Marti Oakley

 

Medicare Advantage: Only an advantage for those glorious “stakeholders”

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“It isn’t the patients who are bankrupting Medicare….its the service providers on all levels. If the states and insurance companies need to “recapture” their expenses…why not start with those who are gaming the system?”

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According to the US Census Bureau, annual home ownership rates between 1982 and 2017 shows the population of those 65 or older represented just over 80% of all homes owned. This statistic has made the elderly prime targets for estate theft by predatory guardians and attorneys, and now under Medicare Advantage, the state/insurance companies can attack the estate because for some reason they have to be able to recapture the costs of long term care that you financed to begin with.

Now, ask yourself why, after investing in Social Security and Medicare over your lifetime, and….having to pay in most cases exorbitant premiums each and every month once you retire, along with co-pays, deductibles and a host of non-covered services, what you could possibly owe to the state or the insurance company?

But under Medicare Advantage, the combining of Medicare and Medicaid, after you having invested a portion of your earnings over your working lifetime, paid premiums, co-pays, deductibles and paid taxes to support these healthcare programs, these “stakeholders”, the [state/insurance company] must recapture the costs associated with long term care you might have needed, once you pass away.

Now think about this. You worked all your life and invested in Social Security and Medicare. You paid income tax every year which helped pay for medical care for the poor called Medicaid. You bought your home and have been assessed property taxes every year just for doing so, and continue to pay property taxes while you remain there, and long after the mortgage has been paid off. If you hadn’t paid those property taxes they would have already taken your property from you!

Currently, the bills in each state covering this “recapture”, prohibit the state from seizing property if there is a surviving spouse living in or on the property. But once the surviving spouse dies or are themselves put into long term care, the state/insurance company can attack the estate in order to recover those costs. Even if there is joint tenancy or co-ownership of property by those who are not otherwise responsible for, or legally bound to the deceased, the state/insurance company has first rights to the assets. And this recapture takes place before any inheritance can be received by the beneficiaries of the estate. Of course there is no intention of anything to remain for heirs.

Medicare Advantage is a prime example of how to deal with a sector of the public that government views as a waste population and desperately desires to be rid of. The elderly. With the federal government now owing Social Security an estimated 3 trillion dollars in stolen surplus funds that they never had any intention of repaying, and the medical industry overall defrauding Medicare of an estimated 30-60 billion dollars each year (this by the government’s own estimates) Medicare Advantage is poised to be the coup de gras. By attaching Medicaid to Medicare under this ubiquitous plan, if you are in long term care or any facility like hospice, the state has the right to attach your estate, take your home and any other assets you might have in order to “recapture” those costs once you die.

Of course these new “advantage” policies include vision, dental, hearing and other items not normally covered by Medicare. But it seems to me, if an effort to stop the massive fraud taking place by the medical industry with regards to Medicare were to be addressed with as much vigor as they apply to finding ways to cut benefits, limit services and deny coverage, we could easily pay for any and all services for the elderly with a few billion annually to spare.

The states routinely request bids from insurance companies to offer these policies. The state does not of itself sell insurance. It negotiates contracts with insurance companies. It is the insurance company that sells the insurance the state is promoting. Several plans offered by several insurance companies at varying rates of cost and coverage are all sponsored by the state via corporate contracts. The state is itself the top stakeholder in the negotiations and they are negotiating to see who will benefit most from contracting against you, the public, for profit.

The question you need to be asking is: Which “stakeholder” is actually going to be entitled to recapture the costs?” Is it the state? Or the insurance company? Or both?

If there is one term that has come to signify corruption, collusion, and an all out assault on the public in any area of government, it is has to be the term “stakeholder’s”. What this term signifies are those entities, organizations, corporations and others who have a vested financial interest in the issue at hand and who will enjoy increased profits even at the cost of human rights, life or liberty. These precious “stakeholders” write the bills, send swarms of lobbyists into the halls of congress and contribute handsomely to the campaign coffers of politicians who willingly sell their votes in lieu of those contributions. And even when commenting is requested from the public, unless the comments are in line with the proposed plan they are summarily ignored and/or disposed of. They don’t care what you think or want anyway. YOU are the commodity they are negotiating over.

The public is not a stakeholder…only a recipient and financier

Both state and federal legislators routinely vote to pass bills they have neither read, nor understand and obviously do not care how adversely it may affect the public at large. A reading of any bill dealing with health, insurance, prescription drugs or other topics makes it readily apparent that the sponsor or supposed author of the bill could not have possibly written the bill themselves, or had any part in it. They don’t have that kind of technical knowledge nor the interest in acquiring it. The bills are written by the corporations who will benefit from it. The bills are presented once the corporations have paid the financing fees, also known as campaign contributions.

