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 information for the state of Florida and its counties is below.
Who is eligible for Medigap Plans?
Basically, Medigap plans are available to Medicare recipients that have Part A and Part B coverage and who are not enrolled in Medicaid or a Medicare Advantage Plan. Patients who wish to enroll in a Medicare supplement plan will have to enroll during the open enrollment period.
This period last 6 months and begins the month that the patient turns 65 and when the patient enrolls in Medicare Part B. NOTE: this is a one time open enrollment window! Unlike Medicare Advantage plans, open enrollment doesn’t occur for every senior every November!
What do I do if I missed the Medicare Supplement Open Enrollment period? How can I get a Medigap policy after open enrollment?
Seniors who have missed the open enrollment period may still apply for a Medicare Supplement policy. However, there is no guarantee that a company will sell or approve the senior’s medicare supplement application. Seniors who apply later will need to meet medical underwriting requirements or meet other select criteria. Seniors who have missed the open enrollment window can find more information here.
How do I switch to a Medicare Supplement plan from Medicare Advantage?
Patients cannot have both a Medicare Supplement plan and a Medicare Advantage Plan, but seniors who have a Medicare Advantage plan are able to change. It is important for the senior to remember that
Why should I choose a Medigap Plan over a Medicare Advantage Plan? What is the difference?
Perhaps the most important distinction is in limits to patient choices. A Medicare Advantage plan will often dictate limitations to the patient — the patient cannot see any doctor or go to any hospital. Unlike a Medicare Advantage PPO or HMO a Medigap plan allows a patient to choose any doctor that accepts Medicare and use any hospital.
This is a crucial difference. Seniors that travel out of state to visit family or friends will want to make certain if they choose an Advantage Plan that the plan network includes preferred doctor or hospitals in the area they will visit.
Are Medicare patients under 65 eligible for Medigap plans?
If you are under 65 and a disabled person receiving Medicare benefits, you may indeed be eligible for such a plan. Here is a helpful video from CMS (Center for Medicare and Medicaid Services)
When are the 2014 Medigap rate quotes released for the next year? What month should I shop for Medicare Supplement plans for the next year?
Unfortunately, there is no set date when the Medigap and Medicare supplement plan costs are released by the Center for Medicaid and Medicare Services. Private insurers submit their next year projections and then CMS compiles the list and releases it sometime in the fall. Check back here this fall for 2013 updated Medigap rate information !
Can I use my Medicare Medical Savings Account (MSA) to pay for a Medicare supplement plan?
Unfortunately, Medicare eligible seniors cannot use a Medicare Medical Saving Account (MSA) to pay for a Medicare supplement plan. MSAs are set up to have a high deductible Medicare Advantage plan with a savings account. The government deposits money into the account to pay toward Medicare covered expenses. This is an amount that is usually less than the high deductible. This type of plan may require significant out-of-pocket expenses for enrolling seniors, and unlike Medicare Supplement plans, generally limits choice of doctor and facilities as a traditional Medicare Advantage plan.
Find rates for Medicare Supplement or Medigap Plans in Florida Counties
Male age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from United American Insurance Companyquoted from $1775.00. Second best is Everence Association Inc. This compares with the highest cost plan offered from $3952 from American Pioneer Life Insurance Company…for the same plan!
Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is also from United American Insurance Company priced from $1775.00. Second best is Everence Association Inc. for 1798.60. Compares to the highest cost plan offering from American Pioneer Life Insurance Company at $3952.
Other insurers providing a Medigap policy in Miami-Dade County, FL include Aetna Life, Blue Cross Blue Shield of Florida, Colonial Penn Life, Columbian Mutual, Everence, Gerber, Globe Life and Accident, AARP Medicare Supplement and many others.
Blue Cross Blue Shield of Florida offers Plan B rates at 2734.80
There is a wide difference between Colonial Penn Life at 3355 and Global at 2633
Female Age 67 (non-smoker) — Price for Medicare Supplement Plan B range from:
United American has the most competitive rate Broward County females at 2615
United Healthcare has a solid premium cost of 2712
Sterling Investor Life Insurance offers at 3651 for a preferred plan and 3285 for standard
Other Florida county information:
Best Medicare Supplement Plan A rate quoate (for a female smoker aged 65) is offered from Transamerica Life Insurance Company at rate of $1397.
Columbian Mutual life quotes a Medigap Plan F for a price of $2558.
Leon County Franklin County
Medicare Supplement plan rate quote for Medigap Plan A for a male non-smoker aged 65 is offered from several companies. Companies that offer rates under 1500 include Globe Life and Accident Insurance, Blue Cross and Blue Shield of Florida, Hartford Life Insurance Company and Transamerica Life Insurance Company.
Liberty County Gadsden County
Santa Rosa County
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.
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
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
Polk County Hillsborough County
Fewer medicare supplement plans seem to be offered in Hillsborough County, but here are some of the available plans:
Indian River County
St Johns County