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Under this plan beneficiaries with income 135% below the national poverty guidelines would be eligible for full prescription drug coverage and a sliding scale would be provided for those under 175% (Health Policy 2001).
The most controversial aspect of these proposals was whether or not Medicare should remain a public insurance that is managed by the federal government. Supporters felt that this program should continue existing programs in scope and nature while opponents claim that a program of this sort should exist in the private market. Proposals suggested that a national standard for drug benefits should be established with all beneficiaries being eligible for standard benefits and increased benefits being given to those who incur catastrophic expenses. The addition of a prescription drug benefit to Medicare, while providing seniors additional choices in how they receive their health services, is a critical modernization of the program.
In 2003 the Medicare Modernization Act (MMA) provided prescription drug coverage to Medicare beneficiaries. It is estimated that more than 40 million beneficiaries have chosen to enroll in this voluntary program since 2006 (Neuman & Cubanski, 2009). This Act provided two very important provisions the first being that beneficiaries with...
Under the second provision, the Act moved those beneficiaries who were dually covered by Medicaid and Medicare off of Medicaid and onto Medicare part D (Neuman & Cubanski, 2009). This avoided duplication of services thus reducing potential for waste.
Fraud, Abuse, and Waste
The size and complexity of the Medicare program has made it vulnerable to fraud, waste, and abuse. Fraud characterizes intentional acts of deception such as benefits paid for deceased patients or prescriptions written by deceased doctors. Waste describes the inaccurate payment for services including duplicate payments or overpayment of invoices. Abuse is the intentional use of the program outside of the way that is designed such as going to multiple physicians for multiple prescriptions. This often results in types of illegal acts or substance abuse.
All of these issues directly tie into the financial and social responsibility issues that need to be addressed. The elimination of fraud would increase the effectiveness of our healthcare system and ensure that our public health program is not a catalyst to a public health problem. In fact, Medicare fraud has been estimated to total 60 billion dollars per year in improper
Medicaid and Medicare Fraud Describe health news story combating health care fraud Medicare Medicaid• Examine evaluate corporate structure governance, culture, focus social responsibility • Recommends Medicare and Medicaid fraud: An overview Medicare and Medicaid fraud: An overview While there is still little consensus regarding the best ways to go about enacting healthcare reform, one issue that unites both Democrats and Republicans is the need to eliminate Medicaid and Medicare waste, fraud and abuse. According
Fraudulent activities such as these resulted in violations under the act, including a fine of not more than $25,000.00 or imprisonment for not more than five years, or both. Analysis of Current Fraud legal analysis of the current fraud committed in the Medicare and Medicaid programs indicates that reforms are in place to detect this fraud, and the involvement of governmental, local and federal police and investigation authorities has increased
This site contains no information directly related to the problem of substance abuse within the profession. The industry related information on the workplace environment is geared towards serving the nursing professional, and especially protecting their rights in the various nursing workplace settings. It begs the question of why, when substance abuse is a problem in the profession, the site offers no resources to the nursing professional as to where they
Miscoding on the Billing Forms Discussion Board The fundamental basis for auditing Medicare and Medicaid billing is that the services provided are confidential, patient privacy must be protected, and the written word of the provider is the record of service provision upon which a review must be initiated (Harris, 2007). Auditing, however, must extend beyond the written record to establish that the services were actually provided to the patient or client
Fraud and abuse present significant problems for the healthcare sector, leading to both financial losses and reduced quality of care. The outcomes of fraud and abuse are similar; but fraud and abuse are legally differentiated based on motive. According to Magellan Healthcare (2019), fraud is committed with clear intent, whereas abuse “involves actions that are inconsistent with sound fiscal, business or accepted behavioral healthcare practices,” (p. 1). Determining intent to
Healthcare Fraud Identity theft and fraud of many types and forms are obviously a major inconvenience and hindrance to anyone that falls prey to a person that engages that crime. There are many variants and forms of fraud and identity theft out there. One of the more insidious and nasty examples of those crimes would be that which relates to healthcare. Indeed, to have people's wallet, healthcare and the taxpayer dollar