On Friday, (July 22, 2016), the Department of Justice charged three individuals for conspiring to create a fraud scheme which billed more than $1 Billion to Medicare & Medicaid. One of the saddest parts of the story - "patients who were drug addicts were prescribed opioids - including OxyContin and Fentanyl to entice them to stay in the facilities." You can find more about the $1B case in this WSJ article. This story made front page news this weekend, and rightfully so since $1B is a lot of taxpayer money! But, you know what is sad about this story? $1B is only 0.17% of the ~$600B spent each year on Medicare. According to a Bank of America study (see Infographic below), Seniors (65+) spend an average of $3,450/month or ~$41,400/year. So, what is 0.17% of $41,000? About $69/year. To put this in perspective, it would be as if you found out your landscaper overcharged an extra $5.75/month on your bill. What should you do? This math above is not intended to downplay the fraud that these alleged individuals committed. Actually, just the opposite - it's intended to bring perspective to the massive amount of money ($600B) this country spends on Medicare each year. We should all be scrutinizing the program to ensure it lasts for generations to come. Example EOB Above. Here is a good article on how to read an EOB.
I hope the DOJ continues to pursue these cases and prosecute to the full extent allowed by law. More importantly, I hope fewer and fewer individuals attempt to scam our Medicare Program in the future.
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In the media today, it is tough to find an objective source of information. You may have noticed that I am very interested in non-partisan reports, and I try to keep our blog updated with my perspective on these reports. About a month ago, the Medicare Board of Trustees Report was released which showed a projected depletion of the Hospital Insurance fund by 2028. You can find my article here related to this report. CBO 2016 Long-Term Budget Outlook Last week (July 12, 2016), the non-partisan Congressional Budget Office (CBO) released the Long-Term Budget Outlook, which is a broader report that shows similar concerning trends. • Here are a few of the key takeaways directly from the recent CBO Report.
This strong language is from a non-partisan CBO report. This is not a scare tactic from one side of the aisle. We need this to be one of the top issues that are policy makers are focusing on after the election. Medicare & Social Security are two great benefits in this country – but we need policy reform initiated ASAP to keep these systems financially viable for generations to come. I am always curious to get people's perspectives on these key issues. Is this economic projection blown out of proportion or is it a major risk? What are some suggested solutions? I presented a few solution paths in my last article on the Medicare Board of Trustees Report, . Feel free to share your thoughts on our blog. According to the Centers for Disease Control (CDC), there are ~29m people in the U.S. (about 1 in 11) that has diabetes. Check out the entire CDC Diabetes infographic here. For Diabetics going on or already on Medicare, confusion is common. How do I pay for my needles & testing strips? What about the insulin? Is my pump covered? These are just a small sampling of questions that we hear often related to Diabetes & Medicare. Some responses to the FAQs are below. Are my blood testing equipment & supplies covered by Medicare? Testing Strips, Monitors, Lancet Devices & lancets are covered by Medicare Part B. This is good news for individuals who have original Medicare with a decent Medicare Supplement (e.g. Plan F or G) since Medicare will pay 80% of the cost and the Supplement will pay the other 20%. What about my insulin? Medicare drug plans (Part D) cover injectable insulin not used with a pump. Insulin can be very expensive and will most likely result in reaching the Part D donut hole (aka Coverage gap) of Medicare. Find out more about Part D and the Donut hole. What if I take Metformin (or a similar drug) instead of insulin? These drugs are generally covered under Part D. You want to make sure you pick the correct Part D plan when you initially enroll in Part D, and each year during your Open Enrollment (Oct 15 – Dec 7). More information and a short video about the Part D RX analysis can be found here. ![]() www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE18011.pdfIs my insulin pump covered? As a general rule, insulin pumps are not covered by Medicare. However, if a doctor provides a prescription indicating the insulin pump is medically necessary, then Part B (and a Medicare Supplement) will cover both the insulin pump and the insulin. Read this: Medicare's Coverage of Diabetes Supplies & Services These are just a few of the FAQs we hear related to diabetes. If you are Diabetic or interested in learning more, you should definitely read through the Medicare’s Coverage of Diabetes Supplies & Services created by CMS (Center for Medicare & Medicare Services). |
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