$1 Billion Medicare Scam Largest in US History – Miami FL

 Medigap by County Information, Medigap in Florida  Comments Off on $1 Billion Medicare Scam Largest in US History – Miami FL
Jul 232016
 
Charges were filed against one of Florida’s wealthiest healthcare operators in a $1 billion Medicare care fraud scheme, announced the U.S. Attorney’s Office during a press conference in Miami, Florida on July 22, 2016. Federal prosecutors stated this is the biggest Medicare fraud scheme in the nation’s history. This has cost Medicare hundreds of millions of dollars due to fraudulent payments. Medicare is the U.S. governments medical program for the elderly and disabled.

Philip Esformes, 47, was charged at his ocean front estate. Along with two other defendants, he is accused of exploiting his network of about 20 Miami-Dade skilled nursing and assisted living facilities to fleece the taxpayer funded Medicare system by filing false claims for services that were not necessary and in some instances not provided. This has been happening over the past 14 years.

Esformes is charged with conspiring with Arnaldo Carmouze, 56, a Palmetto Bay physician’s assistant, and Odette Barcha, 49, a former director of outreach programs at Larkin Community Hospital in South Miami.

Esformes is also being accused of referring his own network of patients to other convicted healthcare fraud offenders, who had swindled Medicare for mental health, prescription drug and home healthcare services and ended up helping federal investigators target the Miami Beach business executive. According to the indictment, the kickbacks were “disguised” as payments for escort services for Esformes as well as related travel and hotel expenses.

Healthcare fraud has been a battle for a long time. This case is the nation’s largest in regards to heathcare and Medicare fraud. It was noted that while his healthcare network billed $1 billion for fraudulent medical services, Medicare paid Esformes’ skilled nursing and assisted living facilities about $500 million since 2009.

“This is the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice,” the criminal division’s assistant attorney general, Leslie R. Caldwell, said Friday during a news conference at the U.S. attorney’s office in Miami.

Medicare plans already cost the government and US citizens a lot of money. Fraud continues to drive the costs up. It is important that law enforcement continues to target this problem.

Medigap and Medicare Supplement Rate Information

 Medigap by County Information, Medigap in Florida  Comments Off on Medigap and Medicare Supplement Rate Information
May 302012
 

Introduction

Seniors that are new to Medicare and eligible to enroll may have a lot of questions about Medicare, Medicare Advantage plans, and Medicare supplements (Medigap).  Seniors are often very confused in comparing plan premiums. This is a daunting task, as rates and available companies will vary widely depending upon the state,  county and zip code that the senior resides in.  Other factors also contribute to price variances, such as the age and sex of the Medicare recipient, and whether the patient is a smoker or not.  

What is the difference between traditional Medicare and Medigap?

Medicare supplements help to cover the costs that regular Medicare Part A and B don’t (such as  doctor visits and outpatient lab tests).  Most of those who worked and paid Medicare taxes will find that there is no cost for Medicare Part A when they retire at age 65.

  • Medicare Part A is often referred to as hospital coverage. It covers a Medicare patient for care that occurs inside a hospital or other inpatient facility (such as a nursing home) as long as the patient was formally admitted into the hospital as an inpatient.  This is an important distinction — patients that are admitted as an outpatient for a procedure then stay in the hospital overnight might find a dramatically different bill! Always ask your hospital whether you are being admitted as an inpatient!


  • Medicare Part B is often referred to the medical insurance coverage component of Medicare.   Per Medicare’s website:

Part B helps cover medically-necessary services like doctors’ services, outpatient care, durable medical equipment, home health services, and other medical services. Part B also covers some preventive services.

Premiums for Medicare Part B have a standard amount, although some higher income individuals may find that they have a higher premium.

Medicare Part B covers diagnostic services and supplies, and preventive care (such as vaccinations for influenza and shingles or tests for early detection of conditions).

