Showing posts with label medicare. Show all posts
Showing posts with label medicare. Show all posts

Friday, February 18, 2011

Medicare Scams Are Great Money Makers -Some Get Caught-

MIAMI – Federal authorities charged more than 100 doctors, nurses and physical therapists in nine cities with Medicare fraud Thursday, part of a massive nationwide bust that snared more suspects than any other in history.
More than 700 law enforcement agents fanned out to arrest dozens of people accused of illegally billing Medicare more than $225 million. The arrests are the latest in a string of major busts in the past two years as authorities have struggled to pare the fraud that's believed to cost the government between $60 billion and $90 billion each year. Stopping Medicare's budget from hemorrhaging that money will be key to paying for President Barack Obama's health care overhaul.
Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder partnered in 2009 to allocate more money and manpower in fraud hot spots. Thursday's indictments were for suspects in Miami, Los Angeles, Dallas, Houston, Detroit, Chicago, Brooklyn, Tampa, Fla., and Baton Rouge, La.
They show that "health care fraud is not easy money," Holder said at a press conference in Washington.
A podiatrist performing partial toenail removals was among 21 indicted in Detroit. Dr. Errol Sherman is accused of billing Medicare about $700,000 for the costly and unnecessary procedures, which authorities said amounted to little more than toenail clippings. The podiatrist billed Medicare for 20 nail removals on three toes of one patient, according to the indictment. He charged Medicare about $110 for each procedure.
A message could not be left at Sherman's office Thursday.
A Brooklyn, N.Y., proctologist was charged with billing $6.5 million for hemorrhoid removals, most of which he never performed. Dr. Boris Sachakov claimed he performed 10 hemorrhoid removals on one patient, which authorities said is not possible. An employee who answered at Sachakov's office declined comment Thursday.
Sachakov had been arrested last year on charges related to a separate scam. Sachokov denied the charges.
Authorities also busted three physical therapy clinics in Brooklyn, run by an organized network of Russian immigrants accused of paying recruiters to find elderly patients so they could bill for nearly $57 million in physical therapy that amounted to little more than back rubs, according to the indictment.
In Miami, two doctors and several nurses from ABC Home Health Care Inc. were charged with swindling $25 million by writing fake prescriptions recommending nurses and other expensive aids to treat homebound patients, authorities said. The services were never provided. A message left Thursday was not immediately returned.
In total, nearly three dozen defendants were charged in Miami in various scams that topped about $56 million.
Thursday's totals exclude busts two days earlier in Miami that netted 21 suspects accused of bilking $200 million from Medicare.
"These unprecedented operations send a clear message. We will not tolerate criminals lining their pockets at the expense of Medicare patients and taxpayers," HHS Inspector General Daniel R. Levinson said.
For decades, Medicare has operated under a pay-and-chase system, paying providers first and investigating suspicious claims later. The system worked when the agency was paying hospitals and institutions that couldn't close up shop and flee the country if they'd been overpaid. But as Medicare has expanded to one of the largest payer systems in the world, he agency has struggled to weed out crooks. There are about 1.3 million licensed suppliers nationwide with 18,000 new applications coming in every month.

"We can arrest and charge people every day and it still won't make a dent until changes are made to Medicare," said FBI special agent in charge John Gillies.

He called for criminal background checks and fingerprints of providers. He also suggested Medicare use unique, secure numbers for patients instead of Social Security numbers, making it easier to cancel Medicare cards in fraud cases.

Sebelius has promised more decisive action on the front end, by vigorously screening providers and stopping payment to suspicious ones, under greater authority granted by the Affordable Care Act.

Authorities also announced Thursday they were adding strike forces in Chicago and Dallas.
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Notes by blogmaster:
Yes great money makers indeed, I ought to know my mother Clara G. Fernandez is still being billed along with Medicare who pays for medical supplies she has yet to use,stuff like colostomy bags , wheelchair and equipment rental stuff she never even needed!
She has her own! Every month when I got the bills I used to call the fraud dept and they would say, well it happen so long ago it would be hard to prove, I go well OK... whatever, Don't worry about it, you have a loyal and subservient servant base who will pick up the bill in the form of higher taxes....

Friday, October 26, 2007

Hearing for Appoinment of Emergency Temporary Guardian

Clara's 4Th guardian was confirmed in place at today's hearing.

Present were Clara's family, Clara, and her long time friend Angela McClain, all in attendance to show their support. Both Ray Fernandez and Angela represented Clara.

"Allegations of Contempt," never materialized due to lack of ample evidence, evidence presented to the contrary.

The guardian shall report back to the court in 15 days or less.

