PHILADELPHIA: ‘ TWO DEFENDANTS CHARGED WITH MEDICARE FRAUD ‘

#AceNewsServices – PHILADELPHIA – Nov.07 – Fritzroy Brown, 37, and Thael Kuran, 22, both of Philadelphia, PA, were charged today by indictment with conspiracy to commit health care fraud and making false statements in connection with health care matters, arising from their operation of Brotherly Love Ambulance, Inc., announced United States Attorney Zane David Memeger.

defendants-charged-in-ambulance-health-care-fraud-scheme

PHILADELPHIA: ‘ TWO DEFENDANTS CHARGED WITH MEDICARE FRAUD ARISING ‘

Fritzroy Brown was also charged with theft of government funds and wire fraud for obtaining unemployment benefits while working full time at Brotherly Love Ambulance.

The indictment charges four other individuals with taking illegal kickbacks from Brotherly Love Ambulance and its employees.

According to the indictment, Craig Brown, 46, Derrick Brown, 44, William Conner, 61, and Keisha Regusters, 37, all of Philadelphia, PA, received kickbacks from the company to induce them to ride with Brotherly Love Ambulance or to induce other Medicare beneficiaries to ride with Brotherly Love Ambulance.

Craig Brown is also charged with making false statements in connection with health care matters; Derrick Brown and William Conner are charged with making false statements to federal agents. 

Source: 

#ANS2014 

#fraud, #medicare

`Obamacare Pro’s and Con’s of Enrolment by 31 March 2014 or risk paying a fine ‘

#AceHealthcareNews says according to WASHINGTON (AP) that everyone is sick of hearing about the health care law?
With plenty of people have tuned out after all the political jabber and website woes.

But now is the time to tune back in, before it’s too late, as we are being told that the big deadline is coming March 31.

By that day, for the first time, nearly everyone in the United States is required to be signed up for health insurance or risk paying a fine.

Healthcare.govHere’s what you need to know about this month’s open enrolment countdown:

ALREADY COVERED? NO WORRIES

Most people don’t need to do anything. Even before the health care law passed in 2010, more than 8 out of 10 U.S. residents had coverage, usually through their workplace plans or the government’s Medicare or Medicaid programs. Some have private policies that meet the law’s requirements.

If you’re already covered that way, you meet the law’s requirements.

Since October, about 4 million people have signed up for private plans through the new state and federal marketplaces, the Obama administration says, although it’s not clear how many were already insured elsewhere. In addition, many poor adults now have Medicaid coverage for the first time through expansions of the program in about half the states.

President Barack Obama is urging people who have coverage to help any uninsured friends and relatives get signed up.

NEED COVERAGE? IT’S CRUNCH TIME

Chances are you’ll hear more reminders about health care this month. The push is on to reach millions of uninsured people.

The administration, insurers, medical associations and non-profit groups are teaming up with volunteers to get the word out and guide people through the sometimes-rocky enrollment process. They plan special events at colleges, libraries, churches and work sites.

Singing cats, dogs, parrots — even a goldfish — are promoting the message in TV and online spots from the Ad Council.

A big hurdle for the effort: As recently as last month, three-fourths of the uninsured didn’t know there was a March 31 deadline, according to polling conducted for the Kaiser Family Foundation. Most said they didn’t know much about the law and had an unfavourable opinion of it.

Plus, many worry they won’t be able to afford the new plans.

The enrolment campaign is emphasizing that subsidies are available on a sliding scale to help low-income and middle-class households pay for their insurance.

How to enrol? Start at HealthCare.gov or by calling 1-800-318-2596. Residents of states running their own marketplaces will be directed there; people in other states go through the federal exchange.

After March 31, many people won’t be able to get subsidized coverage this year, even if they become seriously ill.

The next open enrolment period is set to begin Nov. 15, for coverage in 2015.

DEADLINE DETAILS

There are exceptions. The big one is the Medicaid program for the poor.

People who meet the requirements can sign up any time, with no deadline.

Also, people remain eligible for Medicare when they turn 65.

If you are insured now and lose your coverage during the year, by getting laid off from your job, for example, you can use an exchange to find a new policy then. People can sign up outside the open enrolment period in special situations such as having a baby or moving to another state.

You can choose to buy insurance outside the marketplaces and still benefit from consumer protections in the law.

People who do that wouldn’t normally be eligible for premium subsidies. But the Obama administration says exceptions will be made for people whose attempts to buy marketplace insurance on time were stymied by continuing problems with some enrolment websites.

MILLIONS OF PEOPLE WON’T GET COVERED

Some 12 million people could gain health coverage this year because of the law, if congressional auditors’ predictions don’t prove overly optimistic.

Even so, tens of millions still would go without.

That’s partly because of immigrants in the country illegally; they aren’t eligible for marketplace policies.

Some of the uninsured will not find out about the program in time, will find it confusing or too costly, or will just procrastinate too long. Some feel confident of their health and prefer to risk going uninsured instead of paying premiums. Others are philosophically opposed to participating.

