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How To Report Medicare Fraud Or Abuse

Medicare is a federal health insurance program for people who are 65 and older. Medicare works within a network of doctors to provide beneficiaries, like yourself, with proper care. However, sometimes people will abuse their power and take advantage of the program. When this happens, it is considered Medicare fraud, or Medicare abuse. This is a serious issue that needs to be reported.

womans hands on a calculator in front of an open laptop — *Billing mistakes can happen with Medicare sometimes.*

Billing Errors

Everyone has been there, opening up a bill only to notice an extra charge, or a couple of charges that are unidentifiable. Unfortunately, at times these billing mistakes can happen with Medicare.

Accidents happen. Just be sure to keep an eye on your bills and contact Medicare, or your doctor if you see a charge you do not recognize. They can explain why the bill has extra charges, or realize it was a mistake and correct it. These kinds of mistakes are not considered fraud or abuse.

Fraud

Medicare fraud does not just affect you, it affects taxpayers financially, and affects the availability of services for Medicare beneficiaries. An act is considered fraud when it is done intentionally, or abusing the Medicare system for personal gain. For example, it is one thing if your doctor bills you accidentally for services not provided, but for it to happen multiple times is a clear case of Medicare fraud.

Medicare fraud is when a doctor or health care provider sends a bill for services or products that were not medically necessary, more than once. If it is a pattern, or recurring issue, then it is fraudulent and considered Medicare Abuse. Some things a doctor might say or do that you should report are:

cartoon of a person sitting in front of a laptop with "fraud alert" on the screen — *Beware when a doctor states the following:*

Saying “the more tests performed, then the less you pay out of pocket.”
Offering you a gift to get you to use their services
Waives a copayment
Saying the copayment is higher on a no-coplay plan
Telling you they know how to get Medicare to pay for something that isn’t covered on your plan. (Tells you that you can receive coverage on a non-covered service).
Claiming that Medicare endorses their products or services

Reporting It

Pay attention to your bill and look through your Medicare Summary Notice often. This will give you a clear understanding as to what is covered through your insurance, and how much things are. If you are overcharged for services, or products, then you are a victim of Medicare Abuse. When you report fraud or abuse, your name will be kept anonymous, so your doctor will not know it was you. Be

cause odds are if he or she is doing it with you, then they are doing it with others.

Report Medicare fraud or abuse by:

Call the Medicare fraud tip line at 1-800-HHS-TIPS (1-800-447-8477). The TTY number is 1-800-377-4950.
Email: You can also send up to 10 pages describing the incident to [email protected].
Fax your report (up to 10 pages) to 1-800-223-8164.
Mail the report (up to 10 pages) to the Office of the Inspector General HHS Tips Hotline, P.O. Box 23489, Washington, DC 20026-3489.

As stated, billing errors can occur, but if it keeps happening, then fraudulent activity is happening. Make sure to always stay on top of your bills, and know what is covered and what is not.

Surprise Bills Could Be Coming! Get To Know What’s Changing With Medicare in 2020

Big changes are coming for Medicare next year, affecting your coverage and wallet. Medicare Supplement plans C and F will disappear. Part B premiums and deductibles will rise. And for the first time since 2010, Medicare is changing the surcharges on high-income beneficiaries. Make sure you aware of all the changes ahead so you can make the necessary adjustments to fit both your needs and budget.

Part B

For 2019, the standard Medicare Part B premiums are $135.50 a month. Next year’s increase is projected to be about $144.30 a month.

Many seniors depend on Social Security to help pay for their premiums. For 2020, Social Security’s COLA, or cost of living adjustment, is expected to be about 1.6%. This would increase the benefit to $23 a month, which will in turn cover the increase in Part B premiums.

Medicare Premium and deductible prices for 2020 chart

The Part B deductible was $185 in 2019, and is now projected to increase to $197. In order to help pay for the deductible, Medicare beneficiaries will be forced to sign up for a Medicare Supplement plan.

Medicare Supplement Plans C and F

As mentioned, Medicare Supplement plans help beneficiaries pay for their Part B deductible. Plans C and F will no longer be available for purchase by newly-eligible Medicare beneficiaries.

As long as the beneficiary is enrolled in Medicare before 2020, they can keep their plan C or F, or can apply for them at a later date. These two plans are popular plans because they are the only ones that cover the Part B deductible in full.