------------------------------

Thursday, October 18, 2007

Sen.Rodham Hillary Clinton Live Webcast on Healthcare 2008

Live Webcast: Sen. Hillary Rodham Clinton on “Health Care 2008: Presidential Candidate Forums”

On Thursday, October 18, 2007 at 2:00 p.m. ET, a discussion with Senator Hillary Rodham Clinton (D-N.Y.) will be webcast live during the next “Health Care 2008: Presidential Candidate Forum.”

Numerous polls indicate clearly that Americans believe health reform and the uninsured are the nation’s most important domestic challenges. Several Presidential candidates already have released health reform proposals or principles, or are planning to do so. However, to date, candidate debates and other venues have not been conducive to in-depth discussion about the candidates’ visions for health reform.

Wednesday, September 19, 2007

Blatant Medicare Fraud.-

Please click to enlarge documents

This is a fraudulent Medicare Bill for over $3,000 if you look at the date of October and November of 2005 , I can personal guarantee you that Clara has been in my care un interrupted from November 1999 to the date she was kidnapped on August 20, 2004 and then again from the date she was rescued on August 5th, 2005 to present and I can guarantee you that Clara has never ever used any Ostomy Bags. Of course it won't do any good to reported it since the people who are responsible seem to be protected by the State of Florida.


People think that Clara has Medicare so she doesn't need any money , little do they know that the facts are that there has been so much over billing, duplicate billing, fictitious billing , in the feeding frenzy that followed her incapacitation that Medicare now turns down even the most basic of claims , as it is evident in this bill which is clearly marked "MEDICARE DENIAL"

You be surprised how much corruption is actually going on and we are trying to expose it so that meaningful changes beneficial to elders can be made but if you the citizens of this country and the courts think all of this is alright, specifically that Clara the once proud and independent elder is now losing her home and does not even have Medicare to fall back on , and has to go back to the people that hurt her then it is alright with me too.
And this is not just an isolated incident.

Sunday, September 9, 2007

Steal An Estate ! - It is Easy - Never Work Again!



by stealanestate

STEP ONE: Assess Opportunities & Establish Yourself

Identify Elderly Affluent People Who Are Alone - Target people who do not have strong family relationships, who are either estranged from their families and children or whose families live and work out of state. (Older widows make the best targets and they are easy to wine and dine, afterwards you can put them in a nursing home and no one will ever miss them)

Elderly Childless People Are Best - Children and grandchildren are hard but not impossible to displace. Childless people may not have obvious heirs making it much easier for you to establish your position.

Never work alone, a close relative of the victim works best, find one who is easily influenced and offer him a large take and use him/her as a patsy to get the inside information, account numbers, etc. And always make it look like a family squabble, if you can make it look like sibling rilvary you are half way there, authorities will brand these cases "Civilly Matters" and look the other way.

Assess Their Estate Decisions - How large is their estate? Do they have a will? How strongly do they feel about the disposition of their assets? The greater their uncertainty, the better it is for you.

Length of Life Span - Unless your target is terminally ill or very elderly, expect this to be a long term project. Once you are sole beneficiary you will still need to defend your position until they expire. Hastening their death is outside of our scope.

Alcohol Helps - Alcohol lowers people’s resistance, raises their susceptibility to suggestion, makes them relax, feel good and festive. It’s easy to manipulate alcoholics and make them angry and emotional. (Drugs are better you can farm out from different doctors who are eager to get on the Medicare gravytrain who will prescribe from Darvocet to Ambiem or a cocktail thereof.

People Are Susceptible To Suggestion When Sleepy - Especially during those hazy, lazy moments when they are just drifting off to sleep or waking up. Visit or telephone when the impact of your communication will linger in their minds long after you finish. (Yes and if they have been diagnosed with forgetfulness, dementia, or Alzheimer's your odds improve tenfold)

Always be Smiling, Positive and Loving - They must see you as special, especially deserving and associate you with only the most positive, wonderful feelings.

Always Take Their Side And Fault Anyone Who Disagrees With Them - This is the GOLDEN RULE! You want them to eventually sever or discount all other relationships so they rely, trust and love only you. ( and make sure that they are totally isolated, no phone calls, mails,nothing gets in and nothing gets out.)

Leave Them On A High Note, Feeling Very Good About You - Treat each interaction as a professional. Each performance must further your goal of showing them you are their ONLY deserving heir.

Talk To Them Like Family - Tell them they are the wonderful father / mother or aunt / uncle you always wish you had. Plant family associations and connections in their mind.

Tell them that their husband/wife is dead, if they have one, tell them that their caregivers abandoned them, tell them that you are all they have.

Get Into A Position Of Trust And Authority - Manage their checkbook, their investments, their grocery money. Whatever you do, be VERY Honest. Your purpose is to show how honorable and trustworthy you are. Don’t steal early, wait for the big prize.

Keep them on the move and confused!

