut hole" upsets many Medicare members who use large amounts of prescription drugs. They reach the donut hole quickly, especially if they use Brand and Specialty drugs. Then they are stuck paying "out of pocket" until they reach $4850 "out of pocket." Then the price goes down. The good news is, with the new healthcare policy, the donut hole will be closed by 2020.

Part C: Medicare Advantage (MA) Plans are plans offered by private insurance companies that combine hospital and outpatient services into one package for those who are enrolled in both part A and B (MA) and can also include prescription drug coverage (MAPD). Many of these plans have $0 Premiums for both the MA and PD portions of the plan. Many medicare members LOVE MA and MAPD plans because their costs are much lower. $0 Premiums. Lower copays for their doctor visits, hospital stays and prescription drugs. Many people wonder how private Healthcare providers can provide all of these benefits at $0 premiums and lower costs.

Supplemental Plans: Offered by private insurance companies to supplement government offered Part A + B Medicare. They are not compatible with MA plans. They are sold with monthly premiums.

Discovering the Facts about Medicare. What a Revelation! No Wonder Its Going Broke!

Sometimes I wonder how much people really know about the Medicare program. I used to think Medicare was a free health policy for old people. I thought it was a government program administered by the government. Now, however, I realize how wrong I was.

Medicare was originally passed in 1965 under the Social Security Act of 1965. Since the beginning of the Medicare program, the Center for Medicare/Medicaid Services (CMS) has contracted with private companies to operate as intermediaries between the government and medical providers. These contractors are commonly already in the insurance or health care industry (Healthcare Providers). Contracted processes include claims and payment processing, call center services, clinician enrollment, and fraud investigation.

There are two parts to the original Medicare program and they continue today: Part A and Part B. Part A covers Hospital stays with a large deductible. (2010 deductibles = $1068 for days 1 – 60; more for additional days). Part B: covers Doctors Visits and Medical Care. (copays = 20% of Doctor/Medical Care visits/usage).

There were gaps in Medicare Part A + B. Some healthcare providers offered Supplement insurance to cover some of those gaps (termed MediGAP policies). In 1992, CMS standardized these MediGAP policies.

In 1997, with the passage of the Balanced Budget Act of 1997, “Medicare Advantage (MA)” plans were created to allow Medicare participants to purchase their A+B benefits from a private Healthcare Provider. Some people call this “Part C.” But there was still a gap. No coverage for Prescription Drugs.

In 2003, with the passage of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, these Medicare Advantage (MA) plans expanded to include Prescription Drugs.

Then in 2006, Medicare Part D went into effect. Anyone with part A +/or B became eligible to purchase a Prescription Drug Plan (PDP), again through private insurance companies. However, there still is a huge coverage gap (Donut Hole) in Prescription Drug coverage. (more on that later)

When I found out about all the involvement by the private Healthcare industry in Medicare, I was amazed, especially when I found out that in 2010, Medicare provided coverage to 46M people. 83% are people ages 65 and older and 17% are people with permanent disabilities (under 65). Enrollment is expected to reach a peak of 78M by 2030 when the majority of Baby Boomers are fully enrolled. With all of this private Healthcare Industry involvement and with the large rate of Boomers ready to enter the program, no wonder it is scheduled to go broke soon.

My First "Meemaw's Medicare Journal" Blog! Young Kids, DO NOT CHANGE Social Security OR Medicare Unless YOU Pay Me Back EVERY DIME I Paid In!!

This is my first post. I am a baby boomer. I am 60 years old.
There is so much to learn about Medicare. I am starting my blog so you can join me on my venture into retirement, social security and Medicare.

The 1st thing to understand is: Social Security is NOT Medicare. Medicare is Healthcare. Social Security is not.

Social Security is a benefit which I earned based upon my years of work and paying into the system. Social Security is a mandated retirement system in the US that was established in 1935 as a part of President Roosevelt's New Deal. Regardless of what Republicans say, it is not an Entitlement.

I am eligible for Social Security at 62. Of course I will not receive my FULL social security benefits at 62. I will receive about 75% of it. For those born between 1943 and 1954, for example, you can start collecting benefits at age 62, but you’ll only get 75 percent of what you’d get if you waited until 66. If you wait until 67, you get 108 percent of your monthly benefit. And at age 70, you collect 132 percent — the maximum you can get by delaying benefits.

But your total lifetime payout depends on how long you live. The average life expectancy in the U.S. in 2003 was 74.8 years for men and 80.1 for women, or 77.5 for both sexes, according to the Centers for Disease Control and Prevention. If you make it to 65, your life expectancy rises to an average of 83.4 for both sexes.
Let me share my numbers with you. I have earned enough credits to qualify for benefits.
At age 62, my SS checks will be about $1,800.
At 66, my SS checks will be: $2,400.
At 72, my SS checks will be: $3,200.

If I become disabled right now, my SS checks will be: $2,400.

If I die tomorrow, I've earned enough benefits for my spouse to receive $1800 a month.

My one time Death Benefit will be $255. Seems paltry, but then again, this plan was developed in Roosevelt's era and has not been updated since. Back then, that is what the funeral and casket/burial cost. Times have changed. (But no one told the Republicans. Go figure!)

My little Social Security flier (which I receive at least once a year with my latest updates) told me: You have earned enough credits to qualify for Medicare at age 65.

Ahhh Medicare. The Republicans keep telling us this is an entitlement. However, it is important to note that in order to be eligible for Medicare, you must have worked for 40 quarters. (Let me do my math, count my fingers and my toes...Wow! That's 10 years to qualify and I've worked 40.)

For those young kids that say you are working to pay for my Social Security or Medicare I say: I BEG TO DIFFER! I worked 40 LONG YEARS of my Life! I have PAID INTO THE SYSTEM FOR 40 LONG, HARD WORKING YEARS! ANYTHING I COLLECT, I EARNED OFF OF MY HARD WORK, BLOOD, SWEAT AND TEARS!!! If you want to CHANGE the System, then I expect YOU will pay me back EVERY DIME I Paid Into the System!