Medicine
When given a chance to operate the entire payment package, what do Health Insurance Companies (HICs) do? For the past 8 years HICs have been given the freedom to operate Medicare Advantage - the high prestige seniors plan from CMS.
When is it "gaming the system" and when is the line crossed to fraud?
The inconsistencies in HIC, GAO, and CMS efforts span the range of health care delivery. There is a pattern to the result. Some payment formulas benefit those with many billions while other payment designs penalize those with far less - like small health operations. One side helps those in need and the other side helps themselves.
Insurance companies in their role as payers have a great track record - deny and delay payment to those who do provide services. Turn about should be fair play. Why does CMS not deny or delay payments to insurance companies overpaid for Medicare Advantage plans? Given the magnitude of the problem, why has CMS not suspended, reduced, or otherwise reformed the program?
Physicians get blamed for upcoming in wave after wave of media blitz, yet insurance companies do mega-upcoding worth 70 billion more in Medicare Advantage dollars and few hear about it?
Medicare Advantage Seniors are urban and are often better off with a wide range of health, eye, dental, and other benefits. Contrast this with Medicaid patients that get the most restricted care packages and often have to beg to get care and appointments?
And where are the priorities of GAO - the government watchdog. It makes me mad when GAO targets rural hospitals for a measly 500 million in savings, due to what GAO brands as "overpayment." But GAO has failed for 7 years to audit insurance companies making 12 billion a year too much
Investigations by the Center for Public Integrity, CMS, and now GAO
Improving Health Care is Not Likely for 2600 Counties
Basic Health Access Web Basic Health Access Blog World of Rural Medical Education
- The Impact Of Maldistribution Of Awareness
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- Distribution Failures Behind By Many Designs
The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand. As previously...
- The Government Control Card Still Plays Well
The Politifact Lie of the Year in 2010 was awarded to the term "Government Takeover." Government Takeover or Government Control in various forms emerged from Republicans, health insurance association consultants, and certain media outlets. A brief attempt...
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It is about time that Small Health Care received some attention as the small hospitals and small practices, but will this continue. Off and on over past decades, primary care has received much attention, but the attention has not resulted in changes in...
- Damn The Reality Of Small Practices - Full Speed Ahead
The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small...
Medicine
What Health Insurance Corporations Do
When given a chance to operate the entire payment package, what do Health Insurance Companies (HICs) do? For the past 8 years HICs have been given the freedom to operate Medicare Advantage - the high prestige seniors plan from CMS.
- HICs helped design the complex payment formulas for MA
- HICs found a way to upcode higher patient complexity for MA patients
- HICs shoveled in the profits using the design that they helped to shape their way
When is it "gaming the system" and when is the line crossed to fraud?
The inconsistencies in HIC, GAO, and CMS efforts span the range of health care delivery. There is a pattern to the result. Some payment formulas benefit those with many billions while other payment designs penalize those with far less - like small health operations. One side helps those in need and the other side helps themselves.
Insurance companies in their role as payers have a great track record - deny and delay payment to those who do provide services. Turn about should be fair play. Why does CMS not deny or delay payments to insurance companies overpaid for Medicare Advantage plans? Given the magnitude of the problem, why has CMS not suspended, reduced, or otherwise reformed the program?
Physicians get blamed for upcoming in wave after wave of media blitz, yet insurance companies do mega-upcoding worth 70 billion more in Medicare Advantage dollars and few hear about it?
Medicare Advantage Seniors are urban and are often better off with a wide range of health, eye, dental, and other benefits. Contrast this with Medicaid patients that get the most restricted care packages and often have to beg to get care and appointments?
And where are the priorities of GAO - the government watchdog. It makes me mad when GAO targets rural hospitals for a measly 500 million in savings, due to what GAO brands as "overpayment." But GAO has failed for 7 years to audit insurance companies making 12 billion a year too much
Investigations by the Center for Public Integrity, CMS, and now GAO
Improving Health Care is Not Likely for 2600 Counties
Open Season Upon Small Health Care
Continue on to Open Season on Small Health By Big Media
Summary of Small Health Complexities
How To Resolve Health Access for 40 States Behind By Design
Preventing Rural Workforce By Design
Starting to Solve Societal Inequities - Support for a SMART Start from the Very Beginning of Life
Perverse Health Payment Dividing US - More for Fewer and Less for More, and Penalties for Those Caring for Those Most in Need
Global Fails Local But Local Focus Succeeds Globally
Domino Decline By Design - as ERs Close, Those Nearby Face Challenges, as Small or Rural Hospitals Close or Practices Where Needed...
Declines in Health Care Delivery Despite Increases in Health Spending - If We Keep Accelerating Non-Delivery Costs, We Can Continue to Remain Behind Health Care Demand
Best of Basic Health Access
Blogs indicate that primary care can be recovered and should be recovered.
Robert C. Bowman, M.D. [email protected]
Basic Health Access Web Basic Health Access Blog World of Rural Medical Education
Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.
- The Impact Of Maldistribution Of Awareness
Health designs in the United States work for few people in a few locations at high cost. This health design spends so much on administrative and highly specialized services that basic services and basic health access are insufficient for most Americans....
- Distribution Failures Behind By Many Designs
The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand. As previously...
- The Government Control Card Still Plays Well
The Politifact Lie of the Year in 2010 was awarded to the term "Government Takeover." Government Takeover or Government Control in various forms emerged from Republicans, health insurance association consultants, and certain media outlets. A brief attempt...
- Will Small Health Make The News Long Enough To Matter?
It is about time that Small Health Care received some attention as the small hospitals and small practices, but will this continue. Off and on over past decades, primary care has received much attention, but the attention has not resulted in changes in...
- Damn The Reality Of Small Practices - Full Speed Ahead
The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small...