Caregivers: Report Medicare Fraud and Receive Financial Reward

Medicare and Medicaid fraud have been a huge contributor to high costs of health care for seniors, with both improper reimbursements and unnecessary treatments and billings.  We are talking about billions of dollars in fraud.  The Department of Health and Human Services is now increasing the reward for anyone who reports fraud to as much as 15% of the amount recovered up to $9.9 million (and since billions of dollars in fraud has taken place, this maximum, unfortunately, is needed).  Here is their revised whistleblower reward program for those turning in companies and doctors who are fraudulently billing Medicare.
 
Medicare's new fraud alert reward has been modeled on an IRS program that has returned $2 billion in fraud penalties and unpaid taxes since 2003, the Health and Human Services Department says.
 
Senior caregivers who feel a senior is receiving medical treatment that is unnecessary or received medical doctor invoices for services that were not performed should call the Inspector General's hotline to report Medicare fraud.
 
The proposed rule would also strengthen certain provider enrollment provisions. One would allow HHS to deny enrollment of providers who are affiliated with an entity that has unpaid Medicare debt. It also would allow CMS to deny or revoke billing privileges for individuals with felony convictions, and revoke privileges for providers and suppliers who are abusing their billing privileges.
 
Under the proposed rule, HHS also would expand the ability of its Senior Medicare Patrol program to educate more Medicare beneficiaries about suspicious billing by providers that could be evidence of fraudulent activities. Total funding for all the 54 current SMP projects amounts to $7.3 million.
 
The Scooter Store has been a recent Medicare and Medicaid fraud spotlight for their laser focus on taking advantage of a high reimbursement for power wheelchairs for seniors - only they decided to give seniors cheaper scooters instead of high quality wheelchairs and even went so far as to have a network of medical doctors "approve" the senior's need for the power wheelchair.  
 
However, the federal government must also take some responsibility for The Scooter Store exploitation, simply because their juicy fees attracted The Scooter Store to play the fraud game. But of course the old reimbursements that were fat and juicy were due to lobbying by these groups.  The Wall Street Journal investigation also exposed that home health companies received a $2,000 bonus after the 10th R.N. home visit, and guess what?  The largest home health agencies always made sure they had 10 visits. This was not set-up to benefit seniors, but just another example of payments that make it into legislation due to strong lobbying.
 
Obama Care, as the new healthcare law has been labeled, does have some very positive aspects which include "accountability of care".  In addition, some Medicare reimbursements which were a bit unnecessary (i.e., would never survive in the private sector), were revamped.
 
Power wheelchairs payments were formerly paid in one lump sum by Medicare. Profits of thousands of dollars per wheelchair were pocketed by The Scooter Store immediately.  As of last year, though, this changed and a more reasonable rental fee was paid for the power wheelchairs.  Then The Scooter Store ran into cash flow issues and this, according to some former employees, stimulated even more aggressiveness to "get approval by a medical doctor" for a power wheelchair for a senior - going to 3 doctors or more and even coding doctors based on how difficult or easy it would be to get them to approve the wheelchair.
 
A whistleblower turned in The Scooter Store several years ago and this placed them under more scrutiny as they continued to push the envelope by selling power wheelchairs to individuals who did not really need one.  They even sent out direct mail promotions advertising they could obtain a "Free" wheelchair for seniors.  
 
Caregivers can help be the watchdog for Medicare fraud.  As senior caregivers are involved with day-to-day care, you have the inside view of all medical care and can quickly see when something seems unnecessary.  As more fraud is stopped, it is hope the senior care dollars will go towards actually paying for senior care.
 

Hilarity for Charity Raises Money for Alzheimer's Disease: April 25th in Los Angeles, California

Hilarity for Charity, presented by GIV Mobile, presents a variety show in Hollywood tomorrow to raise money for the fight against Alzheimer's Disease.  Actors Seth Rogen and Lauren Miller created Hilarity for Charity after being actively involved in the Alzheimer's community, in order to create awareness about the disease among the younger generation.