Move fast to get a new Power Of Attorney (POA) this will cancel out the legitimate heirs, don't worry if the legitimate heirs documents are much older than yours, it doesn't matter they always look at the most recent date, regardless of the circumstances

Once you done this step and have the POA move fast to destroy the heirs and hide the money beyond reach, If you are in Florida, you are in Luck ! Laws defining abuse, neglect, or exploitation as defined in F.S Section 415.102, are hazy, unbiguous hard to understand and hardly enforced. Don't worry about F.S. 709.8 Section 2(D) that states that a POA can not be used for the agent's benefit, this statue is very selectively or not at all enforced.

And if your victim is incapacitated don't worry about F.S 709.1 that states that principal must be competent at time that the POA is used and as long as no petition for incompetency is filed. This law is not enforced either!.

Cash Gifts - Make sure they know how much you really love them and not their money. Close their Certificate of Deposits and other liquid investments , open joint accounts and then have money swept into your own personal account.

AS soon as the victims are throurougly confused sneak Quit Claim Deeds for them to sign, don't worry they won't remember that they signed them later.

Get the venue changed to a city un familiar to the victim or their family, even if you have to lie and manipulate the court system, No one will ever hold you accountable.

Act Like The Perfect Son Or Daughter - Be the perfect child they always wish they had. Appear far more deserving than any of their family members.

Create A Fun Secret Conspiracy, Build Secrecy Early - Tell them their daughter/son/rightful heir might get a little upset and jealous, so let’s just keep it our little secret! Let’s have fun and not tell them! They don’t have a right to know about everything you do any how!

STEP TWO: Discredit and Displace The Heirs. smear and totally destroy existing heirs, remenber they are the only thing standing between you and the money! (The Big Prize).

File as many false complaints as possible, Remember that Constitutional Protection don't apply to Department of Children and Families Investigations, so as soon as you know an investigation is finished call the hotline and file another, they will be investigated for another three (3) months regardless of the outcome of the last investigations and you will drive the victims crazy!

It’s A Military Campaign - You are investing time and energy to gain control of their estate. If victorious, you will never have to work again. It is a long term project that requires guts, drive, determination, hard work and dirty deeds. Enjoy Doing Evil and Being Ruthless and Cruel.

Your Goal: To Completely Discredit and Disinherit Existing Heirs

Hate The Heirs - You must absolutely hate and despise the heirs you are disinheriting. You need to transfer a vicious, angry hatred to your target so that neither of you feels badly about what you are doing. Show no mercy. Hate is an absolute prerequisite for success.

Collaborate If You Can - Is there an unhappy family member who can help you disinherit the others? Collaborate with them. Make sure you always have more on your collaborator than they have on you.

Truth and Righteousness - Show them the real truth about their heirs, how their heirs have abused and misused them for years.

SEVER ALL COMMUNICATIONS WITH THE HEIRS - This is VERY IMPORTANT! If your target refuses to communicate with their heirs, the heirs can’t exert influence, change their minds or fight your plans.

Use Anger & Betrayal - Get your target very angry with their heirs and keep them angry so they will cease all communications with the heirs. Make them feel angry, betrayed, devalued, used and abused. Use every tool at your disposal, create conflict every way you can.

Creating Conflict - If reasons to be angry with the heirs don’t exist, create them. The heirs are in the dark, they don’t know what you are doing. Tell damaging lies, falsify letters and “proof” of the heirs horrible dishonesty and misdeeds.

Continue Your Campaign of Conflict with the Heirs - Be relentless. Start small and gradually build over time. Do everything you can to destroy their relationships and any positive memories of their heirs.

Rewrite Reality Repeatedly Over Time - A lie repeated over and over again over time eventually becomes truth. This is one of your most powerful tools. Repeatedly demonstrating what bad people their heirs are will eventually make your target believe it.

Discredit and Disparage - It is very hard to get people to go against long held, deep set beliefs and values. It’s much easier to change their memories and perceptions of reality.

Repeatedly Ridicule and Revile The Heirs - Laugh, make ridicule fun and entertaining. Bond with mutual hatred of the heirs, their greed and all their misdeeds.

Develop a Fun, Secret Conspiracy - Involve your target in fun little dirty tricks that hurt and harm the heirs. Encourage them to enjoy playing tricks to punish their heirs for all their abuse and mistreatment.

Discredit and Destroy the Heirs - Hurt and weaken them any way you can. Can you harm their business? Their career? Spread damaging lies about them? Do it, your financial future is at stake. Destroy them if you can so they can’t fight you.

Involve the Goverment, file complaints with the Postal Police, FDA, DCF, DEA in short everyone you can think of, these agencies will be eager to investigate the heirs, creating havoc and seriously disrupting their lives, scoring points in your favor.

