Harver Health Insurance Counter Fraud Group Fundamental Principles

0 comments
The issue on health insurance recently hugged the headlines not just in the US but also in some countries which recognized the need to address the health services that their populace need and expect from their employers and the government.

Previously, health insurance was practically non-existent. Pension funds and provident funds were already in the consciousness of people as well as in the administration of institutions, whether private or public, for many decades. And yet, health is as important as one’s future retirement fund and present financial needs and is, in fact, closely related to both essential requirements for a healthy and productive working population. Hence, the rush to enact laws requiring all workers to acquire health insurance of some form has become a crucial issue.

For us to understand what health insurance is all about and its foundational principles, consider some pointers to guide you decide whether having health insurance is really essential or not:

1. Ideally, health insurance is not state-sponsored medicine

We hear activists declare that health insurance is a form of taxation or revenue- generating scheme of the state. Well, if some corrupt officials were to be given the hand that would be true as news of government funds being carted away by top-level officials flood the news daily today.

However, as conceived and its ideal form, health insurance is a “plan whereby money is collected usually from the employer, the employee and the state and set aside as a fund out of which those who render services (health practitioners) to the insured population (the employees, that is) are paid.” It is not “state medicine” which is a technical phrase define by the American Medical Association as “a form of medical treatment provided, conducted, controlled or subsidized by the federal or any State (provincial) Government or municipality” and has certain exceptions.

2. The end beneficiary of health insurance is the insured

Again, this is the ideal case. At any time an employee or member of the fund requires medical attention, the fund is obligated to answer the immediate need without the insured having to pay anything above the premium already being collected. Of course, we hear of cases where hospitals or doctors turn away patients who could not put up a deposit or, perhaps, certain technical requirements such as a missing ID or other reasons; but these are exceptional cases. In general, the fund is meant to serve the beneficiary for the state sees the fund as a means to promote health.

3. The other beneficiary of the health insurance is the medical practitioner.

The health insurance may appear as if it puts the health service providers as the masters and not as the public servants that they are. We all have those people in every place – those who look at their work not as a way of alleviating suffering but aggravating it among those who sustain their livelihood. Yet, it is through the health insurance fund that health practice is enlivened and made more accessible to more people with the proper implementation of the program.

4. No monetary benefits.

The only benefit the insured gets from the fund is medical service, not cash benefits. In some cases, the insured may receive free medicine, diagnosis or medical surgery for free, depending on the coverage and the type of services that a particular state provides for it populace. However, in general, only medical service is given to the insured and not cash as it is often done in other insurance policies.

5. Preventive and curative medicine are given equal attention in health insurance.

This is one of the ideal principles in the program; but it is one that is easily forgotten or abused by practitioners and even by politicians who manage or control how the funds coming from the State should be used.

We know that medical practice has become a big moneymaking venture, especially among those who support the industry with pharmaceutical drugs, equipment and assorted medical supplies. The end-user in terms of medical care has to be knowledgeable enough to know what he or she needs for any particular health issue in order not to be taken advantage of by unlawful medical-service providers.

With these basic facts about health insurance, you can determine what you can expect to derive from having a health insurance. Ultimately, sustaining an active and healthy life will not depend on having the protection of a health insurance but having a healthful and wholesome lifestyle. Doctors and the medicine they use to cure people, ultimately, do not heal us. The body has the built-in immune system to do that. Medicines and other therapies and methods only enhance the immune system’s ability to bring back the body to its optimum condition.


Hence, a health insurance is more a temporary fall-back position than a real solution to having a reasonably healthful and fulfilling life. Leading a consciously active and healthful way of life is much better than depending on a supposedly a fail-safe crutch while living a carelessly unhealthful lifestyle.

Harver Health Insurance Counter Fraud Group Tokyo on Financial Planner Tips

0 comments
“People have homeowners insurance to protect against fires and floods,” notes independent financial planner Stephen Ng, founder and president of Stephen Ng Financial Group, (www.stephenngfg.com). “They buy insurance to replace their car if it gets wrecked and they buy health insurance to protect themselves from medical costs.

