Enrolling in Medicare is a very important part of retirement that you must take care of as soon as possible when retirement looms. You don’t want to take any chances with a lapse in coverage that could cost you lots of money from your wallet. So you need to enroll in Medicare right away and the best way to do that is when you become eligible.
Federal employees don’t really have any other stipulations than that of the general public when it comes to enrolling in Medicare. You should still call the Social Security Administration when nearing Medicare enrollment and ask for any information you need. No special perks or benefits are available for you to ask about, just ask about enrolling in your coverage.
If you visit the website for the Office of Personnel Management you can get some great tips on how federal employees should enroll. The same benefits that are available to everyone else are available to you. It is recommended that you study up on the benefits of the different parts of Medicare to be prepared for enrollment.
With the health care debate in full swing, CBS's 60 Minutes television program recently aired a story in which it claims that Medicare fraud is now a $60 Billion dollar a year crime (I capitalized the "B" in billion to emphasize the enormousness of this number). It is utterly unbelivable. You can view the story as it aired in the video below:
The Medicare program, which now servers about 46 million senior and disabled American citizens, has become an easy and incredibly profitable target for criminals.
According the the 60 Minutes story, Medicare fraud is now a more popular crime in the city of Miami than Cocaine drug dealing among criminals. This is due to lighter prison sentences, lesser law enforcement on their trail, the non-violent nature of the crime and the high profitability and simplicity of the scheme.
In the story, 60 Minutes correspondent Steve Kroft rode along with law enforcement in the city of Miami and found Medicare contracted business after business who had charged Medicare for thousands or millions of dollars in inventory, but were basically vacant buildings with no sign of ownership or customers. The assumption was made that these businesses truly had no customers. They were simply billing Medicare using stolen patient information and collecting the money without providing any medical equipment or services.
As a matter-a-fact, most of these businesses were in the middle of warehouse districts where elderly or disabled consumers would rarely go.
Later in the story, Kroft interviewed an anonymous former Medicare Miami-area fraudster who is now serving a 12 year federal prison sentence. In the segment, he was simply referred to the man as "Tony".
Tony told Kroft that he stole about $20 million dollars from American taxpayers through Medicare fraud. He said it was ridiculously easy to do and that he is not a criminal mastermind. He actually estimated there were 2000 to 3000 or even more criminals in the Miami area alone working Medicare fraud schemes. (Please note: this problem is not relegated to Florida. The FBI has busted Medicare fraud rings in Detroit, LA and many other cities across the country).
Tony also said he normally purchased information about real Medicare recipients for about $10 each and then used this information to complete false invoices and claim forms and then wait 2-4 weeks for the direct deposit to hit his bank accounts. He said he commonly purchased 1,000 or even 10,000 of these real Medicare recipients information at a time. That's how profitable the data was to him.
Tony said he normally sorted through Medicare materials to find the most expensive items to bill for. These items included prosthetic arms and legs, electric arms, power wheelchairs and more.
Later in the story, Kroft interviewed a woman who runs Medicare's fraud prevention department. She said that due to low resources and legal issues, Medicare is simply not able to stay ahead of the problem like it would like.
According to the Medicare website, if you feel you are a victim of Medicare fraud you are supposed to either call the Medicare claims processing company or complete an online form providing the following data from your Medicare Summary Notice (MSN) Form:
The provider's name and any identifying number you may have.
The item or service you are questioning.
The date on which the item or service was supposedly furnished.
The amount approved and paid by Medicare.
The date of the Medicare Summary Notice.
The name and Medicare number of the person who supposedly received the item or service.
The reason you believe Medicare should not have paid.
Any other information you may have showing that the claim for the item or service should not have been paid by Medicare.
The frustrating thing is that even if you do this, the fraud is not guaranteed so stop. In the news segment, Kroft interviewed Clara Mahoney, a 76-year old Medicare fraud victim. She said she has been reporting suspicious and outright fraudulent items on her MSN since 2003. Items including air mattresses, wheelchairs and urine bags have been charged and she has never received any of the items. She said the fraud continues to this day (six years later) even though she has reported it many times and has requested that Medicare "flag" her account.
Another Medicare recipient, Ed Davis - a former federal judge, said he has been charged for two artificial limbs, even though both his arms work fine.
