Medicare Fraud Rose Dramatically During COVID

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A new internal report revealed that new channels of Medicare fraud opened up during the COVID pandemic.  This was due in large part to meet newly emerging health care needs of older Americans which left the program vulnerable to falsified billings.  In just one example, the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services released a study in September that said it had already detected potentially fraudulent billings related to telehealth from more than 1,700 health care providers.  This translated to a loss to the government of $128 million.  In California, a federal jury convicted Mark Schena, the president of a Silicon Valley medical technology company, of a conspiracy to bilk Medicare and private insurers out of $77 million.  They marketed a COVID test not approved by the Food and Drug Administration (FDA) and paired it with other expensive tests.  Also in our state, health-testing laboratory owners Imran Shams and Lourdes Navarro face charges of defrauding Medicare out of $214 million.  They used COVID testing as a pretext to add on expensive and unnecessary respiratory pathogen tests while paying illegal bribes to medical marketers for directing doctor’s orders to their labs.

Medicare Advantage Plans Taking Advantage Of Some Seniors

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Medicare Advantage Plan members have more than doubled since 2007 according to a study done by the Kaiser Family Foundation.  However, they are not always the great deal as they seem on the surface.  The Wall Street Journal recently profiled Bob Miller who had surgery on one eye but just a few weeks later when he was scheduled to have surgery on the other eye, he was informed the night before that the surgery was canceled because his Medicare Advantage plan refused to cover it.  Unfortunately, you will not be able to figure out if some plans are covering your planned medical care until you fill out the medical preauthorization form and send it in.  Miller eventually got the cataract surgery but had to wait several weeks.  “Prior authorization policy when levelled in such a heavy handed and irrational way is an undeniable power grab by insurers to really put profits over patients,†said Alice Epitropoulos, the ophthalmologist who performed the surgery on Miller.

Medicare AARP Plan Attacked From An Unexpected Source

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We all know how hard it is shopping for a supplemental Medicare Plan, also known as Part D.  The Wall Street Journal recently took issue with AARP’s marketing of products like health, life and auto insurance, saying, for instance that the AARP MedicareRX Preferred Plan, insured by UnitedHealth Group Inc., carries the highest premium among all national stand-alone Medicare drug plans.  AARP has advocated that the 1.74 million members who make up 9% of the market for Part D plans should switch to a cheaper policy.  Kaiser Family Foundation backed up this opinion stating in a report that, “We’re certainly at the point where this AARP plan is so expensive that it’s likely that most people in it could save money by switching,†according to Juliette Cubanski, co-author of a report on the issue.

New Federal Database Tracks Nursing Home Ownership

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Officials at the Centers for Medicare and Medicaid Services finished up a new database which allows the public, state regulators and researchers to track common ownership, something which can be very important at looking out for poor management.  The data was required by President Joe Biden due to the large amount of federal funding that goes out to them.  Nursing homes were among the deadliest places to be during COVID-19, in large part due to lack of training and caregivers bringing in the virus, which spreads incredibly rapidly.

Medicare Catastrophic Coverage Cap Starts In 2025 : Too Late For Many

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The climate health bill recently passed by Congress provides quite a bit of relief for seniors.  However, the fact that not all provisions kick in next year has some seniors worried.  USA Today recently profiled Jackie Trapp, one of more than 1.3 million Americans whose drug spending exceeds Medicare;’s definition of “catastrophic†coverage.  Jackie has incurable blood cancer and is on a chemotherapy regimen which costs $240K per year and results in $21,740 in out-of-pocket expenses for the drug Revlimid.  “We used to donate a healthy amount to charity.  Now, I’m receiving charity,†she told USA Today.

Medicare And MediCal Fraud Likely Involved In Some TeleHealth claims

A person holding a stethoscope in front of a laptop.


The federal government has generally been in favor of TeleHealth since the beginning of the COVID-19 pandemic.  However, a recent report from the Department of Health and Human Services Office of Inspector General found less than 1% of the 742K Medicare-certified doctors billed Medicare nearly $28 million in TeleHealth claims that resulted in a half million claims that are “problematic.â€Â  This is sure to cause further investigation.

Medicare Open Enrollment From October 15 To December 7 : Check Your Options!

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Medicare Open Enrollment arrives, with their Annual Election Period (AEP) running from October 15 to December 7.  Those who are in a standalone Part D drug plan should check and make sure that they have the best coverage possible for the prescription medication that they are on.  Coverage and plans change every year so getting the right plan could save you hundreds or even thousands of dollars per year.  Similarly, if you are looking at a Medicare Advantage Plan should look at your likely health needs, including hospitals, doctors, durable equipment, as well as prescription costs.  Alliance on Aging has a number of free presentations on this topic.  Click here for the dates and locations.

Medicare Part B Bills To Decline 3% Next Year

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For the first time in a decade, Americans will be paying less next year for Medicare Part B.  The 3% decrease in premiums (a savings of $5.20 per month for most people) comes after a tough year with extremely high inflation.  “To millions of seniors and people with disabilities on Medicare, that means more money in their pockets while still getting the care they need,†President Biden said.

 

Walmart And United Healthcare Form Joint Venture For Medicare Advantage Enrolles

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Walmart announced that it is rolling out a major partnership with UnitedHealth Group to provide healthcare services and improve the patient experience for Medicare Advantage enrollees in certain markets.  The 10-year partnership was announced Wednesday.  The duo will begin the rollout in Florida and Georgia in 2023, where Walmart Health has a combined 15 locations.  Eventually, they plan to roll out the service across the country.  “No matter who your insurer is, this 10-year collaboration is going to enable us to deliver the care needed, first in Georgia and Florida,†Dr. Cheryl Pegus, EVP of Walmart Health & Wellness, said in an interview.  Medicare Advantage plans have increased in popularity in recent years, with the program adding more than 2 million beneficiaries in 2022, boosting the program to 45% of Medicare enrollees, according to a study by The Chartis Group.

President Biden Signs Sweeping Prescription Drug Reform

A table with many different types of pills on it.


On August 16, President Joe Biden signed the Inflation Reduction Act which includes:

About $370 billion into policies aimed at reducing U.S. Greenhouse gas emissions.  $10’s of billions of dollars will go toward supporting renewable energy development, lowering the costs of electric vehicles, building out public electric car charging stations, etc.

The bill is the most significant prescription drug legislation to pass in 20 years. Diabetic seniors won’t have to pay more than $35 a month for insulin.  Starting in 2026, out-of-pocket costs for all prescription drugs will be capped at $2,000 a year for Medicare recipients.

Because the bill raises more revenue through higher taxes than it spends, it’s projected to reduce the federal budget deficit by close to $300 bill over the next ten years.