Medicare Surcharges

With these monthly payments, Medicare covers 80% of charges, and the other 20% is up to the beneficiary. Some seniors have a higher income than others, and as a result, they also pay a higher price.

This higher price is referred to as a “surcharge”. The surcharges are imposed because these higher-income beneficiaries can afford to pay more for healthcare. The surcharge is called IRMAA, which stands for Income-Related Monthly Adjustment Amount.

For the past couple of years, high-income beneficiaries were in the set income bracket of $85,000 for an individual, and $170,000 for a married couple. Starting in 2020, the income brackets will be adjusted for inflation.

2019 & 2020 Medicare Surcharges chart — *2020 Medicare Surcharges*

The surcharge will now apply for those making an income of $87,000 as an individual, and $174,000 for a married couple. Premiums in 2019 range from $189.60 a month to $460.50 a month, depending on income. For 2020, these amounts are projected to range from $202 a month to $490.50 a month, depending on income.

The Centers for Medicare and Medicaid Services have not announced the actual increase in Part B premiums and deductibles yet. However, the projections are enough to make a Medicare beneficiary prepare for the upcoming changes. Seek out any Medicare Supplement plans you might want to get, especially if it is plan C or F.

Do not be in disarray or panic about the changes ahead. If you are enrolled in Medicare, signing up for a Medicare Supplement plan does not have to be a hassle. EZ.Insure can take care of the research of all the plans within your region, provide you with the best options that meet your coverage and price, and sign you up. You will be given your own personal agent who is highly trained within your region. We offer you all of these services for free! To get started, simply enter your zip code in the bar above, or to speak with an agent, email [email protected], or call 888-753-7207.

Medicare’s “3-Day Rule” Lawsuit Goes To Trial

There was confusion and misinformation regarding the 3-day rule for skilled nursing facility coverage. In order to get the 100 days of skilled nursing coverage from Medicare, the mandate states a beneficiary must spend at least 3 days in the hospital as an inpatient. However, doctors and hospitals can admit elderly patients on an “observation stay,” which does not count as an “inpatient.” A class-action lawsuit ,filed back in 2011, challenged Medicare’s eligibility

Empty courtroom — *Medicare’s 3 day ruling is finally going to be heard in the courtroom.*

rules for skilled nursing coverage. Trial over the lawsuit is finally being heard in a federal courtroom.

Observation Stay

After an “observation stay,” senior patients are then discharged to a skilled nursing facility, complete with a bill. Because a substantial number of hospitals follow these routines, seniors are often forced to pay these bills out of pocket. Medicare will not cover the costs since it does not qualify as full admission.

In recent years, Medicare imposed strict limitations on hospital admittances. This explains why patients who are admitted are put under “observation.” Medicare pays one-third less for an observation patient than one who is in full admission. While Medicare benefits from these cost-saving tricks, it’s the patients that suffer.

Medicare Costs

Another way Medicare saves itself money is by shifting the cost of hip and/or knee replacements onto the beneficiaries. Medicare encourages doctors to perform these replacements as outpatient surgeries so that discharges happen within a few days.

Caucasian woman sitting in a hospital room hooked up to an IV. — *Many doctors will put a patient under “observation stay” in order to bypass the rule, and have patients pay the bill out-of-pocket.*

This has caused an uproar with patients because many of them simply cannot afford sky-high medical costs. So in turn, about 14 patients filed a class-action lawsuit. If they win, Medicare might have to reimburse almost 1.3 million beneficiaries.

President Trump’s Medicare chief, Seema Verma, listened to the complaints and voiced that something does have to change in order to help the beneficiaries. She stated, “We’ve talked a lot about the operational changes that we’re making, the policy changes that we’re making, but at the end of the day, this is about putting patients first.” If the 3-day rule does in fact change, the costly bill following a hospital visit will be alleviated, and many beneficiaries will be happy.

Wait! Before You Drop Medicare For Employer’s Healthcare Coverage Read This!

It is more common for retired seniors to work. Almost 27% of people aged 65-74 are in the workforce, and the projected stats are rising. Some seek extra money, while others do it to pass the time. When you turn 65, you are enrolled in Medicare Parts A and B. If you decide to go back into the workforce, you can opt to drop Medicare Part B coverage and expenses. Coverage of the benefits you receive from Part B will be replaced with the employer’s group health insurance. You can always opt to go back to Medicare at any point, but there will be some repercussions if not done at the right time.

