Medicare Watch

Americans United in Support of Current Medicare Program

The majority of Americans oppose premium support proposals that would fundamentally change Medicare, according to the Kaiser Family Foundation’s February 2012 health tracking poll. Under these proposals, the federal government would provide a capped payment or voucher to individual beneficiaries to purchase private insurance or, in some cases, either private insurance or Original Medicare. The poll found that 70 percent of those polled believe “Medicare should continue as it is today, with the government guaranteeing seniors’ health insurance and making sure that everyone gets the same defined set of benefits.” Only 25 percent believe that Medicare should be converted to a premium support or voucher system, even if people have the option of purchasing Original Medicare. According to the poll, not only do current beneficiaries support the continuation of Medicare as it presently stands, but high levels of support for the program exist across all age groups, including among those ages 18 to 49.

Though premium support proposals are not new, they have gained attention over the past several years as a result of the deficit-reduction debate. Versions have been proposed in the 2011 House Republican budget, more recently by Representative Paul Ryan and Senator Ron Wyden, and by presidential candidate Mitt Romney. Regardless of whether the proposals offer the option of purchasing Original Medicare, they reduce Medicare spending by shifting greater out-of-pocket costs to Medicare beneficiaries. According to the Congressional Budget Office, over time, the plan included in the 2011 budget passed by the House of Representatives would double out-of-pocket costs for people with Medicare. According to the poll, half of those polled do not support any Medicare spending reductions, even for purposes of federal deficit-reduction. An additional 36 percent of individuals polled only support minor reductions in Medicare spending.

Read the Kaiser Family Foundation’s February 2012 health tracking poll.

Medicare Private Health Plans Must Improve Fraud Detection

Medicare private health plans, also known as Medicare Advantage (MA) plans, need to tighten their oversight of fraudulent activities and claims, according to a report released by the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG). The system-wide audit of MA fraud oversight found inconsistencies in MA plans’ implementation of fraud and abuse detection and corrective action plans. The audit also found that MA plans may lack understanding of fraud and abuse program policies. Three MA organizations identified 95 percent of all fraud and abuse incidents reported to the Centers for Medicare & Medicaid Services (CMS) under the MA program. Nineteen percent of MA organizations did not identify any incidents related to both their health and prescription benefit programs.

In its report, the OIG recommends that CMS take action to improve MA plans’ implementation of fraud and abuse detection, reporting and corrective actions by conducting better oversight of the private plans’ compliance with policies to prevent fraud, waste and abuse. Other recommendations include requiring MA plans to refer potential incidents of fraud and abuse that require additional investigation to CMS or other entities. Currently, such reporting is voluntary. The OIG also recommends that CMS develop more specific guidance for MA plans that help define fraud and abuse incidents more consistently across all plans.

In other news pertaining to Medicare fraud, this week, HHS and the Department of Justice reported another victory in the government’s continuing effort to fight Medicare fraud through the Health Care Fraud Prevention and Enforcement Action Team (HEAT). In Dallas, Texas, law enforcement agents arrested individuals associated with the largest Medicare fraud case orchestrated by a single provider in history: $375 million in fraudulent home health care claims for services that beneficiaries did not require or never received.

Read the OIG report, “Medicare Advantage Organizations’ Identification of Potential Fraud and Abuse.”

Read the HHS press release, “Dallas Doctor Arrested for Alleged Role in Nearly $375 Million Health Care Fraud Scheme.”

Medicare Reminder

If you are enrolled in Original Medicare, Medicare will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings or dentures, and it will not pay for you to get fillings. Some Medicare private health plans, also known as Medicare Advantage plans, cover routine dental services. If you are enrolled in a Medicare Advantage plan, call your plan to see what dental services might be covered.

Original Medicare will cover some dental services if they are required to protect your general health or if you need dental care so that another health service that Medicare covers will be successful. For instance, Medicare may pay for dental services if you need surgery to treat fractures of the jaw or face. While Medicare may pay for these initial dental services, it will not pay for any more follow-up dental care after the underlying health condition has been treated.

Learn more about Medicare coverage of dental services and other resources that can help you pay for dental care at www.medicareinteractive.org.

Spotlight

On Wednesday, Senator Bernard Sanders released a report concluding that America faces a dental crisis. According to the report, as many as 130 million Americans do not have dental insurance, and more than 47 million have difficulty accessing dental care because of where they live. In addition, one in four individuals over the age of 65 has lost all of their teeth. The report recommends increasing the number of dental providers and requiring a minimum adult dental benefit under Medicaid. 

Read Senator Sanders’ report.