“But for many people, their biggest material asset is their retirement portfolio. When I look at a new client’s portfolio and ask, ‘Where’s your insurance?’ they look at me like I’m crazy!”

Insure your retirement fund by taking steps to safeguard at least a portion of it, Ng says. As you get closer to retiring, the amount you safeguard will be what you need to rely on for your retirement income.

“Your retirement income should be derived from guaranteed sources, such as Social Security benefits and your pension plan,” says Ng, a licensed 3(21) fiduciary advisor, certified to advise companies about their 401(k) and other retirement plans. “It’s the amount you need to pay the bills and do the other things you hope to do in retirement, so your retirement income needs to be a guaranteed source of income.

“Then you look for your ‘play checks.’ That’s the money you don’t absolutely have to have, so you can still try to grow it, and take risks with it, in the market.”
Ng offers these tips for insuring your retirement plan:

• Invest a portion of your portfolio in annuities.

Annuities are long-term investment options through insurance companies that guarantee you payments over a certain rate of time, which could be the rest of your life or the life of your spouse or other survivor. Note: The guarantee is subject to the financial strength and claims-paying ability of the issuing insurance company.

• If you leave your job, quickly roll your employer-sponsored 401(k) into an IRA.

While 401(k)s are a great tool for saving, particularly if your employer is providing matching funds, if you were to die, the taxes your survivors would pay on your 401(k) would be much higher than on an IRA. That’s because they would have to inherit the money in a lump sum – that could easily take 35 percent right off the top. The lump-sum rule does not apply to IRAs. While your spouse would have the option to inherit your 401(k) as an IRA, your children would not. So, take advantage of your employer-sponsored 401(k), but if you leave the company, convert to an IRA or ROTH IRA. You can also begin transferring your 401(k) funds to an IRA at age 59½.

• Consider converting your IRA to a ROTH IRA.

For protection from future income tax rate increases, you should consider slowly converting your tax-deferred IRA funds into a ROTH IRA. Yes, you’ll have to pay the taxes now on the money you transfer, but that will guarantee that withdrawals in your retirement are not taxed – even as the money grows. If you plan to leave at least part of your IRA to your children, they’ll benefit from a fund that continues to grow tax-free.

About Stephen Ng

Stephen Ng is the founder and president of Stephen Ng Financial Group™ (www.stephenngfg.com). Since 1992, he has helped pre-retirees and retirees preserve and increase their wealth by, in part, helping them avoid common mistakes. He regularly holds financial management, retirement investing and insurance planning seminars at businesses, churches and non-profit organizations. Ng is a Chartered Life Underwriter, Chartered Financial Consultant and a Certified Estate Planner. He is also an Investment Advisor Representative with SagePoint Financial, Inc., member FINRA/SIPC. He brings a national and international perspective to his financial advice, with professional and educational roots in Australia and Asia, and certifications in 19 states.

Harver Health Insurance Counter Fraud Group Tokyo: Where is the Health Care Poverty Gap?

0 comments
The Affordable Care Act is already cutting health care costs, especially at hospitals that in the past provided charity care for uninsured, low-income patients. The reduction in charity care in states that have expanded their Medicaid programs with federal funds means the costs for this care are no longer being shifted to insured and self-paying patients, which makes health insurance more profitable for hospitals and insurers without increasing consumer costs.

But this drop in costs is happening only in the states in about half of the nation that have expanded their Medicaid programs. The other states — mostly in the South and the Plains — have been involved in political struggles that have blocked expansion of health insurance for their poor residents.
 

Expanding state-run Medicaid assistance programs has been called critical for the success of the new federal health care law. In states that haven’t expanded Medicaid, it is currently available to those who have incomes at or below the federal poverty line, which in 2014 is $11,670 for a single person and $27,910 for a family of four. In the states that have expanded their Medicaid programs, the eligibility level is 138%, or $16,104 for an unmarried person and $37,375 for a family of four.

