Fraud And Abuse Of Medicare

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

Medicaid and Medicare was created and called the Social Security Act of 1965 to provide coverage for medical treatment for qualified individuals and their families. Medicaid is a program that is jointly funded and managed by the federal and state governments that reimburse hospital and physician for providing care to qualified patients who cannot afford medical expense. To qualify for Medicaid he or she must be a United States or resident citizen which, includes low income adults and their children, people with certain disabilities and senior citizens. “Medicaid and Medicare is overlooked by the Center for Medicare and Medicaid,

Part A The central point of this scenario is far more than just healthcare management. Instead, it has elements of medical ethics and the huge amount of bureaucracy often engendered by the American healthcare system. Medicare Part A is hospital insurance that helps cover care in hospitals and skilled nursing facilities. In general, it covers inpatient care and inpatient rehabilitation costs. Medicare Part B covers medically necessary services: doctors', medical equipment, home

The Medicaid program is a federal health insurance program for the under-privileged and incapacitated. The plan is managed by states within comprehensive limits instituted by the federal government. Together the federal and state governments finance the program, with the federal share ranging from 50 percent to 74 percent. Now Medicaid currently makes up 7 percent of the federal budget and 23.7 percent of all state expenses. Approximately sixty million people are enrolled in the Medicaid program and 400 million is spent annually.

Medicaid provides healthcare insurance for individuals and families with low income. The federal government controls the program, but the states establish their own eligibility requirements and determines the type, duration, rate of payment, and amount of services. Even though the state can make final decisions on what they

Medicare and Medicaid are very different, Medicare is a insurance federal program while Medicaid is an assistant program for low income people of any age. Medicare then serve people over 65 years primarily, under Medicare patients pay the costs through deductibles for hospitals and other cost. Medicare consist in two part; Part A which is the hospital insurance and Part B which is the Medicare insurance, they also have Part A Premium and Part B Premium. The Medicare Part A Premium you pay certain amount of money a month, but if you are 65 and meet certain criteria that they have ,you can get the Premium-free Part A. Medicare Part B after you meet your deductible, you normally pay 20% of the Medicare approve amount for doctors services, including

In this essay my intentions are not to describe in full the features of the Medicaid as an insurance program or to make standing revision of its budgetary or galenic form. Instead, I will compel a short recount on its original characteristics when it first started and the positive or negative performance the program provides its recipients in the United States population. Furthermore, I will move bases on how Medicaid is affecting our budgetary systems and its upcoming sustainability. Nevertheless, this paper will contour how the Medicaid program has grown as a major framework of the United States and the unique

Medicare Part C is “Medicare Plus (+) Choice plans offer a number of health care options in addition to those available under Medicare Part A and Part B.” Fordney, M. T. (2017). The plans on Medicare Part C include, “health maintenance organizations (HMOs), fee-for-service plans, provider-sponsored organizations, religious fraternal benefit societies (RFBS), and Medicare medical savings accounts.” Fordney, M. T.

The United States “spends 17.6% of the Gross Domestic Product on healthcare” (Niles, 2015, Pg.53). Two programs that are supported by this gross domestic product are Medicare and Medicaid. Medicare is the “federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease” (Centers for Medicare & Medicaid, n.d.). On the other hand, “Medicaid is a program that helps with medical costs for people with limited income and resources” (Centers for Medicare & Medicaid, n.d.). Without these programs the elderly, the disabled, and low income families would not be able to afford medical care or prescriptions. As a result, the health of these individual’s would deteriorate and they could possibly

Medicare Advantage Plan (Plan C) is a type of Medicare health plan offered by private companies. It contracts with Medicare to provide all Part A and Part B benefits. This plan covers most Medicare services for a senior. (Source: medicare.gov)

At its initiation in 1965, Medicare expected to provide health insurance to Americans age 65 and older and to younger people with certain disabilities or health conditions. It was a two-part plan. Part A providing payment to the hospital, home health following hospital stays, skilled nursing facility, and hospice care for the aged and disabled. Part A is paid by payroll deductions with no premiums for those who contributed. Part B, is an optional medical insurance program for which enrollees pay a monthly premium. Part B can be used to pay for physician, outpatient hospital, home health, and other services for the aged and disabled. Although it was considered during the 1930’s as a part of president Roosevelt new deal. It was believed that the inclusion of the plan could jeopardize the success of social security and hence was not added at that time. President Truman officially initiated the talks on national health insurance program, but LBJ finally signed it into law and added it to the Social security amendment in 1965. Since 1965 Medicare had changed multiple times with extended eligibility to individuals under age 65 who have long-term disabilities or end-stage renal disease. Addition of Part C (Medicare+Choice), also known as Medicare Advantage, drug benefit inclusion or Medicare Part D, the most recent Patient Protection and Affordable Care Act. The responsibility for overseeing Medicare and it funding lies with the Department of Health and Human Services (HHS).

Clearly, the Medicaid program is ripe for a major overhaul, a task that the federal government has thus far been unwilling to undertake. I chose this topic because I believe that the Medicaid program can be rescued and revitalized by leadership; otherwise, it is likely to be eroded. Medicaid is a government-sponsored program whose objective is to provide patients with health assistance upon meeting specific criteria. Medicaid is an insurance program that is available for disadvantaged persons, including the elderly, who cannot afford health benefits because of low incomes or other factors. This program is subsidized by government funds and in many instances, will cover the costs of basic

Both Medicare and Medicaid are managed by the Centers for Medicare and Medicaid Services (CMS), which is a division of the U.S. Department of Health and Human Services. Medicare was created in 1965 when people of over 65 found it impossible to get private health insurance coverage. Medicare is a Federal health insurance program that pays for hospital and medical care for elderly and certain individual with disabilities. The program consists of two main parts for hospital and medical insurance (Part A and Part B), and two additional parts the provide flexibility and prescription drugs (Part C and Part D). Medicaid is a health and medical service program for certain individuals and families with low incomes and few resources. Primary oversight is handle at the federal level, but each state establishes its own standards, determines the type, amount, duration and scope of services, sets the rate of payment for services, and administers its own Medicaid program. Reimbursement to providers are through a fee-for-service model or through various prepaid arrangements, such as a HMO plan. ACOs create incentives for health care providers to work together to treat an individual patient across healthcare settings, which includes doctor’s offices, hospitals, and long-term care facilities. There are several factors, in my opinion, for ACOs to be successful. Buy-in from all involved with physician leadership, hiring the right professionals who are interested in having the mindset

In the beginning, the basic design of the Medicare program was modeled on the private insurance system in place in the 1960s. The program has a variety of plans and services for its beneficiaries. Part A was a type of hospital health insurance which provided hospital, skilled nursing facility and home health agency coverage. This coverage was provided free of premiums to most eligible members, but those who were ineligible had to pay a monthly premium. In addition, Medicare included Part B also known as supplemental medical insurance. Part B helped pay for physician, outpatient hospital, home health agency and other services. To have this coverage, all eligible members must pay a monthly premium. This program has helped improve the health and longevity of older Americans. Today these programs are commonly referred to as the “Original Medicare,” in comparison to the current state of Medicare due to the changes Congress has made over the last fifty one years.