As frustrating as it may be, if you are a victim of Medicare fraud you should alert Medicare to any suspicious items on your statements and document any conversations or correspondence you have with Medicare. This will ensure you are not denied a claim at a later time for an item you legitimately need that was billed previously by one of these criminals.
Many states do a poor job of regulating Medicaid fraud because it is a not a simple matter economically. After all, for ever dollar Medicaid brings into a state, there is a federal matching dollar hat the state receives. Some states even overpay Medicaid providers, collect matching federal funds, and collect kickbacks of overpayments, thus becoming part of the fraud problem.
The question then becomes, what is the sense behind turning the oversight of Medicaid over to the same government that is participating in the fraud? Their actions have created long waiting lists, rationing of care and poor delivery of not enough care, again controlled by the government.
There is another side to the issue, however. What happens when you need to make the numbers work? It’s important to look at the major problem. There are many honest and caring physicians who try to help as many individuals on Medicaid as possible. The problem is that even the busiest physicians that take Medicare can’t take more than about 28% of their caseload in Medicaid patients, they can’t afford to stay in business because the amount they are reimbursed is lower than the services provided. Therefore, if there are too many Medicaid patients seeing a particular doctor, he loses money until he can’t afford to stay in business any more.
We haven’t even talked about the number of children covered by Medicaid for various reasons. There are over 25 million kids that have various forms of Medicaid coverage. There are Targeted Case Workers and Case Management through Medicaid Rehabilitative Services who do all they can to deal with children’s’ physical and mental disabilities – getting help and services for them while keeping expenses to Medicaid and to physicians under control. A federal-state partnership that exists now to cover these expenses could be eliminated if some politicians get their way.
Looking at both sides, the hope is that the politicians will be able to work with the expenses while remembering that these issues are not only about finances, but at the heart of the issues are children and adults with vulnerabilities and disabilities that depend on the Medicaid system to help keep them well.
When elderly individuals go into a long term care facility or assisted living facility and self pay, the cost can be astronomical. Making sure that the person is comfortable, well cared for, in a clean environment and positive atmosphere is not a low budget issue. What happens, though, when a private pay individual converts to Medicaid?
Well, one would think that because all of the payments are now guaranteed, albeit possibly lower, that these facilities that have been raking in money from these individuals and their families, that they would leave grandma, grandpa or aunt Minnie in comfort and without worry without changing a thing.
Unfortunately, this doesn’t always happen. In fact, there is an investigation taking place in New Jersey regarding the company Assisted Living Concepts, owner of eight assisted living homes in southern New Jersey. The investigation was started by the Public Advocate for the state, who has filed papers against the company because of their alleged practice of discharging the elderly when they change from self pay to Medicaid.
Public Advocate Ronald K. Chen is asking for the names, admission and discharge summaries, as well as contact information for every resident of the company who is or has been a Medicaid beneficiary.
Chen says that the investigation was sparked because there is an indication that this company “is placing elderly vulnerable residents at risk by displacing them from their homes in violation of ALC’s state license. Our primary concern is to protect the safety well being and peace of mind of these residents.”
The representative of Assisted Living Concepts, Laurie Bebo, who is also the CEO of the company, refuses to cooperate with the subpoena and states that the company does not have any Medicaid conditions in their license; therefore, they do not have to honor Medicaid patients.
Chen says that state licenses for all eight facilities stipulate that at least 30% of the residents of each of the facilities are to be Medicaid eligible and no resident would be discharged because or if they spent all their money.
Assisted Living Concepts operates more than 200 assisted living residences in 17 sates, containing more than 8,000 units, so this is no small issue. New Jersey may just be the tip of the iceberg.
Medicaid was designed to cover low income individuals and their families for hospital services ( in and out patient), laboratory services, x rays, home nursing care, doctors services, physical therapy, hospice and rehabilitation care. Medicaid recipients must go to a Medicaid-approved doctor who is on the Medicaid list. Sometimes, in some areas, there are a limited number of doctors that accept Medicaid, so some individuals have to search carefully and, once they find the right physician that they are comfortable with that are Medicaid approved and accept Medicaid for payment. As a result, there is often a waiting list for an appointment, even if it’s an urgent situation. In a serious emergency, the doctor’s office may take you right away and “squeeze you in” to their schedule. More often, they send you to the emergency room, which ends up costing you, taxpayers, the community, the hospital and Medicaid more money than if Medicaid reimbursed good doctors enough money to be able to enroll and appoint more, thus eliminating some of the long waiting line.