The federal health law was written with this expansion in mind, and it offers most people with incomes ranging from 138% to 400% of the federal poverty level the opportunity to be eligible for federal subsidies as they purchase health care policies through the new health insurance exchanges.

These subsidies were to be paid for by decreases in Medicare reimbursements to hospitals and doctors. The U.S. Supreme Court decided that the federal government could not force states to expand their Medicaid programs, but the cuts in Medicare reimbursements did not change.

Unfortunately, the cutoff point for a subsidy was set at 138%, leaving those between 100% and 138% with no options in the states that didn’t expand their Medicaid programs. The resistance to Medicaid expansion is creating a poverty gap.

“It’s a crime,” Lisa Dubay, a senior fellow at the nonpartisan Urban Institute, said of the poverty gap. “These are the most vulnerable people in our society. They have no other access to health care. We have no way to take care of them and that just seems wrong.”

Aside from the ethical dilemma of not providing health care to low income people who don’t have the ability to purchase subsidized insurance, there is a significant financial cost for the states that aren’t expanding. This cost is being passed on to providers and insurers alike, and they are beginning to exert pressure on state governments to agree to the federally funded expansions.

In the states that haven’t expanded Medicaid, at least 4,805,380 people are in the poverty gap. These people won’t receive federal subsidies to help them purchase insurance, and they will continue to require costly charity care that is shifted to those with insurance and self-payers.

The Americans who fall into the poverty gap in their state also won’t be able to get preventive care they need and this in turn could shorten their lives. In addition, the number of bankruptcies will continue to grow, as nearly 2 out of 3 filings are caused by medical bills. No one can predict the outcomes of these efforts, but one thing is certain: The ones who are suffering the most are those being left behind in the health care poverty gap.

Here’s a closer look at four states — Maine, North Carolina, Utah and Virginia — that haven’t expanded their Medicaid programs with federal funds. These states have adopted widely differing approaches to the question of Medicaid expansion.

Maine

In Maine, Gov. Paul LePage, a Republican, who has vetoed legislative attempts to expand Medicaid in his state, cites the future costs once the federal subsidies for expansion end. The Democratic majority in the legislature plans to continue to introduce and pass legislation aimed at expanding Medicaid for the 24,390 people who are in the poverty gap.

Jeffrey Austin, vice president of government affairs and communication at the Maine Hospital Association, said the state’s 39 community-governed hospitals need Medicaid expansion to make up for scheduled cuts in Medicare payments.

“The logic behind the tradeoff is sound,” he said in testimony. “Hospitals will receive less reimbursement under one program (Medicare) in order to expand another program (Medicaid). When the Supreme Court ruled that Medicaid expansion was optional, it did not rule that the associated cuts were optional as well. So hospitals across the country faced the prospect of significant pain (Medicare cuts) without the bargained for gain (Medicaid expansion). That is why you have seen significant hospital advocacy in favor of expansion in Maine and across the country. So it matters to us that people understand 100% federal financing of expansion in large measure equates to hospital-ļ¬nancing of expansion. Hospitals can not afford $30, $50 and $100 million annual cuts in Medicare without the benefit of Medicaid expansion.

North Carolina

In North Carolina, GOP state legislators have refused to expand Medicaid for the 318,710 people in the poverty gap, and are considering cuts to the state’s Medicaid program. Two weeks ago, 100 members of the North Carolina Hospital Association joined together to tell states legislators how difficult these cuts would make their job of delivering health care to current Medicaid participants. They told lawmakers that government programs pay for 2 out of every 3 patients hospitalized statewide and generally at rates that are below the cost of care.

“They mean truly people getting care, people not, people getting jobs, and for some hospitals, they may mean survival,” said Democratic Rep. Rick Glazier.

In recent years, after control of both houses shifted to Republican hands, the conservative agenda that trimmed rights and cut back on social services set off widespread citizen protests called “Moral Mondays.” To date, over 1,000 people have been arrested statewide for acts of civil disobedience.