Better yet if you can steal the older persons identity and file the complaints against the legitimate heirs using the Victim's name, it will be much more beliavable, don't worry it's a civil matter no one will ever investigate.

Involve Organized , Stalking and Terror Tactics - Pay criminals to create havoc in the heir’s life, but only do it through intermediaries so it cannot be traced to you. Major life disruptions can be caused by surprisingly minor dirty tricks disguised a life’s bad breaks. Sick, psychotic people enjoy hurting people, getting paid for it is a plus.

STEP THREE: Savor Your Triumph

Enjoy Being Evil - Think about all the wonderful things you will do with the target’s money and how much you enjoy hurting the stupid, unsuspecting and undeserving heirs.

You are so much smarter, evil and deserving than they are. You deserve the money.

The human mind has no firewall. The reality is it's very easy to steal from sick and old people."

Italics and bold are mine for emphasis

Abridged be sure to visit StealAnEstate.Com >> for additional information and insight into how these people work, you have been forewarned, no body forewarned us a few years ago.

Friday, September 7, 2007

Once Independent and Proud Elder Now Dependent on Strangers

Reprint from 6/20/07 1:00 PM

" Like a Puppet on a String" Judge Von Hof 31 ,August 2005

During the almost one year that Clara was improperly taken from her home, She was moved five (5) times at Medicare's expense in order to keep her secreted from her family and isolated while her assets were being transferred.

During this time Clara was to be hospitalized many times for falls (accidents) and with transfers on the increase and a decrease in functional ability which culminated in her disability when she was left in a hotel room alone to fend for herself heavily medicated.

Medicare was notified by the victim families that there was irregular activity , regarding Clara who had full time caregivers 24/7 in her specially equipped handicapped home, yet Medicare was spending thousands in keeping Clara on the move , providing emergency transport to move her to to five (5) locations keeping Clara totally isolated from all husband,friends and family.

Now after Clara's Estate being billed over $150,000 in legal fees from both sides Dr. Fernandez was allowed to be with his wife briefly before he died , he managed to get a hearing before Judge Richard Payne who after having listened to Clara's testimony , and after having heard her friends testimony confirmed that Clara G. Fernandez did indeed live in Key West and not in some other place as alleged by her self appointed caregivers.

Now that Clara is in Key West after being discharged from a period of convalescence at the KWCC, and now that she is in the loving care of her family and friends, and caregivers and Angela McClain has been appointed her 'Guardian" but Medicare refuses to pay for Bed , Wheelchair, and medical supplies! to make her comfortable and safe.

Here is a Fraudulent Bill >> that Medicare paid along with thousands of dollars for emergency transport to keep Clara hidden, and now that she is home and needs it more than ever Medicare has flagged the account and refuses to pay for legitimate services ordered by her doctors.

Now the one independent elder who has now been totally stripped of her Bond accounts , Certificate of Deposits,Stocks accounts, Real Estate Holdings is now dependent on state services.

Tuesday, August 21, 2007

Medicare Will Not Pay for Preventable Conditions Acquired at Hospitals

Medicare no longer will reimburse hospitals for the treatment of preventable errors, injuries and infections that occur in the facilities under a new rule scheduled for publication this week, a move that CMS officials said could save lives and millions of dollars, the New York Times reports. Under the rule, Medicare no longer will reimburse hospitals for the treatment of certain "conditions that could reasonably have been prevented," and the facilities "cannot bill the beneficiary for any charges associated with the hospital-acquired complication" (Pear, New York Times, 8/19).

The eight conditions for which Medicare no longer will reimburse hospitals for treatment include: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters. In addition, the conditions include three "never events": objects left in the body during surgery, air embolisms and blood incompatibility (USA Today, 8/20).

The rule, proposed by CMS in April and mandated by a 2005 law, will take effect in October 2008. CMS officials said that next year they plan to add three additional conditions to the list (Zhang, Wall Street Journal, 8/20).

Friday, July 27, 2007

Senator Kohl Gives States More Power to Regulate Sales & Marketing of Medicare Advantage Plans

Chairman of Aging Committee Delivers on Promise to “Hold Feet to the Fire”

WASHINGTON, D.C. – U.S. Senator Herb Kohl (D-WI), Chairman of the Senate Special Committee on Aging, was joined today by Senators Byron Dorgan (D-ND) and Ron Wyden (D-OR) in introducing the Accountability and Transparency in Medicare Marketing Act of 2007. The bill would give state insurance commissioners the ability to develop standardized marketing and sales regulations of Medicare Advantage (MA) and Medicare prescription drug plans, and regulate both agents and companies in the marketing and sales of MA and prescription drug plans. If passed, the legislation would enable state insurance commissioners to adequately serve and protect Medicare beneficiaries in conjunction with the Centers for Medicare and Medicaid Services (CMS). Currently, states are largely pre-empted from regulating the marketing of MA and Medicare Part D plans. The marketing guidelines for these plans were established by CMS and have proven to be inadequate. Instead of regulating these abusive marketing practices themselves, state authorities must refer complaints to CMS where it appears little has been done to quickly resolve the issues and prevent future problems.