What Medicare Covers

Medicare coverage is divided into two parts, Part A and Part B. Medicare Part A covers hospital care, and is usually free as long as you meet the Medicare guidelines: working at least 10 years before age 65, and being a US citizen. Medicare Part B covers outpatient care, including annual wellness visits every month, ambulance services, orthotics and prosthetics, medical equipment, and mental health care. (80% of costs covered by Medicare.) The monthly premium for Part B is

Clock with coins in 3 rows next to it growing with a green leaf sprout on each row. — *HSAs come with a triple tax benefit, but any contributions are tax-deductible.*

$135.50 for 2019. The cost might be higher depending on income..

What Employers Offer: HSA Plans

Employer’s offer health insurance coverage, and usually a health savings account, HSA, as well. If you are on Medicare Part A, you cannot make any contributions to an HSA. The employer’s coverage is considered a “high-deductible” plan. HSAs come with a triple tax benefit, but any contributions are tax-deductible, and withdrawals are untaxed as long as it is used for qualified medical expenses.

How It Will Cost You

If you drop your Part B plan for an employer’s plan, you can always sign up for Part B again during your Special Enrollment Period or SEP. This period is when you leave your employment, or the employment loses coverage. If you miss the 8-month SEP, you face a late-enrollment penalty, 10% of Part B’s monthly premium for each full year you should’ve been enrolled.

If you drop Part A, you might have to repay the government for any medical services under Medicare that you used. Also, if you collect social security, you will need to repay that back also.

Caucasian woman;s hand holding a pen ready to write on an openedbook with the page titled "my plan." — *If you drop Medicare, returning can be difficult, so think carefully and explore your options completely before making a decision.*

Some seniors buy a Medicare Supplement plan to support their Medicare Part B expenses. When you drop Part B and sign up for your employer’s coverage, then you will also have to drop your Supplement plan. If you decide to go back to Medicare Part B, buying a Medicare Supplement plan will not be as easy. Your coverage could be denied due to pre-existing conditions and health status.

If you plan to drop your Medicare and use your employer’s health insurance plan, it can cost you in the long run. Your decision should be based on how much your employer’s plan costs, your out-of-pocket expenses in a high-deductible plan, and your budget. If you drop Medicare, returning can be difficult, so think carefully and explore your options completely before making a decision.

Is Medicare Underwriting Necessary?

Medical underwriting is a process when a private insurance company reviews your medical history to determine whether they will provide you with coverage, how much to charge you, and whether to set a waiting period before coverage begins. If you have a lot of medical issues, you may have to pay more for coverage or even be denied approval. Pre-existing conditions will come up and can cost you greatly.

denied word in red — *After your Medicare underwriting is complete, companies decide whether to accept you, or deny you coverage due to your pre-existing conditions.*

Medicare Supplement plans help pay for out of pocket expenses such as copays, coinsurance, and deductibles. When

you sign up for a Medicare Supplement plan, you may need to go through the underwriting process. It all depends on when you decide to sign up for a supplement plan. To answer the question if Medicare underwriting is necessary, both yes and no. Find out how to avoid Medicare underwriting, and if you do have to go through it, then what it entails.

The Only Time To Avoid Medicare Underwriting

During the Medicare Supplement Open Enrollment Period is when you have “guaranteed issue rights.” Guaranteed issue means that you will be accepted into any plan regardless of your health condition or pre-existing conditions. During this time, you have a one-time guarantee when companies cannot deny you or charge you more due to a pre-existing condition. The Medicare Supplement Open Enrollment Period is a six month period that begins the first day of the month you turn 65 years old, and enrolled in Medicare Part B.

When You Need To Be Underwritten

If you apply for a Medicare Supplement plan after your Medicare Open Enrollment Period has passed, then you may have to go through the underwriting process. In addition, when you are switching Medicare Supplement plans, you may have to go through the underwriting process. If a Medicare Supplement plan accepts your application, the insurer can choose to make you wait 6 months before covering a pre-existing condition. This is known as a “look-back period,” or “pre-existing wait period.”