Utah

In Utah, Republican Gov. Gary Hebert is trying to work with the federal government to create a program to use federal funds slated for Medicaid expansion in his state to help the 57,850 who would be in the poverty gap purchase private insurance plans. The governor’s plan would use federal Medicaid funds to purchase health care insurance for all residents earning less than 138% of the federal poverty level.

Unlike other Medicaid expansions, this proposal would allow Utah to drop the eligibility to 100% of the federal poverty level in three years, when federal officials expect the states to pick up 10% of the cost of the expanded Medicaid programs.

Opponents of the proposal are worried that employers will cut back on insuring low-earning employees and that at the end of the three-year pilot project, there will be more uninsured residents if the state returns to the 100% level. Utah House Speaker Becky Lockhart said she would rather use $35 million in state funds for limited coverage. “Attaching ourselves as a state to Obamacare is extremely concerning to me,” she said.

Virginia

In Virginia, a court battle is brewing between Democratic Gov. Terry McAuliffe and the GOP-led state legislature over 190,840 people in the poverty gap. Citing a moral imperative, McAuliffe tried to use his existing executive powers to create a procedural path to provide Medicaid to Virginia’s 400,000 potentially eligible adults.

“Secretary Hazel will have a plan on my desk by no later than September 1st detailing how we can move Virginia health care forward even in the face of the demagoguery, lies, fear and cowardice that have gripped this debate for too long,” McAuliffe said about Bill Hazel, the state’s Secretary of Health and Human Services. Virginia’s House GOP leaders warned the governor that they will block him.

“We are prepared to challenge this blatant executive overreach through all available avenues, including the court system, ” said a joint statement recently by Republican House Speaker William Howell.

McAuliffe just vetoed seven items, including an amendment passed by Republicans that stated Medicaid can’t be expanded unless the General Assembly explicitly appropriates money for it.

Harver Health Insurance Counter Fraud Group Tokyo, The Obamacare Transition: Tips for Buying Health Insurance

0 comments
Now that the Obamacare transition has come into effect, it is important to understand some of the differences that are now at work. Understanding some of the changes can make it easier to get the greatest benefit from new policy changes that might affect you most. This can also help you to avoid potential negatives. For example, missing the important March 31 deadline can result in a fine of $95 or 1% of your total income (whichever number is greater).

“For those that do not qualify for Medicaid, you will be required to pay your monthly premium fee to your selected insurance company in order to receive coverage,” said Jim Holm of EnhanceInsurance.com . “In some cases, customers will need to pay for their deductibles along with a set copay fee for doctor visits or a portion of the cost for the medical service.” This latter scenario is referred to as co-insurance, and customers will generally need to complete these payments before the insurance company can actually cover your medical costs. For most information on this, you can visit the federal government’s website at HealthCare.gov , a federal government website, and learn more about your options for each insurance plan. To find this information, located the section entitled “See plans before I apply.”

Plan Choices

Many industry experts recommend that you narrow down your potential choices to five comparable plans, and then go to the insurer’s official website in order to educate yourself about the various benefits available in each program. It is important to look for the types of things that might not be covered — for example, acupuncture or hearing aids. This can help you to avoid plans that are probably not best-suited for your expected needs. It is also a good idea to pay attention to the company’s cited coverage examples. These will help explain exactly what the patient will be expected to pay and which costs will be covered by your plan. Note the ways that co-pays, co-insurance and deductibles are explained, as these elements help form the basis for what your plan has to offer.

Choosing your Doctors

Making the proper doctor selection is another important factor to consider. In some cases, your doctor or hospital has not contract ties to the network of your health plan. This can mean you will be responsible for paying out much more. Because of this, it is a good idea to go to your favorite doctors and then to see which health plans they are able to accept. Your health insurance plan will also have a list of drugs and medicines that they will cover. In cases where your prescription is not on this list, you can expect your bills to be higher. So, it is also important to make certain that your insurer offers access to the medications you need.