  • Medicare Part C is an optional choice for patients that are more commonly referred to as “Medicare Advantage” plans. They are plans offered through private insurance companies  (either a PPO or HMO plans) that envelop both Medicare A and B, but also provide additional services that may include dental coverage, eye coverage, hearing coverage, and urinary catheters and drainage bags. These plans often include Medicare Part D prescription drug plans.  For more information about these types of plans, see our post about Medicare Advantage Plan Rates. They are offered by many HMO such as Cigna or Humana.


  • Medicare Part D plans are plans that cover Medicare patient’s prescription medications. They may be utilized as stand-alone plans or attached to other coverage (such as Medicare Advantage plans). For more information about Medicare Part D see our post about Medicare Part D Plan Rates.

Medicare Supplements cover areas where the other Medicare      options do not.  They cover the costs for care that aren’t covered by Medicare Part A and Part B. This is why such supplement plans are commonly knows as “Medigap” plans — the plans cover the “gaps” that traditional Medicare doesn’t cover.

Click 2013 Medigap plan information for part 2.

Palm Beach County

  • Male smoker aged 69 — Prices for Medicare Supplement plan C offered from these companies:
  1. Hartford Life Insurance has retiree health coverage starting at 2922.
  2. Mutual of Omaha Insurance has coverage that is quite high for this market 5173.00
  3. Humana also offers a plan that is high at 5036
  4. Blue Cross Blue Shield of Florida has plans starting at 3634.
  • Female smoker age 69 — Prices from:
  1. United Healthcare sells Medicare supplement plans for 3461.
  2. Government Personnel Mutual Life Insurance at 3641.52

 

Ok, if all Medicare supplement  plans are standardized, why are the prices different?

This is an excellent question that EVERY senior should ask. The answer is that while the Medigap plan offerings are standardized, all of these companies are competing for your business.   That means that some companies will try to compete for your business on price.

However, it is also important to consider the insurance company’s reputation for customer service.  While one company may be slightly cheaper, previous patients may have a higher opinion of a competitor.  This is why it is important to consider:

  • The standardized plan that offers the overall coverage a senior desires
  • The online Medigap price quotes offered for that plan
  • The reputation and customer service rating for the best priced plans
  • Online reviews of Medigap insurance companies from other seniors

Hendry County
Lee County
Martin County
Glades County
Lee County
Charlotte County
St. Lucie County

What’s the difference between Medicare and Medicaid? Can a person have both?

Medicaid is another program for patients who may qualify based on income means testing. In general, Medicaid  is much more comprehensive than Medicare. However, patients that qualify for Medicare are considered to have both.




Indian River County
Okeechobee County
Highlands County
Desoto County
Sarasota County
Manatee County
Hardee County
Polk County
Hillsborough County

Fewer medicare supplement plans seem to be offered in Hillsborough County, but here are some  of the available plans:

  • Male smoker aged 71:
  1. Gerber Life Insurance offers supplement plans F and G at 2771 and 2556 respectively.
  2. United Healthcare Plan C at 2171 and Plan F at 2187.
  • Female smoker aged 71: (more plan offerings from MOMA than any other company)
  1. Mutual of Omaha has plan C ($3472), plan D ($3151) and plan F ($3483)
  2. Columbian Mutual Life Insurance has Plan F ($2911) and Plan G ($2716)

Pinellas County

  • 2012 Medicare Supplement Rates for seniors in St. Petersburg, Largo, Clearwater
  1. For a Non-smoker Male Age 70 : Sterling Investors Life Insurance has a rate at $3687
  2. In Oldsmar, FL consider TransAmerica Life Insurance at 2366.97
  • For a non-smoker Female age 70 best Medigap Plan D rates include:
  1. Blue Cross Blue Shield of Florida for $2265
  2. Hartford Life Insurance for 2013.

COMING SOON PENDING UPDATES

Indian River County
Pasco County
Osceola County
Brevard County
Volusia County
Seminole County
Lake County
Sumter County
Hernando County
Citrus County
Marion County
Levy County
Alachua County
Putnam County
Flagler County
St Johns County
Clay County
Bradford County
Duval County
Nassau County
Baker County
Union County
Gilchrist County
Dixie County
Lafayette County
Taylor County
Hamilton County
Suwanee County
Columbia County