“The Committee’s investigation into the sales and marketing of Medicare Advantage plans has uncovered questionable practices that border on outright fraud,” said Chairman Kohl. “It is clear that a major disconnect in oversight exists, and it is simply unacceptable to leave our seniors unprotected.”

“Since the Administration is not stepping up to protect seniors from abusive marking practices, it makes sense to authorize state governments to do so,” Senator Dorgan said. “Many state governments have let us know they are very concerned about this problem. They want to act where the Administration has failed to act. I am pleased to co-sponsor legislation that would allow them to protect seniors.”

“A decade ago I helped write a law that put an end to Medicare supplement insurance scams, but today some of the same deceptive practices have resurfaced in the marketing of Medicare Advantage,” said Senator Wyden. “It is time to act to ensure that the promise of health care is no longer used to prey on those who need health care the most.”

The bill is being introduced in response to the Aging Committee’s ongoing investigation of the marketing practices of private Medicare plans and providers, which has uncovered such questionable sales practices as removing seniors from traditional Medicare without their knowledge, signing seniors up for plans they cannot afford, and misleading seniors regarding which physicians and hospitals accept the plan. At a May 16 Aging Committee hearing on the topic, officials representing the state insurance commissions from Wisconsin, Oklahoma, and Georgia described a nationwide pattern of aggressive, and at times deceptive, marketing practices employed by Medicare Advantage sales agents. Executives from three of the companies participating in the voluntary moratorium (Humana Inc., UnitedHealth Group, and WellCare) testified at the hearing that efforts would be made to reform their marketing and sales practice guidelines.

Also in reaction to the Aging Committee hearing, seven insurance companies—which together account for 90 percent of the private fee-for-service (PFFS) Medicare Advantage market—voluntarily agreed to temporarily terminate the marketing and sales of their Medicare private fee-for-service plans to individuals. Abby Block, Director of the Center for Beneficiary Choices at the Centers for Medicare for Medicaid Services (CMS), announced the voluntary moratorium on June 15, saying it will last until such time that the insurers are able to fully comply with the six provisions released earlier this year by CMS as part of new guidelines for 2008.

Specifically, the Accountability and Transparency in Medicare Marketing Act of 2007 would direct the National Association of Insurance Commissioners to establish regulations, set standards for agent conduct, and define prohibited activities with respect to the sales and marketing of MA plans. CMS and the states would then adopt these regulations, allowing both federal and state governments to enforce them. The legislation is comparable to a provision that has been included in the U.S. House of Representatives’ SCHIP package.

Thus far, the bill has received a letter of support from the Medicare Rights Center.
Ashley GlacelPress SecretarySpecial Committee on AgingSenator Herb Kohl, ChairPh: (202) 224-5364 Cell: (202) 340-3299 http://www.aging.senate.gov/

Wednesday, July 18, 2007

Medicare Tutorials -Updated-

Medicare Advantage – Tutorial Michelle Kitchman Strollo, Dr.P.H., principal policy analyst, Kaiser Family Foundation, presents an overview of the Medicare Advantage program in this narrated slide tutorial. The tutorial reviews the basics of Medicare Advantage and the different types of Medicare Advantage plans available. Trends in Medicare Advantage plan participation and enrollment as well as characteristics of Medicare Advantage enrollees are presented. Key policy issues such as the payment system, plan benefits and the impact of Medicare Advantage plans on the traditional Medicare program are also discussed.




The tracker provides local, regional, and national information about Medicare Advantage plans, including HMOs, regional and local PPOs, private fee-for-service plans, and special needs plans, which can be used to examine historical trends. It also has data about Medicare stand-alone prescription drug plans.

Please forward this notice to interested colleagues. KaiserEDU.org is a Kaiser Family Foundation website.

Quick Links: Topics Syllabus Library Journal Browser Research Tools Policy Fellowships
To subscribe, unsubscribe, or manage your email subscription options, including your preference for Text or HTML formatted emails, click here. If you need help or have questions, please send an email to subscriptions@kff.org. Henry J. Kaiser Family Foundation 2400 Sand Hill Road, Menlo Park, CA 94025 (650) 854-9400Washington DC Office 1330 G Street NW, Washington, DC 20005 (202) 347-5270

Saturday, July 7, 2007

Senior Citizens Forced to Leave Their Homes by Medicare Cuts in Home Health Care

July 6, 2007 - Former Mayor and Congressman Ed Koch, and former U.S. House Aging Committee Chief of Staff Bob Weiner, have joined forces to urge Congress to restore Medicare funding to home health care that is being cut by the Bush administration.

