Category Archives: Medicare

Beware of Phantom Pharmacies

Why am I not surprised to find out that federal health officials have failed in their efforts to police the emergence of phantom pharmacies?

These pharmacies are fly-by-night storefront operations that bilk millions of dollars in false Medicare bills and then vanish with the cash.

No permits are needed — there is no store or pharmacy as we know them. There are no medicines on the shelves, no employees, no real in-store customers, and yet these fake pharmacies produce huge bills for medication, defrauding Medicare of millions of dollars a year.

It seems the only people making money these days are the crooks.

How is this accomplished? Thieves, crooks and fraudsters use a legitimate address to establish a fake pharmacy business. Then, using stolen ID and patient insurance ID numbers (mostly from seniors), scammers write fraudulent prescriptions for expensive drugs that were never actually prescribed.

Next, they submit these fake prescriptions for reimbursement to insurers, Medicare or Medicaid. In a single claim, a fake pharmacy canmake anywhere from $2,000 to $8,000. Some “fraudster pharmacies” only exist a few days! By the time the fake reimbursements have been collected, the phantom pharmacies have long since closed and their operators have disappeared without a trace.

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Several Bills Currently In Congress

There are several bills currently in Congress that will impact Medicare and senior service providers:

The first is a reintro­duced initiative to forgive student loans for those medical professionals who agree to service seniors in underserved ar­eas.

The second is a bill which would modify the new rule requiring a face to face doctor visit for ordering Medicare home health nursing services, by expanding the rule to allow nurse practitioners to order the visits as well.

Third, patients, families, and facilities are negatively impacted by the arcane rule requiring a three day stay in the hospital in order for Medicare to pay for the skilled nursing facility charges. There is a bill before Congress that would change this requirement to include “observation” time.

Thanks to Robin Smith Consulting for these valuable updates

Plan For The Worse…Live For The Best

Here is what I know – At 59 I’m healthier than either of my parents were at age 59. I have never smoked. I’m fairly active and exercise some but not overly. I eat fairly well, but not always. I drink socially but not in excess. So what are my odds of remaining healthy and being able to care for myself? Better, I’m sure than my parents but the fact remains that the odds of something happening to me beyond my control still exists. Any number of accidents could befall me. What then?

We Boomers don’t like to think or talk much about aging. For us, and many in our generation, the idea of needing long term care is down the road a ways.

We avoid discussing these issues for several reasons; most notably as discussed above is that of denial. Secondly, I think that we have come to expect that the government will take care of us through Social Security, Medicaid and Medicare. Unfortunately, we ignore the fact that these programs are not fail safe measures of obtaining care especially if we want to remain in our homes. Yes, it is likely some form of government benefits will be there but statistics and finances will make it more difficult for us to receive these benefits.

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What Is Home Health Care?

Simply stated it is the physical and mental supportive system and care services provided to those persons wishing to remain in their homes or assisted living apartments by a caregiver, caregiving agency, and/or assisted living environment when they can no longer perform (without help) the day-to-day activities of everyday living.

Today, many persons are opting for home care, and or home care assistance in assisted living environments as outpatient care has become the ‘norm’ for hospitals and insurance companies. Home care is appealing to many of us as we most often feel that our home is an extension of ourselves.  Receiving ‘in-home-health-care’ can be a great benefit to those recovering from surgery or other medical procedures that can limit their ability to easily take care of themselves, or maybe they just require a little extra help managing things as they grow older or maybe they are learning to live with a medical condition or disability. Whatever the scenario, I urge you to review and consider the questions below as this ‘issue’ nears closer to you and yours.

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Healthcare: Make Your Voice Heard

Several weeks ago I wrote a column in relation to some proposed changes to Healthcare in America and my thoughts regarding those changes. Low and behold others must have felt the same. I think we should all take another long hard look at this ‘healthcare proposal’ of Paul Ryan’s and all others that are presented and then we must be prepared to voice our approval or dislike – loudly!

I have said it before, the Boomers have a strong influence and lately with the mortgage fraud and financial manipulation of securitized investments, many of our contemporaries have seen their retirement funds dwindled to nothing or near to nothing. On top of all that some government leaders, such as Ryan, were thinking of causing those very same Boomer-Seniors to have less health support as they age.

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Getting The Most From Medicare Drug Plans

Thanks to Robin Smith for this informative article

While the majority of the healthcare delivery system is plagued by runaway costs and obtuse and arcane billing prac­tices, consumers often overlook aspects of their benefits that can actually save money, and possibly improve their health. All Medicare Prescription Drug Plans (aka “Part D”), include underutilized features that seniors who take multiple medica­tions may want to utilize. The first is medication manage­ment provided by the plan at no additional cost to the client. Details on this service, as practiced by individual plans, are in the membership booklet, or can be explained by calling cus­tomer service. Secondly, if the senior has a drug prescribed by the doctor which is not in (or has been removed from) the plan’s formulary, the senior does have avenues available to get the plan to cover the drug. Called “step therapy,” the patient’s doctor can write a letter to the plan, stating the rea­sons why the patient must receive the drug. Reasons can in­clude things like: all other drugs for the condition have been tried and failed, interaction with other drugs the client is tak­ing, etc. Once again, the membership book outlines how this benefit may be accessed.

Patients should always discuss whether or not they can afford the drug the doctor has prescribed, as cost is one of the main drivers of medication non-compliance. 78% of the drugs pre­scribed in the USA are now generics, although there is recent evidence that Big Pharma is fighting back by slowing the manufacturing of generics to create shortages. For seniors on multiple medications, consultations with pharmacists are free of charge. To prepare for a pharmacist consult, the FDA has a list of things the senior should bring. Seniors should always include non-prescription drugs on their lists, as drugs like Ty­lenol PM, with an active ingredient of Benadryl, can have very bad side effects when taken by the elderly.

When Medicare Open Enrollment comes around again, sen­iors can bring their medication list to Walgreens or CVS to determine the best PDP plan for them for 2012, free of charge

Home Instead Senior Care Is On Cable!

Finally, we are ON AIR! Just wanted to let our BLOG, TWITTER and FACEBOOK friends and readers know that the Home Instead Senior Care cable show is on! Hope you enjoy watching and hearing from those business’ and people who offer additional support and help to the growing population of seniors. It is my hope that the cable show will offer insight into better managing our families as we all enter into the ‘golden years.’ Here’s the cable station internet, AACS link where you may view the shows that have previously aired. Each week additional shows will be added. Lots more to come…guests are already booked through August. Any ideas for what you may want to know more about, your comments and/or input is always appreciated!

The Budget Battles: The Threat to Medicaid and Medicare

When will we see our elected officials make decisions that support the elderly in this country? We are currently underfunded in almost every area of healthcare and regardless of the claims made by most insurers that they are NOT making money, it seems more likely that they are just NOT making AS MUCH as they used to. Profits are down because people are living longer and instead of cashing out their policies they have opted to ‘hang-on’ to them…We are in a sad state of affairs when it comes to our seniors….

In an editorial written in today’s NY Times…

Representative Paul Ryan’s proposals to reform Medicare and Medicaid are mostly an effort to shift the burden to beneficiaries and the states. They have very little reform in them.

They certainly won’t solve the two most pressing problems in the nation’s health care system: the relentlessly rising cost of care and the shamefully high number of uninsured Americans — now hovering around 50 million. Mr. Ryan is also determined to repeal the new health care reform law. Never mind that the law would make real progress on both fronts, covering more than 30 million of the uninsured and pushing to make health care delivery more efficient and effective and less costly.

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