Figuring out just how many of the uninsured got coverage this year won’t be easy because the numbers are fuzzy.

The administration’s enrolment count includes people who already were insured and used the exchanges to find a better deal, or switched from private insurance to Medicaid, or already qualified for Medicaid before the changes.

Some who sign up will end up uninsured anyway, if they fail to pay their premiums.

The budget experts predict enrolment will grow in future years and by 2017 some 92 percent of legal residents too young for Medicare will have insurance.

But even then, about 30 million people in the United States would go uncovered.

SOME ARE LEFT OUT

A gap in the law means some low-income workers can’t get help.

The insurance marketplaces weren’t designed to serve people whose low incomes qualify them for expanded Medicaid instead. But some states have declined to expand their Medicaid programs. That means that in those states, many poor people will get left out.

People who fall into the gap won’t be penalized for failing to get covered.

Some others are exempt from the insurance mandate, too: American Indians, those with religious objections, prisoners, immigrants in the country illegally, and people considered too poor to buy coverage even with financial assistance.

THE IRS IS WATCHING YOU

The law says people who aren’t covered in 2014 are liable for a fine. That amounts to $95 per uninsured person or approximately 1 percent of income, whichever is higher. The penalty goes up in later years.

A year from now, the Internal Revenue Service will be asking taxpayers filing their forms for proof of insurance coverage. Insurance companies are supposed to provide that documentation to their customers.

If you owe a penalty for being uninsured, the IRS can withhold it from your refund.

The agency can’t put people in jail or garnishee wages to get the money. But it can withhold the penalty from a future year’s tax refund.

Courtesy of: #ConnieCass

#AHN2014

 

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Medicare Drug Plan: “How People Get Caught Up in the Medicare Drug Fraud”

#AceHealthNews says when you are elderly and infirm ,would you expect your doctor, drug company and advisers, to give you a “Medicare Drug Plan” you do not really need. Well according to this recent article that is exactly what happened to this person, under this “Medicare Drug Fraud” read the story ……………………………………………. below: comment and share

Centers for Medicare and Medicaid Services (Me...

Centers for Medicare and Medicaid Services (Medicaid administrator) logo (Photo credit: Wikipedia)

Story of the Events:

At another time in her life, Denise Heap might have tossed aside the insurance forms listing the drugs prescribed to her mother.

The “explanation of benefits” forms came like clockwork and didn’t require any action on her part.

But Heap was worried about her mother, Joyce, who was in the end stages of Alzheimer’s disease. Her health had inexplicably declined in the Los Angeles-area nursing home where she’d been living. So in April, when a thick envelope arrived from her mother’s Medicare drug plan, Heap scrutinized it.

What she found was frightening: Her 77-year-old mother was receiving a raft of medications Heap had never seen before.

As Heap began Googling the drugs, she realized something was drastically wrong. Either her mother was being given expensive medications for conditions she didn’t have 2014 such as breast cancer, asthma, emphysema and high cholesterol 2014 or something sinister was going on: Someone was using her mother to steal drugs.

“I flipped,” Heap said. Medicare’s prescription program, known as Part D, paid for more than “$10,000 worth of meds” in just three months, she said.

She first called Medicare to report her suspicions, she said, then the insurance company that managed her mother’s Medicare drug plan. Neither, she said, seemed very concerned.

“I was like, No, No, No,  You have to understand. I am trying to help you guys,'” she said.

Soon, Heap became convinced someone had stolen her mother’s identity while she was living at a nursing home run by an Armenian couple. The couple kept moving the location of the nursing home. And Heap believed they had over-sedated her mother with high doses of antipsychotics, inappropriately treating her blood pressure and allowing bed bugs to feast on her.

“I knew something crooked was going on,” said Heap, 59, who, with her mother, had co-founded a Holocaust education nonprofit in the 1990s to document stories of German resistance to Hitler.

Frustrated, Heap called Los Angeles County sheriff‘s Sgt. Steve Opferman, head of a task force specializing in prescription drug fraud. As soon as Heap began describing what had happened, Opferman said he knew her mother had been caught up in a fraud scheme involving Armenian organized crime.

Opferman and other investigators say criminals wager that patients and their families will not be like Heap. They bank on the fact that their victims 2014 Medicare beneficiaries 2014 will be too old or too sick to review insurance forms summarizing the medications and services billed in their names. And they count on the tendency of busy family members to give such forms a cursory glance, if that.

“Suffice it to say most people don’t pay attention, let alone know what they’re looking at,” Opferman said.

But Heap’s case, and others like it, shows the important role patients and their families can play in uncovering fraud within Part D. The program now covers 36 million seniors and disabled people and fills 1 in 4 prescriptions nationwide. Last year, it cost taxpayers $62 billion.

In an earlier report, ProPublica found that Medicare’s system for pursuing such fraud is so cumbersome and poorly run that schemes can quickly siphon away millions. Tips such as Heap’s can come into private insurers, which run Part D for Medicare, to contractors hired by Medicare to spot fraud, or to the U.S. Department of Health Human Services inspector general, which investigates health care fraud. But only a small percentage of cases funneled through this chain are prosecuted.