Part of the National Alzheimer's Association, money raised from this event will be directed towards assisting families struggling with caring for someone with Alzheimer's disease and assist with funding support groups and research for a cure.

Lauren Miller became involved in the fight against Alzheimer's disease after her Mother was diagnosed with early onset Alzheimer's disease at age 55.  She learned the challenges of caregiving and communicating how this disease impacts families.

Thursday's event will feature performances and appearances by Garfunkel & Oates, Sadie & The Blue Eyed Devils, Seth Rogen, Bo Burnham, John Mulaney and more.

Hilarity for Charity tickets may be purchased by buying a reserved table or an individual party crasher ticket at HilarityforCharity.com.  You also may make a donation to purchase a Hilarity for Charity Double Bracelet for $38.

Seniors who have been diagnosed with Alzheimer's disease will also need to plan ahead for long-term care needs and understand that Medicare does not pay for long-term care.  The Alzheimer's Association programs are helpful in assisting families to plan for senior care needs.  You can learn about nursing home daily costs nationwide on Caregiverlist.  As more caregivers are needed in the industry, remember that many times only companion caregivers are needed for those with memory loss and this can be fulfilling work for anyone with a caring personality.  Caregiverlist's Career Center connects caregivers with part-time and full-time senior caregiver jobs in their area (all with professional senior care companies).

Caregiver training also assists with learning caregiver skills in order to deliver quality care to seniors and you may also take an online caregiver training course.

And in the meantime, cheers to Hilarity for Charity to adding a laugh to the complexities of dealing with Alzheimer's Disease.

  

Boston Caregivers Keep on Caregiving

Boston, Massachusetts, experienced a week of loss and fear and transportation difficulties this past week after the bombing tragedy at the Boston Marathon.  Senior caregivers manage emotional and physical losses with senior clients each week and when a tragedy of the scale in Boston is added, caregiving becomes even more challenging.

Our hearts and prayers are with all of those in Boston this week and especially to senior caregivers who must overcome all challenges and still make it to their senior client's home each day.

Caregivers also will be needed for those injured in the Boston bombing and both family and professional caregivers will develop the skills necessary to deliver quality care.  Caregiver stress also is a very real experience and everyone must step in to support the caregivers, especially when care needs are not accounted for ahead of time.

Caregiverlist congratulates all of those who have dedicated their life's work to senior care and as the number of seniors in the U.S.A. will continue to grow, we invite more people to consider senior caregiving as a career.  Online caregiver trainin.g is available and senior care companies nationwide continue to hire from 3 to 6 new caregiver employees each week and you may apply for senior caregiver job near you on Caregiverlist.com.

Caregivers can join in the U.S.A.'s moment of silence in memory of the Boston Marathon bomb victims and the survivors, today at 2:50 p.m.

 

Texas City New Braunfels Sues The Scooter Store for Taking Job Creation Money

The Scooter Store, which will go down in history for successfully billing Medicare (and receiving payments) for power wheelchairs which were really cheaper scooters, was raided by the FBI and additional investigators earlier this year.  Now, the city where they are located, New Braunfels, Texas, has filed a lawsuit against the company for pocketing $3.4 million for job creation through a 2009 economic incentive program and then laying off thousands of workers.  The company claims they were impacted by a change in Medicare reimbursements (and tightening Medicare restrictions that helped end the company's practice of obtaining power wheelchair reimbursements from Medicare for cheaper scooters).  

New Braunfels, Texas, would now like $2.6 million of the economic stimulus money back for The Scooter Store's inability to maintain employment levels.  The Scooter Store has laid off 1,000+ employees and is keeping around 100+ employees for now in order to keep collecting the monthly payments on wheelchairs that are not paid off yet.

Caregiverlist originally wrote about The Scooter Store's fraudulent billing and misrepresentation of scooters for wheelchairs back in 2010 when the U.S. Government changed the category of reimbursements to be more clear on the status of a power wheelchair vs. a scooter which had 3 wheels and in no way can offer the mobility protection that a power wheelchair does to a senior who truly has mobility issues.