In an op-ed today in Newsday, "Congress Must Restore Funds for Home Health Care", Koch and Weiner say, "As the health care debate takes off in the presidential campaign and in Congress, let's not ignore the silent sadness of growing numbers of elderly being forced unnecessarily into nursing homes."

They point out, “In the last seven years, while the Medicare budget for nursing home stays has dramatically increased from $13.6 billion to $15.7 billion, home health care has been cut by 25 percent, from $14 billion to $10.5 billion. It is cut further in the Bush administration's proposed fiscal year 2008 budget, which calls for an ‘inflation freeze’ that would slash $410 million in fiscal 2008 and $9.68 billion over five years.

"Many of us have or have had older grandparents, parents, other relative or friends living in nursing homes. In nearly every case, the elderly person did not want to go; many cried over it.
“Home care allows the elderly to maintain their dignity and independence, sleep in their own beds, and stay in the house they have long enjoyed (or in the house of a child or relative) - unless their condition deteriorates to the point where an institution is absolutely necessary."

However, "Home health care doesn't have nearly the lobbying power of big institutions like the nursing home industry and the hospitals, they add."

"In addition to providing a higher quality of life, home health care is far cheaper - now averaging one-fifth the price of nursing homes and a tiny fraction - 3% - of the cost of hospitalization according to federal HHS Medicare statistics."

Koch and Weiner conclude, "Senior citizens should not be forced into nursing homes for lack of alternatives. The new Democratic Congress needs to restore the priority of home health care for senior citizens."

Koch and Weiner, who was Koch's legislative assistant in Congress, say that "national policy has reversed" from "common sense legislation" Koch and Weiner worked on and got passed to give senior citizens alternatives to nursing homes -- health care in people's own homes.

Medicare, Medicaid May Save $70 Billion in New Bush Budget Proposal

February 2, 2007 – President Bush is expected to unveil his plan next week for balancing the budget and over $70 billion of the savings are expected to come from Medicare and Medicaid, two programs of critical importance to most senior citizens. Higher Medicare premiums for higher income seniors and holding back on the fees paid to home health agencies, hospitals, nursing homes and other health care providers are expected to produce most of the savings, according to the New York Times. Democrats are not welcoming these ideas, finds KaiserNetwork.org. Read more...

Read more on> Politics for Senior Citizens> Medicare> Medicare Drug Program

Tuesday, June 19, 2007

Medicare Refuses to Pay for Clara's Wheelchair & Bed After Long Torturous Road Home!



Please click on image to enlarge

This is the refusal letter that was received by Southernmost Medical Supply , a small business, recently opened to save elders the long drive to Miami or the wait for medical supplies that are often needed quickly and from a local source. This letter was received from Medicare who refuses to pay for the electrical bed and supplies he delivered in order for Clara to be home.

Reason being double billing , the feeding frenzy after Clara's incapacitation had some people in the medical (field) jump on the Medicare Gravy train, and Clara was billed excessively for emergency transport, ostomy bags, a host of tranquilizer drugs, and non existent goods and services.

"Florida neglects wheelchair users to save money"

Revised on 6/18/07 Due to the ongoing discussion about Medicare we will publish a series of articles discussing this problem.

I am writing this letter on behalf of disabled people across the state of Florida because many disabled people are afraid to speak up for their rights. Many disabled people who rely on a combination of Medicaid and Medicare are suffering in silence, unable to get what they need in order to live a decent life and to avoid being in constant pain.

I was born 32 years ago with severe cerebral palsy. I grew up in Central Florida, where my family settled after leaving Laos.

Most people have no clue what people who are in wheelchairs have to deal with. Wheelchairs are like cars to disabled people, they are an absolute necessity. We need wheelchairs so that we can get around and live a normal life.

Wheelchairs need to be as comfortable as possible because we have to spend up to 12 hours or more a day in them. This is why wheelchairs cost a lot of money. Every little part has to be customized to fit our body so we won't get pressure points and sores.

In my case, most of the parts must be strong because of my strong muscle tone. When the wheelchair is not made to fit the person's body just right, it causes medical issues. And this costs the system more money.

It is becoming impossible to find a qualified wheelchair company that meets the needs of a person with severe disability. The good companies aren't taking clients with Medicare anymore. Good companies aren't getting paid on time and not getting paid what the equipment is really worth. This is because of the fact that the people who are in Tallahassee, when they make the laws, they don't seem to think about the disabled. All they seem to think about is how to save money.

So now we are stuck with companies that have no clue what to do with a severely disabled person.

