The number of people enrolling in Medicare is rising from 39.7 million in 2013 to 55.7 million in 2015. In fact, according to the CommonWealth Fund, there are projected to be 81 million enrollees by 2030.
The second part of this Medicare fraud and abuse series is designed to examine some of the most common ways that Medicare fraud and abuse manifest themselves.
This is a common abuse perpetrated on Medicare patients. This is when a medical facility bills you or the government for a service, treatment, or medication you never received. The guilty party can be your doctor padding your claims to increase their profit or it can be the result of identity theft.
No Medical Necessity Fraud
No Medical Necessity Fraud can be one of the most difficult to identify. In a typical case, a medical provider will submit a claim for medications, ambulatory services, or medical devices that the patient did not actually need. In extreme cases, victims can even be subjected to dangerous surgeries with little to no possible benefit. While it helps unscrupulous providers pad their pockets, it puts patients at risk and places extra costs on the Medicare system. Since most patients are inclined to trust their doctor's opinion, it can be difficult to know whether a given medical procedure is actually necessary.
Many important surgeries are made up of a number of essential steps, but each step is considered part of the larger procedure -- they are bundled. But many times, a doctor can receive a greater amount of money by billing for each individual step separately. By doing this, the doctor can increase their own profits, leaving you and the Medicare system will be facing an undue burden.
Pharmaceutical companies have huge profit margins on many of their basic products, despite the availability of less expensive generic options. That is because the pharmaceutical reps often provide incentives for doctors to prescribe their medications, including financial benefits, among other things. At its worst, doctors will prescribe medication that offers no real benefit for a patient in order to fulfill their part of the agreement made with the pharmaceutical companies.
There are a number of different ways Medicare and Medicare Advantage patients may be defrauded. While the fraud might seem harmless to some, certain kinds may have life threatening results for the patient. But don't worry, in the next blog of this series, we will look into what you can do to prevent health care fraud.
The Commonwealth Fund, "Medicare's Numbers Game," April 2015
B 0249 10
Medicare open enrollment season, which runs between October 15 – December 7, 2017, is fast approaching. During this time thousands of Americans will be applying for benefits. While Medicare and Medicare Advantage offer benefits to millions of people, fraud and abuse are two issues that adversely affect Medicare and the people who depend on it. In fact, a 2015 report found that as much as $60 billion was lost through Medicare fraud in 2014.
In this three-part post, we will take a close look at health insurance fraud and abuse, how they happen, and what you can do to prevent them. In this first post, we will explain what Medicare fraud and abuse are and, more importantly, why they matter.
What Is Medicare Fraud?
To put it simply, one type of Medicare fraud occurs when someone knowingly makes a false claim for services and procedures that never happened. That means your doctor or another party is charging the Medicare system for services never rendered. Because health care providers are reimbursed by the government for treating Medicare patients, it is a potentially lucrative form of fraud that costs taxpayers billions every month. We will dive deeper into the types of Medicare fraud in post two.
What Is Medicare Abuse?
Medicare abuse is a little different. One example is when a doctor administers treatments or procedures that do not truly benefit a patient. These procedures can range from unneeded but harmless prescriptions to potentially deadly surgeries. In this case, work is being performed by the doctor, but the work was not necessary. Medicare abuse exposes patients to unnecessary risk.
Why Should Anyone Care?
People seem to care more about Medicare abuse because it can have a negative impact on a person's life, even resulting in death. But fewer people seem worried about Medicare fraud. All too often, it's seen as a victimless crime. That simply isn't true. As tax payers, it's your money being stolen and wasted.
Plus, every unnecessary cost to Medicare results in an undue burden on the Medicare system as a whole, which then results in higher premiums and health care costs for everyone who relies on the program.
That's why Medicare fraud should be a concern for every American, whether they pay for private insurance or are on Medicare. In the next post, we will examine the most common methods of Medicare fraud and abuse.
ABC News, "Medicare Funds Totaling $60 Billion Improperly Paid, Report Finds," July 2015
Medicare Consumer Guide, "Preventing Medicare Fraud"
B 0249 09
Medicare is one of the most popular government run programs in the nation. Every day, 10,000 Americans enroll in Medicare and around 37 million rely on Medicare for their preventative health services like flu shots and cancer screenings.
According to the Kaiser Family Foundation, 6 in 10 Americans report that the program is working well. That number climbs when you look at seniors, 8 out of 10 of whom believe Medicare works well for them. But working well and working perfectly are two separate things.