Reporters, using Medicare’s own data, were able to identify scores of doctors whose prescribing within the program followed known patterns of fraud: the cost of doctors’ prescribing jumped dramatically 2014 sometimes by millions of dollars 2014 from one year to the next and they chose brand-name drugs that scammers’ can easily resell.

Some doctors claimed that they 2014 like some of the patients involved 2014 were unwitting victims of identity theft. In other cases, federal investigators found, the doctors were paid for writing bogus or inappropriate prescriptions.

In a response to these findings, a Medicare official said more focus has been placed on fraud detection within Part D.

SpirivaThe drugs listed on Joyce Heap’s explanation of benefits forms are those most-desired in such fraud schemes. They included the asthma drugs Spiriva and Advair Diskus, for which her insurance plan paid nearly $270 a month each, the cholesterol drug Crestor, which cost nearly $170, and the antipsychotic Abilify, for which the plan paid about $920 for a 30-day supply.

Advair DiskusOpferman said Heap’s call launched an investigation that uncovered a large Part D scheme allegedly connecting the owners of the nursing home to a North Hollywood pharmacy operation, including evidence that other residents’ identities were used. A September search of the pharmacy where Heap’s mother’s prescriptions were filled found evidence that drugs were being relabeled or repackaged for resale, he said.

The doctor who prescribed the drugs has denied prescribing the majority of them, Opferman said. The case is now part of an ongoing investigation by California’s Department of Justice and his group, he said.

Opferman said investigators might never have known of the scheme without Heap’s tip.

Joyce Heap didn’t live long after her daughter unearthed the problems.

She improved briefly after moving to a new nursing home, where a doctor reduced her psychiatric medications, Denise Heap said. But she died of a heart attack on April 21.

In the months following her mother’s death, Heap said, she sent letters alerting Medicare and her mother’s insurer to the possible fraud. In July she wrote, “Please note that 100% of the prescriptions charged in April 2013 2026 are FRAUDULENT.”

Heap said she is “outraged” Medicare didn’t follow-up and ask detailed questions about her allegations. In fact, it was either her insurer or Medicare 2014 she can’t recall which 2014 that recommended she call the local sheriff if she was worried.

“I would have thought immediately they would have gotten on it,” she said.

But Heap said she is mostly tormented that she didn’t know such fraud schemes existed 2014 and that elderly people like her mother could become prey.

“It’s a hard thing to live with,” she said, tearfully. “I feel like I failed.”

Follow: AceNewsServices

 Courtesy of:  Tracy Weber and Charles Ornstein ProPublica,  Dec. 31, 2013, 10:20 a.m.

 

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Public Healthcare Registers Bumpy Launch of Healthcare Exchange’s

English: Barack Obama signing the Patient Prot...

English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

Courtesy of: The: Pew Research Centre for the People and the Press

A few weeks after the launch of the state-level on–line health insurance exchanges that are a cornerstone of the Affordable Care Act, the public’s impression is that it has been a bumpy Bumpy Launch for Health Insurance Exchangeslaunch. About three-in-ten Americans (29%) say the on-line health insurance exchanges are working very or fairly well while 46% say they are not.

The national survey by the Pew Research Center, conducted Oct. 9-13 among 1,504 adults, finds that awareness of the exchanges has increased significantly over the past month. In early September, barely half (51%) knew that exchanges were going to be available in their state; that has risen to nearly two-thirds (65%) today.

One-in-Seven Have Visited Health Care ExchangesNationwide, 14% of adults report having visited an exchange, and another 23% say they intend to. These figures are higher among the 18% who say they currently do not have health insurance: 22% of uninsured Americans have already visited a site, and another 42% say they intend to do so.

So Far, Most Exchange Site Users Just Learning About ExchangesSo far, most of the visitors to the exchange websites are people who have insurance: 41% of exchange visitors have employer-provided insurance, and another 15% are covered by Medicare, Medicaid or another government program. Some 10% of exchange visitors are self-insured, and 29% of visitors are uninsured. Most (58%) who have visited the sites say they went just to learn more about the exchanges, while 32% say they were looking for health care options for themselves or their families.

Despite offering critical evaluations of how well the exchanges are working, many of the sites’ actual visitors report that they did not face significant problems. Among those who have visited an exchange website, more say the exchanges overall are not working well by a 56%-37% margin. Yet when asked about their own experience on an exchange website, a 56% majority say they personally found the site to be very or fairly easy to use, while 40% say it was difficult to use.

More at: http://www.people-press.org/2013/10/21/public-registers-bumpy-launch-of-health-care-exchange-websites/

#acehealthnews, #health-insurance-coverage-in-the-united-states, #health-insurance-exchange, #insurance, #medicaid, #medicare, #patient-protection-and-affordable-care-act, #pew-research-center, #united-states