Also, the idea that you must get three quotes is crazy. Then someone approves the lowest bid. That's not fair to us at all. We should be able to choose the company that we want. We are the ones who have to use the equipment. What happened to our right to choose?

MANYVONE CHAMPAVANNARATH

Lakeland

Medicare Driving Small Businesses Out


Medicare Drug Program News

Medicare Payment Delays Driving Pharmacies Out of Business, They Say

Average 3 store closures per day in 2006, first year of drug program

June 14, 2007 – Senior citizens may be getting their drugs cheaper through Medicare Part D, but they may soon have problems finding a place to get their prescriptions filled. In 2006, on average, more than three community pharmacies closed everyday, as a result of slow reimbursement by Medicare during the first year of the prescription drug program, according to the National Community Pharmacists Association. Read more...

Thursday, May 17, 2007

Senator Kohl Decries Deceptive And Confusing Sales Practices Of Medicare Advantage Plans, Vows Continued Oversight By Committe

PRESS RELEASE May 16, 2007

Spurred by Hearing, Industry Promises to Improve Training of Insurance Agents

WASHINGTON – At a hearing held today by the U.S. Senate Special Committee on Aging, Chairman Herb Kohl (D-WI) challenged the sales and marketing practices employed by insurance agents selling Medicare Advantage plans. Medicare Advantage plans, which are private plan options offered to Medicare beneficiaries as an alternative to traditional Medicare, now account for nearly 20 percent of total Medicare plans and are an increasingly profitable enterprise for many corporate providers. The Committee’s investigation has uncovered such questionable sales practices as removing seniors from traditional Medicare without their knowledge, signing seniors up for plans they cannot afford, and misleading seniors regarding which physicians and hospitals accept the plan. Officials representing the state insurance commissions from Wisconsin, Oklahoma, and Georgia offered testimony about complaints they have received concerning the aggressive, and at times deceptive, marketing practices of Medicare Advantage sales agents.

“Widespread confusion, and in some cases outright misrepresentation and fraud, have been associated with the sale of these plans. Our investigation has revealed a disturbingly consistent picture, one which only seems to be growing,” Chairman Kohl said. “Too many seniors are paying a terrible price for those frauds, misunderstandings, and outright ignorance. This is simply unacceptable.”

Based on current law, the Centers for Medicare and Medicaid Services (CMS) has exclusive authority to investigate and discipline plans marketing and selling Medicare advantage products, leaving states only with the power to investigate and enforce violations against individual insurance agents. Abby Block, Director of the Center for Beneficiary Choices at CMS, offered testimony about this federal-state oversight relationship, one which has left a sizable enforcement gap and has exacerbated the problems found by the Committee.

In response to this enforcement gap, Chairman Kohl announced his intention to work with the National Association of Insurance Commissioners and other stakeholders to develop legislation that would give states expanded authority to oversee plans and agents. Kohl also stated the Committee’s intention to continue exercising oversight and investigation of the industry and its sales practices.

“If more hearings are necessary to hold feet to the fire, we will hold them,” said Chairman Kohl. “Cleaning up these marketing and sales practices is a priority of mine. Let me be clear, this issue will not go away after this hearing.”

Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP), revealed during testimony today a new initiative to strengthen training for its members’ agents and brokers. AHIP represents approximately 1,300 health insurance plans. Additionally, executives from Humana Inc., UnitedHealth Group, and WellCare—all of which are corporate providers of Medicare Advantage plans—announced efforts to reform their marketing and sales practice guidelines during their testimony.

A webcast of the hearing will be available later this afternoon on the committee webpage: www.aging.senate.gov

Testimony from the hearing is available on the committee webpage: http://aging.senate.gov/hearing_detail.cfm?id=274320&

Ashley Glacel Press Secretary Special Committee on Aging
Senator Herb Kohl, Chair Ph: (202) 224-5364
Cell: (202) 340-3299 www.aging.senate.gov

Pharma Profits Sky High From Medicare Part D

by Ronni Bennet

According to U.S. House of Representatives Committee on Government Reform investigators, prices for the ten most prescribed, brand-name drugs under Medicare Part D climbed 6.8 percent in just four months – from mid-December 2006 to mid-April 2007.

The price of my one drug of choice or, rather, my physician’s choice for me – Lipitor – increased by 9.6 percent during the same period, from $76.91 for a month’s supply to $84.27, and the list price has climbed by five percent.

[The reason the list price is less than the actual increase has to do with rebates drug companies pay the Part D insurance companies. If you really want to know, you can read Jonathan Weisman’s story in the Washington Post.]

Of course, Part D subscribers’ co-payments are less than that full price – until they hit the doughnut hole during which they pay all drug costs until they reach the $3600 out-of-pocket limit when Part D kicks in again. So those who reach the doughnut hole will be paying more now.
Because most Part D subscribers have a fixed co-payment those who, like me, do not reach the doughnut hole, will see no change in their cost - this year. Premiums are likely to increase in 2008.