Federal laws state that if you become eligible for Medicaid, which is based on income and need, the states may not reduce other welfare benefits you are receiving. In addition, we have been hearing a lot about trying to exclude legal immigrants from Medicaid system. The problem with this is that Medicaid only requires – by law – for an individual to establish and prove residency (and meet low income requirements) to apply for and, if approved, receive Medicaid benefits. States cannot impose citizenship requirements on anyone who needs Medicaid benefits. Regardless of age or whether or not the individual works is not a reason that Medicaid can use to eliminate you from the program.
Unfortunately, these situations are taking place in a number of states. If you or someone you know feels that they are not being treated fairly regarding Medicaid benefits, you can contact some places that can help. Information is available to you through www.seniorlaw.com.
It is becoming too common to hear about fraudulent and dishonest individuals trying to either frighten or trick Medicare recipients – especially seniors – into either changing their coverage to inferior plans or giving out personal and sensitive information so they can use it for various types of fraud.
Yesterday, in Pocatello, Idaho there was an NBC news story stating that such a group was targeting individuals in the area by calling them up and telling them that their Medicare was at stake. They would offer a discount Medicare card that was intended to replace the valid Medicare card they already have.
The person that called one woman was a male, who told her about the discount card and stated that he needed some information first. It is interesting that he already had her bank routing number and her address, which is unsettling in itself, but he then asked for her Social Security number and her bank account number.
Fortunately, the woman had a clue. She knew that something wasn’t right, and she had already heard that there was a scam, so she did not give the individual the information he was asking for. Then the man told her that she would lose her benefits for three months, since she would not give the requested information. Instead of continuing the conversation, she called the police.
Unfortunately, other individuals who are Medicare recipients have not fared so well. As a result, the Pocatello police have warned seniors about this scam. They have told seniors in the area to be extremely careful about relaying any personal information, especially over the phone. It is also important to note that there are certain ways to verify that the individual is truly from Medicare. If you have caller I.D., the number will show up or the name Medicare or CMS will come up on the I.D. In addition, it is rare that you would be asked for your bank account number unless you call them and ask for direct deposit. Also, they will not usually ask for your Social Security number because they have it. They will often read it to you and have you verify it.
If you are not comfortable with the person who is calling or the questions they are asking, get their name, their employee identification number and their phone number, plus their extension and the city they are in. They should readily give you that information so that you can call back, or they will give you the main number to call and tell you that you can talk to anyone there. If they won’t give you the information you request or if they hang up when you ask, they are probably not legitimate. If this happens to you, report it to your local police as well as the agency they say they are from, such as Medicare or Social Security.
It is important to be aware of people and situations that could jeopardize your benefits or finances. Trust your instincts, and be cautious. Don’t give information out unless you are sure who you are speaking to. Stay on guard and keep yourself safe.
The Scooter Store is the nation’s largest provider of powered mobility, which includes electric wheelchairs and scooters. Founded by Doug Harrison, the company has recently battled Medicare over allegations that it committed fraud or abused the Medicare system.
Medicare provides medical coverage for citizens aged 65 years or older and certain disabled persons younger than 65 years. It is the U.S. Government’s health insurance plan for elderly Americans. Medicare is the nation’s largest provider of managed care with over one billion claims submitted each year. Medicare fraud and abuse is inevitable due to the sheer volume of claims and the tens of millions of members.
Medicare, the U.S. Government’s health insurance program, provides medical coverage for citizens aged 65 years or older and certain disabled persons younger than 65 years. With over one billion claims processed annually, Medicare has become the country’s largest managed provider of medical care. With more than a billion transactions, tens of millions of members, and an increasingly-complex system, Medicare fraud and abuse of the system is inevitable.
In the story, 60 Minutes correspondent Steve Kroft rode along with law enforcement in the city of Miami and found Medicare contracted business after business who had charged Medicare for thousands or millions of dollars in inventory, but were basically vacant buildings with no sign of ownership or customers. The assumption was made that these businesses truly had no customers. They were simply billing Medicare using stolen patient information and collecting the money without providing any medical equipment or services.