The Underwriting Process

Private insurance companies will have extensive health-related questions on their applications. It will go over your entire medical history, both past and present. If you have a pre-existing health condition that may be expensive for the company to cover, they can choose to deny your application.

white paper that says checklist with boxes down a line with checkmarks in them. — *During the Medicare underwriting process, companies will go through your medical history and check off which conditions may be considered an expensive health risk for them to cover.*

If you have a health condition that needs constant attention, chronic, or incurable, then you may be denied. Certain medications can also be a reason for denial, especially for the incurable or chronic health conditions, simply because it will be too expensive for the insurers to cover. Often times minor conditions such as BMI, high blood pressure, and cholesterol are not issues for carriers. If you have pending surgeries or treatments, then it is best to get them done before applying. Serious health conditions such as rheumatoid arthritis, dementia, chronic lung disorders, lupus, MS, major heart disorders, and kidney failure will be an automatic denial of coverage for the company.

If you are still within your Medicare Supplement Plan Open Enrollment Period, then great, no better time to get started and sign up for a plan. If you have passed this guaranteed issue window, you can still apply with caution. And if you get denied, then it is not the end of the world, our agents will search through all available Medicare Supplement plans and help you.

EZ.Insure has highly trained agents who will search through all the Medicare Supplement carriers in your region, whether you are within the open enrollment period or not. Your personalized agent will compare all the plans, their coverage, and their quotes. To get started, you can enter your zip code in the bar above, or speak to an agent directly by emailing [email protected] or calling 855-220-1144. We will be by your side throughout the process, walking you through it, while providing you with the best advice and options.

Is Medicare Possible Without Social Security?

Many seniors think that they have to collect their Social Security benefits in order to enroll in Medicare. While yes, Medicare and Social Security go hand in hand in some ways, it does not necessarily mean you have to collect your SS benefits quite yet. They are separate. A person is able to collect Social Security benefits as early as age 62, and the latest you can begin collecting is age 70. Full retirement age is 66 years old. What all of this means is the earlier you collect benefits, then the lower your monthly benefits will be. Medicare benefits work differently. You must enroll in Medicare when you turn 65, or there are penalties, and you do not have to collect Social Security in order to begin Medicare. The following section provides an in-depth explanation of how it all works.

When To Sign Up For Medicare

While it pays to wait to collect Social Security benefits at a later age, this is not the case for Medicare. If you do not sign up for Medicare during your initial enrollment period (3 months before you turn 65, the month of your 65th birthday, and the following 3 months), it will cost you. You will have to pay a 10% increase in your Part B premiums for every year you do not sign up.

If you are still working and covered through your employer’s health benefits, then you will receive a special enrollment period once you leave your job. The job must have at least 20 or more employees, and if they do not, then you will need to sign up for Medicare during the initial enrollment period, or you will face the fine.

Auto-Enrollment

Auto-enrollment into Medicare happens when you are collecting Social Security benefits. If you decide to collect your Social Security benefits before age 65, the government will assume you have retired. So when you turn 65, you will automatically be enrolled into Medicare Parts A and B. You cannot enroll into Medicare before the age of 65, even if you are collecting SS benefits.

If you are working, then you can opt out of Medicare Part B, as long as the employer has 20 or more employees. But, you must keep Part A because you cannot have Social Security without Part A.

Social Security Sets off Part A

As mentioned above, Social Security benefits are essentially linked with Medicare Part A. The reason you do not pay for Part A is that you have paid taxes during your working career towards these benefits.

Medicare Is Possible Without Social Security

notebook opened up with the word "planning" written on the page. — *Plan ahead in order to make sure you are collecting the collecting the optimum amount of your benefits.*

You can certainly enroll in Medicare without collecting Social Security benefits. You have the option of waiting until you are 70 years old to start collecting these SS benefits. The longer you wait to start collecting SS, the more benefits you will receive monthly. However, you cannot afford to wait to sign up for Medicare. The longer you wait past your 65-year-old initial enrollment period, the heftier the repercussions may be on your Part B premiums.

If you do sign up for Social Security benefits before the age of 65, then when you turn 65 years old, you will automatically be enrolled at least into Medicare Part A. No exceptions. Most people choose to have their Medicare Part B premiums automatically withheld from their checks. So, if you do decide to hold off on collecting your Social Security benefits, know that you will have to pay the Part B premiums out of pocket. This is about $135.50 a month.

If you have questions or need Medicare help, our agents are ready to help. EZ.Insure offers highly trained Medicare agents in your region. They will assist you with any questions you have regarding Medicare, and help you save money by looking into Medicare Supplement plans. They will provide you with quotes and guide you in the best direction for your situation. Get started by entering your zip code in the bar above, or to connect with an agent email [email protected] or call 855-220-1144.

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