A major flaw in the Medicare program is the risk for both fraud and abuse. Fortunately, there are ways for concerned seniors to help combat both, thanks to the Senior Medicare Patrol.
What Is the Senior Medicare Patrol (SMP)?
The SMP is a network of specially trained volunteers who seek out evidence that abuse or fraud has occurred and report it to the proper authorities. In doing this, the SMP helps to prevent undue burden on the Medicare system that could potentially cause a rise in the price of senior health care.
Who Are the Volunteers?
The vast majority of the roughly 5,000 nationwide volunteers are civic-minded Americans who are retired and on Medicare. Like a neighborhood watch, these volunteers are among the first defense against the sort of fraud that could have devastating effects on the Medicare system.
What Do SMP Volunteers Do?
SMP volunteers are responsible for a number of services geared towards improving the life of Medicare beneficiaries and their families. Among the most common tasks are:
Whether you are looking for a way to help combat the issues of insurance fraud and abuse, or you are looking for a way to find out if you yourself might be at risk, SMP offers a number of services and opportunities that might interest you. To learn more about this important program, visit the official website.
This concludes our three-part series on Medicare fraud and abuse. Knowing what to watch out for can make a real difference in your risk of being taken advantage of.
If you have any additional questions, give us a call at Bankers Fidelity at (866) 458-7500.
The Henry J. Kaiser Family Foundation, "The Public's Health Care Agenda for the 113th Congress," January 2013
Senior Medicare Patrol, "Become a Volunteer"
B 0249 11
Diabetes is a serious and pervasive disease in the United States. With around 9% of the population suffering from this disease, it is among one of the most common chronic diseases faced in our country -- especially among the elderly. According to National Diabetes Statistics Report, 2017, the percentage of adults 65 and older living with diabetes has increased to 25.2% (U.S. Centers for Disease Control and Prevention, National Diabetes Statistics Report, 2017).
In this three-part series, we are taking a closer look at this disease and its effects on Americans. In this second installment, we will be examining the way that diabetes affects the elderly, especially those on Medicare.
Diabetes Prevention and Medicare
The increased emphasis on offering preventative health services through Medicare has meant that there are now more resources available to help those who are at risk of developing diabetes. Medicare beneficiaries can now be diagnosed and receive medical advice that may help prevent the disease from fully developing.
Diabetes and Original Medicare
When it comes to diabetes care, Medicare Part B is probably the most relevant portion of what is traditionally considered Original Medicare (Part A and Part B). Part B covers many important outpatient services, medication, and supplies for diabetes care. Some (but not all) examples of what is included:
· Blood Glucose Strips
· Lancet devices
· Glucose Control Solutions
· Insulin Pumps and Pump Supplies
· Obesity Screening
While Original Medicare does cover a wide range of diabetes medical treatments, you will be required to pay a monthly premium. You will still be responsible for a deductible on many of your medical expenses. Typically, that deductible will be 20% of the Medicare-approved cost. Medicare Supplement insurance may cover those gaps in which Original Medicare does not cover.
Diabetes and Medicare Part D
Part D is an important plan to consider if you suffer from diabetes. That is because Part D allows you to choose a prescription drug program. While Original Medicare generally only covers insulin that is used in a pump, Part D allows you more flexibility. In addition, you could have more access to other drugs that can be helpful in combating diabetes.
Medicare Part D will cost an additional premium and requires a copay or deductible depending on the specific plan you choose. Additionally, you will need to pay attention to the coverage gap. This temporarily increases the copay on prescriptions after a certain amount has been spent (this “amount” is not enough to qualify for emergency coverage, though).
Medicare may be very beneficial for people with diabetes. Still, you will need to carefully weigh the benefits of different Medicare plans to find what is right for you.
In the third portion of this series we will examine the way that diabetes can affect life insurance.
While both Medicare Advantage Plans and Medicare Supplement Insurance plans are both designed to provide additional coverage that Original Medicare doesn’t account for, they are in fact two very different plans and should not be confused with each other.
The biggest difference is that Medicare Advantage Plans are designed as an alternative to Original Medicare. Those who enroll in these types of plans are still in the Medicare program, but the new Advantage Plan is where the benefits come from. There are also requirements that must be met in order to enroll in a Medicare Advantage Plan, including having Original Medicare Part A and Part B.
On the other hand, Medicare Supplement Insurance works alongside Original Medicare and is designed to provide coverage to fill the gaps where Medicare doesn’t cover. These costs include deductibles or co-payments.
