Medicare Fraud Effects All Medicare and Medigap Participants

With the nation’s attention focused on the current healthcare debate, many U.S. citizens are growing increasingly concerned over the promise of an increase in healthcare bills over the coming year and decades. Medicare participants, especially, stand to see a significant increase in the cost of their healthcare, according to some experts, especially supporters of the Republican party.

In the face of these expected fee increases, the Florida Department of Health and Human Services has just announced a shocking case of Medicare fraud in Miami-Dade County, Florida. According to a report released by the Department of Health and Human Services Office of Inspector General, Miami-Dade County received about half a billion dollars for Medicare in-home health care payments in 2008. This amounts to a payment of more than the entire nation combined.

Despite the huge amount of claims from Miami-Dade County, the county only accounts for slightly more than half of the nation’s claims. Moreover, only 2 percent of patients who receive home health care live in the county. The Medicare fraud is not only blatantly obvious, but it is costly for everyone; Medicare fraud amounts to more than $3 billion each year because of false claims.

Medicare fraud comes in many forms. In some cases, healthcare agencies have billed the Medicare program for home health services that they claim were rendered for homeless people. IAccording to an article published Monday by the Associated Press, “a large percentage of the patients are diabetics who claim they are blind and bill Medicare for a day and night nurse to give them insulin shots.” However, upon further investigation, the beneficiaries are not actually blind.

“What we’re finding in a lot of the cases is the patients don’t even have diabetes and certainly aren’t blind,” said Kirk Ogrosky, who heads the Medicare Fraud Strike Force across the United States for the Department of Justice. The report indicates that Medicare payments for home healthcare for diabetics in Miami are eight times the national average.

Medicare beneficiaries who participate in the Medicare scams may stand to benefit financially for their services. According to the AP article, patients are paid between $700 and $1,400 for their participation. Eight suspects in Miami were charged with getting $22 million from the system through fraud.

What does this fraud mean for Medicare beneficiaries across the country? Ultimately, it means that the Medicare system pays out a significant amount of money from shared coffers for fraudulent claims, reducing the available money for real claims. As Medicare funds are stretched thin, Medicare payments to providers are ultimately reduced and Medicare fees for beneficiaries are ultimately increased.

To help protect themselves against the negative side effects of Medicare fraud, many Medicare participants would benefit by enrolling in Medicare Supplemental insurance plans that will help to cover the costs of many healthcare services and products that are not covered by Original Medicare. Medicare Advantage plans may also provide Medicare participants with more options when it comes to getting the right healthcare for their needs.

Ultimately, Medicare fraud costs the nation billions of dollars and increases fees for all participants. However, by taking steps to protect themselves from these fee increases, many Medicare beneficiaries can minimize the effects of Medicare fraud on their own pocketbooks.

Medicare participants have until December 31, 2009 to make changes to their Medicare plans for 2010, including the addition of Medicare Supplemental insurance.

Medigap Insurance Medicare Supplements Affect on Home Health Care

What’s Covered and What’s Not

Medicare covers therapy, both physical and occupational therapy plus speech language pathology services. It also covers counseling, certain medical supplies, durable medical equipment, as well as assistance with day-to-day activities like bathing, dressing, grooming, eating, and toilet activities. For most of the other medical equipment, Medicare will provide coverage of 80% of its cost.

On the other hand, Medicare will not cover 24-hour home care, delivering meals to your home, and services that are not related to health care like housekeeping. You will also be required to pay 20 per cent for medical equipment not covered fully by Medicare like wheel chairs, walker and oxygen tanks.

On Medigap and the Possibility of Larger Coverage

Medigap, a supplement to Medicare insurance, covers certain services that Medicare doesn’t cover. This might just also be the solution to patients on home health care. When used together with a Medicare supplemental plan, Medigap Insurance allows the patient to enjoy a larger coverage in terms of health benefits.

More often than not, Medigap and Medicare can cover a substantial portion of the costs on home health care. Insurance companies offer a variety of Medigap policies (Plans A through L), but since each type comes with specific benefits, it is best to compare the highlights closely. For one, Medigap policies vary by cost, and many insurance companies require you to have both Medicare Parts A and B in order to purchase a supplemental plan (5).

For senior citizens with both Part A and Part B of Medicare insurance, their home health care situation is, by default, covered. Thus, they get to save 20 per cent of their pocket expenses on medical equipment.

The cost of home health care should not cost an arm and a leg especially with Medicare and Medigap Insurance just within reach. Just keep in mind what your Medicare (and Medigap) insurance benefits are.

Ask information from your physician, home care agency, and insurance officer at Medicare Supplemental Insurance center.