DL Open Thread: Saturday, October 8, 2022
Virtually Every Insurer Has Committed Fraud Through Their Medicare Advantage Plans. Yes, including Highmark, which has been accused of overbilling by the Inspector General. But Carney and DeMatteis knew that. They just didn’t/don’t give a shit:
Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.
Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost. If trends hold, by next year, more than half of Medicare recipients will be in a private plan.
But a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.
The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.
As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.
It goes without saying, read the entire article. Especially recommended for John Kowalko and Karen Peterson.
Ukraine Blows Up Key Russian Supply Link:
KYIV, Ukraine — A giant explosion ripped across the Crimean Bridge, a strategic link between mainland Russia and Crimea, in what appeared to be a stunning blow early Saturday morning to a symbol of President Vladimir Putin’s ambitions to control Ukraine.
Kremlin spokesman Dmitry Peskov acknowledged the government had no timeline for repairing the 12-mile bridge.
Kremlin Axes Military Commanders:
Far from bestowing glory on Russia’s military brass, the war in Ukraine is proving toxic for top commanders, with at least eight generals fired, reassigned or otherwise sidelined since the start of the invasion on Feb. 24. Western governments have said that at least 10 others were killed in battle, a remarkably high number that military analysts say is evidence of grievous strategic errors.
The upheaval in the upper ranks of uniformed officers highlights Russia’s fundamental mistakes in war planning, and the dysfunctional chain of command that resulted first in Moscow’s failure to achieve its primary military objective — the quick capture of Kyiv and toppling of the Ukrainian government — and more recently in the retreats on the eastern and southern fronts.
Rethugs: If You Love America, You Love Russia.
Time for Biden to wrap himself in the Ukrainian flag–and challenge the Rethugs’ love for Putin and Orban. See, is that so hard?
TruthSocial Deal On Verge Of Collapse. Per usual, it looks like Trump will walk away unscathed, leaving wreckage behind. It’s his business model.
Expanded Voter Options Ruled Unconstitutional By Delaware Supreme Court. So. What can we do? Elect Kyra Hoffner and Russ Huxtable to the State Senate, ensuring a super-majority, and elect Frank Burns in the House, making a yes vote on a Constitutional Amendment more likely. Because that’s how we’re gonna get it done, if we get it done.
What do you want to talk about?
Ask your doctor about “Medicare Advantage”, then step back as the reply will most likely not be pleasant. If Medicare Advantage now owns half of all Medicare recipients suspect that number is not voluntary, much like Delaware state workers the high and mighty have been swayed by that lowest form of life the lobbyists. It is yet another Republican ploy in the eternal game of lies that proclaims “Private is always better!”. Like hell it is.
The Medicare Advantage plans are run by insurance companies; they’re out to make a profit, not help people.
Exactly.
Carney and DeMatteis are in favor of health care on the cheap for retirees–even if we’re talking about the DENIAL of health care.
lol, this is all insurance companies. Every single one.
…except traditional Medicare.
Yesterday I saw a clip on the news of an American general saying that if Putin uses weapons of mass destruction in Ukraine, or anywhere else, the US should focus on de-escalation…WHAT? Fuck that. How about assured destruction, with a tap on the kremlin’s door for good measure. Nazis can only be defeated by force of arms, and we know what Putin is…de-escalation, no, Armageddon
.
El Som, Kowalko and Peterson should read what entire article?
click the link. lol
https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html
Accurate and factual information piece being distributed by RISE:
MEDICARE ADVANTAGE IS NOT OUR MEDICFILL!
The State claims its new Medicare Advantage provides the same benefits, provider network, and out-of-pocket costs as our current Medicfill plan. NOT TRUE!
Medicare Advantage plans all follow the same managed care business model. Delaware’s is no different. Medicare Advantage:
Takes over your Medicare benefits and decides your care, not your doctor
Profits from denying and delaying your medical care. (HSS Inspector General’s report of 4-22-22)
NOT THE SAME BENEFITS
The State says Medicare Advantage will “provide the same benefits” as Medicfill. Even a quick review of its 38-page “Medical Benefits Chart” shows this is not true. For example, when you call 911 for a medical emergency, ask the operator about insurance coverage. If a paramedic unit and a fire company ambulance both respond from different agencies (as is typical), Medicare Advantage will not pay for both, at least if one is out-of-network. (Benefits Chart, pg. A1-5)
PRIOR AUTHORIZATIONS THAT DELAY AND DENY CARE
The State says Medicare Advantage will require “some” pre-authorizations for medical services. “Some” is actually 2,030 (1,690 procedures + 340 drugs)! (Highmark contract, 9-29-22)
A 2021 American Medical Association survey found 93% of physicians report Prior Authorizations (PA) delay necessary care.
PA leads to serious adverse events requiring medical intervention (34%) and life-threatening events (18%). https:www.ama-assn.org/system/files/prior-authorization-survey.pdf)
MORE LIMITED PROVIDER NETWORK
The State says we will have “the same provider network.” A Kaiser study (2017) found Medicare Advantage networks include only 46% of all physicians in a county, on average.
GREATER OUT OF POCKET
The state says Medicare Advantage will have “the same out-of-pocket costs.” The “Evidence of Coverage,” however, released by the State on 9/29/22, shows we will pay a share of costs to all providers. The “Medical Benefits Chart” says the maximum out-of-pocket costs are $1,000 (but doesn’t include certain payments). For care deemed “not medically necessary” by the insurance company, we will pay the entire cost. For surgery, “you pay the cost-sharing amounts for outpatient surgery. Even if you stay in the hospital overnight, you might still be considered an ‘outpatient.’” (Medical Benefits Chart , pg. A1-26)
HELP US HELP YOU!
Please donate to Rise Delaware to help defray the costs of suing the State to stop them from taking our benefits. Checks made out to Rise Delaware can be sent to P.O. Box 7262, Newark, DE 19714 or you can contribute on-line at gofundme.com/f/risedelaware. Please be as generous as you can! Join our email list by emailing RISEDelaware@gmail.com.