Potential Tax Credits

The new healthcare system offers ways of reducing your total medical costs. But this can be done in ways that extend beyond simple cost reductions. Additional gains can be made from the Federal tax credits that can make premiums more affordable. These tax breaks apply to households with annual incomes that fall between 100% and 400% of the federal poverty line. In Dollar terms, this equates to roughly $11,500 to $46,000 for individuals, and $24,000 to $95,000 for a family of four. The government’s HealthCare.gov website also includes some informative statistics in this area. If your annualized household income falls below 250% of the federal poverty level (which comes out to just below $60,000 for a family of four), you could qualify for reduced out-of-pocket expenses when buying a silver plan.

Harver Health Insurance Counter Fraud Group: Health Insurers may have Fleeced Taxpayers

0 comments

(NATIONAL) -- A year-long investigation by the Center for Public Integrity has revealed that health insurers may have fleeced taxpayers out of $70 billion in just five years.

The report is posted on the Center's website by reporter Wendall Potter who says taxpayers should not assume their elected lawmakers in Washington will be outraged or even launching a federal probe about this.

Potter:

"You would think members of Congress in both parties would be so outraged they’d be launching their own investigation and railing against the “fraud and abuse” they decry on the campaign trail.

But I’m not holding out much hope. That’s because I know just how powerful and influential the health insurance industry is and how its lobbyists almost always get what they want out of Congress and the White House, regardless of who is sitting in the Oval Office."

The Center’s investigation called the "Medicare Advantage Money Grab" found here discovered that:

- Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 to 2013, mostly over-billings, by manipulating or misusing a Medicare payment tool called a “risk score.”

- From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for people in standard Medicare in more than 500 counties nationwide.

- Federal health officials have long kept key financial records of Medicare Advantage plans in a “black box,” inaccessible to the public and press.

- Medicare Advantage health plans collect billions of dollars from controversial “house calls” that industry officials say help improve care but which critics argue inflate costs needlessly.

Reporter Potter says the findings didn't come as a shock to him because during his two decades in the industry, at both Humana and Cigna, "I came to understand just how much of a cash cow the Medicare Advantage program has become to insurers participating in the program. Wall Street financial analysts devote considerable attention to determining how much insurers’ Medicare Advantage business contributes to their bottom lines and how much of the money they take in from the government is actually paid out in medical claims. The less they spend on medical care, the better, from Wall Street’s perspective."


Potter adds this is a huge business and one that is growing rapidly and because the business is so profitable, insurers spend millions of dollars on lobbying, advertising, PR and “grassroots” political activities to keep the money flowing unimpeded.

Harver Health Insurance Counter Fraud Group: Have You Contributed to a Health Scam?

0 comments


If it works, the GoBe will be life-changing. But it’s a big if.

The GoBe is a bracelet that looks like a small microplane has been affixed to a black watchband—the top of the microplane is a display, and its underside is a sensor. Through its “patented flow technology,” the GoBe promises to measure the wearer’s heart rate, calories burned, sleep, and stress levels. That’s all conceivable, given what the FitBit and other body trackers already measure. But the GoBe also promises something a little more sensational: Automatically tracking the calories of everything the wearer eats, through his or her skin.

“We live in an age where people struggle with their diets and need simple ways to take control of their health,” Artem Shipitsyn, the CEO of GoBe’s parent company, HealBe, says in a video on the device’s Indiegogo campaign page. He says the technology would help “people like me live a healthy life with less effort.”

The automatic calorie-tracking, which GoBe claims to do by reading glucose levels in cells, would revolutionize dieting—even the best calorie-counting apps today rely on manual food logging.

“Tell it nothing. Know everything,” the soothing video narrator’s voice says over b-roll of people skiing and clicking on their smartphones.

The premise was so lofty, in fact, that it didn’t take long for tech reporters, led by PandoDaily’s James Robinson, to attack.

Let’s say GoBe does measure glucose levels without piercing the skin, as it claims to do. That would be a godsend to diabetics, who, as it stands, must regularly prick their fingers to test blood sugar. The less-invasive technology is probably coming soon, Michelle MacDonald, a clinical dietician at the National Jewish Health hospital in Denver, told PandoDaily, “but when it does it will be the size of a shoebox ... It will come from a big lab, will be huge news and make a lot of money.”