Senior Care Planning: Living to be 105-Years-Old

Senior care costs vary widely, based on the care needs required for the senior and the living situation.  Does the senior live in a home that has been paid for fully and receive social security benefits?  If so, they can better pay privately for caregiving services.  If the senior does not own a home and requires full 24-hour caregiving services, they may qualify for Medicaid benefits, for very low-income seniors, and receive care in a Medicaid nursing home.  This is the safety net for all Americans currently.  However, as nursing home daily costs can vary from $100 to $400 per day, even the Medicaid senior care services are predicted to evolve as the number of seniors will quadruple in the coming decade.

Plan ahead for your own senior care needs to smooth the path for your family.  Remember, life expectancy of a child born in the U.S.A. today is 100 years.  Remember also that how you live your life today - eating right, exercising and finding a fulfilling life purpose, all impact the quality of your health as you age.  Nursing homes are often an extension of a hospital stay for seniors who may need rehabilitation and Caregiverlist's nursing home directory provides the daily cost of nursing homes nationwide.

Happy Birthday to this 105-year old senior who shared her photo with us celebrating her birthday at 105 with her great-granddaughter celebrating her 5-year-old brithday:  Birthday twins at 5 and 105!

Caregivers - let us know how old your senior clients are and if you can top age 105 - photos are welcome.  Enjoying sharing special life moments are another of advantage of working as a senior caregiver.

Nursing Home Costs Nationwide: Review Daily Costs of Nursing Homes

Senior care costs are an item that many of us do not plan ahead for - we just hope that it will never be a need.  However, the reality is that all of us should plan for needing senior care services for at least 2 years of our lives.  

Medicare, the health insurance program for all American seniors, does not pay for long-term care.  In the event a senior should "spend-down" all of their assets, they may qualify for Medicaid, a version of Medicare insurance for very low-income seniors with few assets.  Each state administers Medicaid benefits in conjunction with federal funding, which means the financial spend-down requirement varies in each state and you may view these financial requirements on Caregiverlist.

Medicaid financial qualification requirements in most states must be no more than $2,000 in assets for a single senior and $3,000 in assets for a couple.  There is an anti-spousal poverty provision that will allow one spouse to maintain more assets while the other spends down to qualify for Medicaid benefits.  This can especially be needed if one senior has memory loss or another age-related illness which requires years of caregiving services.

Nursing homes are often an extension of a hospital stay as Medicare will pay for rehabilitation services in a nursing home after a hospital stay.  However, Medicare does not pay for 100% of all the costs of a nursing home and only pays for the first 20 days of the daily fee (remember, some activities and hair care and other services cost extra) and then from days 21 to 148 the senior must pay $148 per day.  This means, in some instances, switching to one-on-one care in the home can be more cost effective.

Seniors should investigate nursing homes in their area before they need nursing home care, especially since there is a chance if a sudden medical condition such as a stroke or hip replacement, requires rehabilitation, the hospital may do a quick discharge to a nursing home in the area.  You may also receive information from licensed senior home care agencies.

Nursing home costs range from $100 to $400 or more per day.  You may review the daily costs of nursing homes nationwide in Caregiverlist's Nursing Home Directory to plan ahead for your senior care needs.

 

 

Caregiver Tales: Happy Easter!

Chicago caregivers may run into this bunny car, parked in downtown Chicago, this weekend.  Enjoy the holiday weekend, whatever your religion may be.  Sending wishes of Spring to all caregivers!  One of the best parts of being a caregiver is sharing in all the different ways of celebrating Springtime for Americans and a cute bunny springs eternal!  Remember that caregiver stress is real, so take time for a smile and if you would like to share your caregiving story with others, please do so, as we welcome more individuals to become professional senior caregivers and apply for a caregiving job as more caregivers are needed!

 

 

Seniors Saving Billions a Year on Prescription Drugs Thanks to Affordable Care Act

Doughnut holes are for pastry shops, right?  Wrong.  Not when it comes to our friendly Congress passing legislation that makes no sense.  A doughnut hole was actually included in the previous prescription drug benefit for seniors and recently corrected in the new healthcare law - it was a hole in payouts for benefits.  And when this type of legislation happens, it does spark the thought that lobbying can be very successful.  The prescription drug companies have spent millions lobbying Congress and as Open Secrets publishes, the drug company's lobbying dollars match when the legislation gets passed.