Unlike Medicare Advantage Plans, if you buy a Medicare Supplement Insurance plan, you must still be enrolled in Original Medicare. The original plan will provide all hospital and medical coverage and the supplement plan will cover those some cost-sharing expenses.
Another benefit of having certain Medicare Supplement Insurance plans is that some of them will help cover other costs, such as medical coverage for those outside the U.S.
When determining which options is right for you, it is important to think about the different benefits of each plan. For those considering adopting a Medicare Supplement Insurance plan, you will have the option of choosing from a variety of plans and private providers.
Bankers Fidelity offers various plans in multiple states. Before you decide what is right for you, speak with an agent to better understand exactly what benefits a Medicare Supplement Insurance plan can have.
Diabetes could have an effect on your ability to procure life or health insurance. In this series, we will take a closer look at this disease and the effect it can have on your acquiring Medicare and/or life insurance.
In the first part of this series, we will examine specifically the disease itself.
What Is Diabetes?
Diabetes is a disease that prevents your body from properly processing glucose, or blood sugar. While glucose is an important energy source, especially for the brain, it can cause problems when left unchecked.
There are two main types of diabetes. Type One Diabetes happens for an unknown reason, although it is largely thought to be based on genetic susceptibility. It is usually found in children and young adults. Type Two Diabetes, the most common form, is the result of poor diet, as well as genetics.
In both cases, the body is no longer able to use insulin properly regulate glucose levels. Insulin, a natural hormone, is either no longer being produced in adequate amounts (Type One), or the body has developed an immunity to insulin, which means you need an amount far above what your body can produce in order to regulate glucose (Type Two).
What Is Prediabetes?
In 2015, 84.1 million Americans, age 18 and older, had prediabetes (U.S. Centers for Disease Control and Prevention, "More than 100 million Americans have diabetes or prediabetes," July 2017). Prediabetes occurs when your body begins to acquire a tolerance to insulin. Your body then ramps up production of insulin to combat your increasing tolerance.
The key distinction here is that your body may recover from prediabetes. With the proper healthy lifestyle and preventative health services, you may be able to keep prediabetes from escalating to the point of no return. Currently, there is no cure for diabetes, which means you will require lifelong treatment to keep the condition under control. People with prediabetes are at a higher risk for Type Two, heart disease, and stroke.
How Can You Try To Prevent Diabetes?
Small steps can make a huge difference if you have been diagnosed with prediabetes. Incorporating small, healthy habits into your lifestyle may help stall or even reverse the development of your body's insulin immunity. Going for a few walks per week and replacing sugary treats with fiber rich fruits and vegetables may have a positive impact.
Diabetes is a widespread problem, affecting the lives of millions. Every year, 1.5 million Americans are diagnosed (U.S. Centers for Disease Control and Prevention, "More than 100 million Americans have diabetes or prediabetes," July 2017). It could have severe consequences for your health, your lifestyle, and your medical and life insurance coverage and premiums. In the next installment of this three-part series, we will examine the intersection of diabetes and Medicare.
While there is much debate as to whether it is a matter of genetics or environment, African Americans are statistically much more likely to be diagnosed with a number of illnesses, even if they have never engaged in high-risk behaviors: African American men, for instance, are 50% more likely to get lung cancer than white men, even with lower tobacco exposure.
While many outside of the LGBTQIA might associate these populations with an increased chance of HIV, there are other ailments that disproportionately affect those communities. The list includes physical maladies such as diabetes and anal cancer, and also a much higher rate of mental illnesses such as depression, especially among the older populations.
Protect Your Medicare Information Online
Understanding Medicare Supplement
Neither Bankers Fidelity Life Insurance Company® nor its Medicare Supplement policies are affiliated with or endorsed by the U.S. Government, the federal Medicare program, or the Centers for Medicare and Medicaid Services. This is a solicitation of Medicare Supplement insurance and an independent agent may call on you. The Medicare Supplement products issued by the Company are insurance policies. Policy form series B 21092 is issued by Bankers Fidelity Life Insurance Company®, Atlanta, GA; policy form series B 21492 is issued by Bankers Fidelity Assurance CompanyTM, Atlanta, GA. Limitations and exclusions apply; actual policy provisions control. Rates subject to change on a class basis. Individually underwritten; application to determine eligibility required.
Products not sold in AK, CA, CT, MA, ME, MN, NH, NY, OR, RI, VT, WA or WI. Plan availability can vary by state.
Get a Quote