Medicare Fraud by Providers is Massive!

It isn’t the patients who are bankrupting Medicare….its the service providers on all levels. If the states and insurance companies need to “recapture” their expenses…why not start with those who are gaming the system?

In 2017, an article from the Center for Public Integrity, titled..Fraud and Billing Mistakes Costs Medicare ..and Taxpayers…Tens of Billions Last Year, written by Fred Schulte:

“Adding in the over-payments for standard Medicare programs, the tally for last year approaches $60 billion — which is almost twice as much as the National Institutes of Health spends on medical research each year.” (end quote)

An article from John Minnino: Medicare Scammers Steal $60 Billion a Year. This Man Is Hunting Them

Luckily, there is another defense against Medicare fraud: whistle-blower lawsuits. Under the federal government’s false claims statute, any insider can sue a company that’s providing fraudulent services, on the government’s behalf. If the whistle-blower lawyers are successful, the plaintiffs collect 15 to 30 percent of the settlement as a bounty. In 2014 there were 469 of these health care fraud settlements—many involving huge pharmaceutical corporations and hospital networks—resulting in $2.2 billion in fines.” (end quote)

As far back as 2010, Forbes was reporting on the massive frauds taking place in Medicare and Medicaid

There are a few common types of Medicare fraud that include:

  • Identity Theft: When a medical professional steals patient information to use to over-bill Medicare.
  • Equipment Substitution: An order for medical equipment may be intercepted, with Medicare being billed for newer or more expensive equipment and the patient being provided with cheap or used equipment.
  • Phantom Billing: A doctor’s office may bill for services never performed.
  • Upcoding: A medical provider may submit bills to Medicare for a more expensive service than the one actually performed.
  • Unnecessary Procedures: A doctor may perform procedures that are not medically necessary in order to bill Medicare for the cost.
  • Generic Drugs: Medicare is often billed for name brand medications when generic drugs were actually provided to the patient.

And why would an insurance company be entitled to your assets after your death after selling you a policy guaranteeing medical coverage if premiums were paid on your behalf by anyone, including the state? Isn’t that the purpose of insurance? The pooling of resources to cover these costs with a built in profit margin. This is fraud! And it is also the legalized theft of property bought and paid for by those “stakeholders” our politicians pander to.

At what point will the public be a consideration in these negotiations that cost us all so much both financially, as well as being the intended recipients of all this corruption?

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https://www.census.gov/housing/hvs/data/charts/fig07.pdf

https://publicintegrity.org/health/fraud-and-billing-mistakes-cost-medicare-and-taxpayers-tens-of-billions-last-year/

https://www.wired.com/2016/03/john-mininno-medicare/

https://www.forbes.com/sites/merrillmatthews/2012/05/31/medicare-and-medicaid-fraud-is-costing-taxpayers-billions/#bac0f8873311

https://www.forbes.com/sites/bernardkrooks/2012/10/04/seniors-need-to-be-wary-of-medicare-fraud/#43b553508d07

From: Physicians for a National Health Program

http://pnhp.org/news/cms-is-giving-unfair-competitive-advantage-to-private-medicare-advantage-plans/

CMS is giving unfair competitive advantage to private Medicare Advantage plans

What is really offensive is that they are taking our tax dollars and giving them to the private insurers so that they can increase benefits and reduce cost sharing for those enrolled in the private plans while they are denying those same benefits and reduced premiums, deductibles, coinsurance, and stop loss coverage for those of us enrolled in the traditional Medicare program. That is patently unfair. If they were honest about wanting true competition between the private plans and the traditional public program they would fund them at the same risk-adjusted level. Instead they are starving the traditional program – a process that will accelerate – while they are enriching the private insurers, though only temporarily until the traditional program is wiped out (then premium support).

Comment:

By Don McCanne, M.D.

Each year the Centers for Medicare & Medicaid Services (CMS) has used a variety of gimmicks to provide the private Medicare Advantage plans with greater reimbursement rates than their costs and what they are statutorily entitled to. This year the padding of the payments is egregiously obscene.

Tying Medicaid to Medicare….

Medicaid, which was formerly the insurance program for the poor has now been tied to Medicare, the invested insurance the elderly have paid for through their working lifetimes.