So this silly doughnut hole was labeled as such because as a senior you would have a benefit to pay for your prescription drug until you took a big enough bite and hit the "hole" and then there was no benefit paid until you got to the other side of the hole and then it would pay again.  Meanwhile, for whatever your health condition is, you need this medication so seniors were very stressed about how they would pay for it while in the "doughnut hole".

I was invited to serve on a research panel, which the government paid for just to make sure that seniors really were confused by their prescription drug plan and that everyone thought the doughnut hole was silly.  As I told them, what private paid healthcare plan would ever sell any such thing?  They wouldn't, because nobody would buy it.  


However, the good news is this:  
the new healthcare law - nicknamed "Obama Care", has saved seniors $6 billion dollars in prescription drug benefits because it eliminated this doughnut hole.  Here is the Health and Human Services news release on the announcement.

 

Health and Human Services Secretary Kathleen Sebelius announced this week that more than 6.3 million people with Medicare saved over $6.1 billion on prescription drugs because of the new health care law.

“By making prescription drugs more affordable, the Affordable Care Act is improving and promoting the best care for people with Medicare,” Secretary Sebelius said.

The Affordable Care Act makes Medicare prescription drug coverage (Part D) more affordable by gradually closing the gap in coverage where beneficiaries must pay the full cost of their prescriptions out of pocket. This gap is known as the donut hole.

People with Medicare in the doughnut hole now receive discounts when they purchase prescription drugs at a pharmacy or order them through the mail, until they reach the catastrophic coverage phase.  The Affordable Care Act gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011.  The law will provide additional savings each year until the coverage gap is closed in 2020.

In 2013, the health care law increases the discounts and savings to 52.5 percent of the cost of most brand name drugs and 21 percent of the cost of covered generic drugs.

Also under the Affordable Care Act, those who choose to enroll in Medicare Advantage and Part D now have access to a wider range of high-quality plan choices, with more four- and five-star plans than were previously available.  The Affordable Care Act continues to make Medicare more secure, with new tools and enhanced authority to crack down on criminals who cheat the program.

Learn more about how the Affordable Care Act closes the doughnut hole.

Review state-by-state information on savings in the doughnut hole.

Learn about senior care costs for long-term care and find nursing homes in your area as you plan for all your senior care needs.

Caregivers Needed: Caregiver Jobs Continue to Grow Nationwide

Senior caregivers are needed, so much so that U.S. News & World Report outlines the need for immigration reform in order to provide enough professional senior caregivers, home health aides and nursing aides for the growing U.S. senior population.

Senior caregiving jobs continue to grow in all cities and towns nationwide as many seniors choose to age-in-place in their own home.  

Part-time, full-time and live-in positions are available - - remember, live-in caregivers do not actually move in to live with the senior but instead stay over-night at the senior's homes for 2 to 3 days in a row and then go back to their own home.  Live-in caregivers earn a full week's pay in a few days.

Part-time senior caregiver jobs often involve simply assisting a senior with meals and medication reminders and companionship.

Apply for a senior caregiver job in your area as no experience is required for beginning caregiver positions as senior care companies will provide you with training.

Caregiver training for basic professional senior caregiving skills can be found through the Professional Association of Caregivers 10-hour online training course.

Refer-a-Friend to a senior caregiver job position and be entered to win $50 and meet our previous Refer-a-Friend winners.

Caregivers enjoy the fulfillment they receive by assisting a senior to enjoy a day by knowing they have assistance for the activities they no longer can easily do on their own.  Caregiving just may be the most fulfiling job you will ever find, knowing you are appreciated by not only the senior you are helping, but their entire family and their friends.  As the need for more caregivers is needed, spread the word to others. You may learn more about employment as a professional senior caregiver on the Caregiverlist Career Center.

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