Abridged Read it all here >>

Thursday, April 19, 2007

Senate Bars Medicare Talks for Lower Drug Prices

By ROBERT PEAR Published: April 19, 2007

WASHINGTON, April 18 — A pillar of the Democrats’ program tumbled on Wednesday when the Senate blocked a proposal to let Medicare negotiate lower drug prices for millions of older Americans, a practice now forbidden by law.

Fifty-five senators, including six Republicans, supported a Democratic motion to limit debate and proceed to consideration of the bill; 42 senators voted against it. The Senate had a brief debate on the merits of the bill, which is a priority for the new Democratic majority in Congress.

Republicans framed the issue as a choice between government-run health care and a benefit managed by the private sector. The benefit is delivered and administered by private insurers under Medicare contracts.

Senator John Cornyn, Republican of Texas, denounced the bill as “a step down the road to a single-payer government-run health care system.”

Democrats said they were merely trying to untie the hands of the secretary of health and human services so he could negotiate on behalf of 43 million Medicare beneficiaries.

“The Department of Veterans Affairs is able to negotiate for lower-priced drugs,” said the Senate majority leader, Harry Reid, Democrat of Nevada. “H.M.O.’s can negotiate. Wal-Mart can negotiate. Why in the world shouldn’t Medicare be able to do that?”

A 2003 law prohibits Medicare from negotiating or setting drug prices or establishing a uniform list of covered drugs, or formulary.

Mr. Reid said Democrats fell short because of “the power of the insurance industry and the pharmaceutical industry,” which spent hundreds of thousands of dollars on lobbying and advertisements against the bill.

The vote also reflected ineffectual advocacy by Democrats, who were slow in responding to the vehement arguments of well-prepared Republican senators like Charles E. Grassley of Iowa.

“Private competition works,” said Mr. Grassley, a principal author of the 2003 law. “The Department of Health and Human Services has had very little experience and a dismal track record” figuring out what to pay for drugs.

Big companies that offer the Medicare drug benefit, like Caremark and Medco Health Solutions, “have more market power than Medicare” because they negotiate for tens of millions of people in private plans, as well as for Medicare recipients, Mr. Grassley said.

Senator Ron Wyden, Democrat of Oregon, said he did not want the government to supplant private plans. But, Mr. Wyden said, Medicare could negotiate better bargains on selected drugs that have no therapeutic equivalents or competition.

The House passed a bill requiring the secretary of health and human services to negotiate drug prices by a vote of 255 to 170 on Jan. 12, eight days after Congress convened. The Senate bill permits but does not require negotiations.

President Bush had threatened to veto both versions. AARP, the lobby for older Americans, supported both.

The Republican senators who joined Democrats in voting to take up the bill on negotiating prices were Norm Coleman of Minnesota, Susan Collins of Maine, Chuck Hagel of Nebraska, Gordon H. Smith of Oregon, Olympia J. Snowe of Maine and Arlen Specter of Pennsylvania.

Two candidates for the Republican presidential nomination, Senators Sam Brownback of Kansas and John McCain of Arizona, were not present.

An aide to Mr. McCain said he was campaigning in South Carolina and would have voted with the Democrats. An aide to Mr. Brownback said he would have sided with most Republican senators.

In creating the benefit in 2003, Congress made a radical departure from traditional Medicare, which has uniform benefits defined by law. Medicare recipients in every state have a choice of prescription drugs plans with different benefits, premiums, co-payments and deductibles. The 2003 law prohibited the government from interfering in negotiations between drug manufacturers and companies that provide the benefit. The House and Senate bills would repeal that ban.

Employers and health plans typically obtain discounts on particular drugs in return for encouraging patients to use those medicines, rather than competing products.

The Congressional Budget Office said that the Senate bill, like the House measure, “would have a negligible effect on federal spending.”

“Without the authority to establish a formulary or other tools to reduce drug prices, we believe that the secretary would not obtain significant discounts from drug manufacturers across a broad range of drugs,” the budget office said.

Some Republicans prepared to filibuster the Senate bill, but that proved unnecessary. Their whip, Senator Trent Lott of Mississippi, said Republicans had blocked consideration of the bill because they did not want to dicker with Democrats over amendments on unrelated topics, “with no happy end in sight.”

Mr. Wyden predicted that the Senate would vote again on the issue, perhaps as an amendment to a spending bill or other measure. “The fight will go on,” he said.

Senator Amy Klobuchar, a freshman Democrat from Minnesota, said the vote showed that “the power of big pharma,” the pharmaceutical industry, “is still a presence in the halls of Congress.”