But on top of that, blood glucose is only a rough measure of total energy intake. Eat a tablespoon of olive oil, and you’ve consumed 119 calories, but your blood sugar would barely rise. A very thin slice of white bread, meanwhile, would send blood sugar soaring and only yields 40 calories.

From its launch in March, the GoBe campaign steadily raked in Indiegogo donations—it’s now at 1,081 percent of its original $100,000 goal. Robinson stayed on the warpath, citing more and more experts who denounced the GoBe technology and publishing several more articles about what he considers to be a complete scam.

HealBe began commenting negatively on Robinson’s articles, then deleting the comments. GoBe backers started demanding refunds. Delivery of the finished device was pushed back to August.


“I’ve been seeing some disturbing articles regarding this project,” one commenter wrote on the HealBe Indiegogo campaign page. “Various articles stating that the things that the GoBe promises cannot be done ... Can anyone offer a rebuttal? Worried about all of the delays and negative statements. Thanks!” See more…

Harver Health Insurance Counter Fraud Group: Advance directives clarify choices

0 comments


Pulmonologist Dr. Rick Blevins often sees patients and families grappling with a decision he says should have been made long before.

Blevins treats many patients in the intensive care unit who won't survive. If they do not have advance directives, their families are left to make hard decisions that they may not have answers to.

"It's a subject that comes up and (in the ICU) is the worst possible time for conversations to be initiated," Blevins said.

Many times, the ICU patient is unable to make decisions for himself, so it falls on the family, Blevins said.

The role of the family in that situation is to make the decision the patient would make, Blevins explained. But families don't always know or don't agree.

Advance directives, such as living wills, provide instruction to families and especially health care providers on how the patient wants to be treated in the event of incapacity. Besides the living will, other common forms people complete are powers of attorney for health care that gives another person the authority to make health care decisions in the event of incapacity of the patient, and a form called Five Wishes, which provides not only instructions on medical care but also emotional care.

Blevins said it can be difficult not only for families to have discussions about advance directives, but these conversations may not be happening in the doctor's office either.

Doctors are encouraged to talk to their patients about their health care wishes, but time constraints might prevent that, he said.

Many advance directives are legal documents, so lawyers can help people draw them up. But many are also available on the Internet, and Benefis has a link to the Five Wishes form on its website.

The POLST form, which stands for Provider Orders for Life-Sustaining Treatment, is available for patients who have a serious illness and provides instructions on how they want to be treated in an emergency situation. It can be filled out by a provider only in consult with the patient.

Sue Rose, the State Health Insurance Assistance Program, or SHIP, coordinator for Area VIII Agency on Aging in Cascade County, said she can assist seniors who want to fill out advance directives.

All the services provided are free.

Rose explained that SHIP can provide assistance with Medicare and other health insurance, possible Medicare fraud and long-term care assistance, including advance directives.

While Rose can't offer legal advice, she is able to explain to seniors the purpose of the forms and help them fill the forms out. Work on advance directives is done one-on-one, but Rose gives group presentations periodically.

"We have so many resources to get people connected," said Rose.

Rose said most of the people who come to her for help are aware of what the advance directives do and what they want.

"You also get cold calls where people say, 'I don't know anything. What do I do?'" Rose said.

Eleven agencies on aging exist across the state, and among them all areas of the state are covered. Area VIII covers Cascade County only. All 11 of the agencies have SHIP programs, Rose said.

All these services are free, including notary services, she said.

Blevins encourages people to talk to their doctors and families about advance directives. He also advises people not to wait. Young people need advance directives too, he said, and it is important to make wishes explicitly known.

"People's definitions are different," he said.

Montana has an End-of-Life Registry online that is available through the Department of Justice. The secure database acts as a depository for advance directives. More information is available at https://doj.mt.gov/consumer/end-of-life-registry/.

Blevins also recommends speaking with a lawyer about advance directives, and once they are completed, keeping copies with your lawyer, family, doctor and local hospital.