Consider what it would be like to have a health insurance plan that capped annual benefits at $2,000. For any medical care costing more than that, you would have to pay out of pocket.
In a McDonald’s health plan, workers can pay about $730 a year for benefits up to $2,000.
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Examples of care that costs more than $2,000 — and often a lot more — include virtually any cancer treatment, any heart surgery, a year’s worth of diabetes treatment and care for many broken bones. Even a single M.R.I. exam can cost more than $2,000. A typical hospital stay runs thousands of dollars more.
So does this insurance plan sound like part of the solution for the country’s health care system — or part of the problem?
A $2,000 plan happens to be one of the main plans that McDonald’s offers its employees. It became big news last week, when The Wall Street Journal reported that the company was worried the plan would run afoul of a provision in the new health care law. In response to the provision, McDonald’s threatened to drop the coverage altogether, until the Obama administration signaled it would grant some exemptions.
This episode was only the latest disruption that the health law seems to be causing. Also last week, the Principal Financial Group said it was getting out of the health insurance business, while other insurers have said they might stop offering certain types of coverage. With each new disruption come loud claims — some from insurance executives — that the health overhaul is damaging American health care.
On the surface, these claims can sound credible. But when you dig a little deeper, you often discover the same lesson that the McDonald’s case provides: the real problem was the status quo.
American families spend almost twice as much on health care — through premiums, paycheck deductions and out-of-pocket expenses — as families in any other country. In exchange, we receive top-notch specialty care in many areas. Yet on the whole, we do not get much better care than countries that spend far less.
We don’t live as long as people in Canada, Japan, most of Western Europe or even relatively poor Jordan. Misdiagnosis is common. Medical errors occur more often than in some other countries. Unique to the developed world, millions of people have no health insurance, and millions more, like many fast-food workers, are underinsured.
In choosing their health reform plan, President Obama and the Democrats eschewed radical changes, for better or worse, and instead tried to minimize the disruptions to the current system. Sometimes, Mr. Obama went so far as to suggest there would be no disruptions, saying that people could keep their current plan if they liked it. But that’s not quite right. It is not possible to change a system as huge, and as hugely flawed, as ours without some disruptions.
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McDonald’s offers its hourly workers two different health care plans, which are known as “mini-med” plans. In one, workers can pay about $730 a year for benefits of up to $2,000. In the other, they can pay about $1,660 a year for benefits of up to $10,000, The Journal reported.
In a memo to federal regulators, McDonald’s executives argued that their version of health insurance “positively impacts” the almost 30,000 workers who are covered. And that’s true. A plan with a $2,000 or $10,000 cap can cover some modest health problems and is better than being uninsured.
But should the litmus test for American health care really be better than nothing?
Mini-med plans force people to drain their savings accounts for dozens of common medical problems. They also force hospitals to let some bills go unpaid, which drives up costs for everyone else.
Senator Charles Grassley, Republican of Iowa, has previously criticized AARP for marketing similarly limited plans to its members. “It’s not better than nothing,” Mr. Grassley argued, “to encourage people to buy something described as ‘health security’ when there’s no basic protection against high medical costs.”
Dr. Aaron Carroll, an Indiana University pediatrics professor who studies health policy, says of mini-med plans: “They’re great if you’re healthy, because you feel like you’re covered. But if you ever need them, they’re so skimpy, they provide very little.” Gary Claxton of the Kaiser Family Foundation adds, “They really just shouldn’t be considered health insurance.”
The plans’ skimpiness is the main reason they ran into legal jeopardy. Under the new law, most plans must spend at least 85 percent of their revenue on medical care, rather than administrative overhead. The McDonald’s plans aren’t generous enough to clear the hurdle.
At the same time, it’s probably unrealistic to expect McDonald’s to give workers decent health insurance. Many of those workers make less than $20,000 a year. A typical family insurance plan would raise their total compensation by more than half, destroying the McDonald’s business model.
The workers, for their part, cannot afford to buy insurance in the so-called individual market. Plans are even more expensive in that market, because it is dominated by people who desperately need insurance — which is to say, sick people.
This is where health reform comes in. It tried to solve the problem by creating what policy experts call a three-legged stool.
First, people will be required to buy insurance, to spread costs among the sick and the healthy. Second, insurers will be prohibited from cherry-picking only the healthiest customers, again to spread costs. Finally, the government will give subsidies to people, like McDonald’s workers, who can’t afford insurance on their own.
Germany, the Netherlands and Switzerland all use a system along these lines to cover everyone, largely through the private sector, for less money per person than this country spends.
The recent disruptions in our health insurance market are partly a result of the fact that the stool’s three legs were not built on the same timetable. Some of the insurance regulations, like the one on overhead costs, are starting to take effect. But the new markets for health insurance, known as exchanges, won’t be up and running until 2014. This timetable has its problems, and the Obama administration will probably need to grant some more temporary exemptions.
In 2014, however, the choice for McDonald’s workers will no longer be between a bad policy and no policy. Through the exchanges, they will be able to buy a real health insurance plan — one that covers cancer, heart attacks, surgeries, M.R.I.’s and hospital stays. Dr. Carroll notes that many families will end up paying less than they are now paying out of pocket and will get more access to care, too.
For insurance companies, these changes won’t be quite so positive. They will no longer be able to sell plans that devote 30 percent of revenue to salaries for their workers. They will not be allowed to compete over which company can come up with the most ingenious ways to say no to the sick. Their benefits and prices will become more public, thanks to the exchanges.
The health care overhaul that passed Congress is far from ideal, as I have written many times in this space. But it does represent progress.
The fact that it is beginning to disrupt the status quo — that some insurance policies will eventually be eliminated and some inefficient insurers will have to leave the market altogether — is all the proof we need. To make sure your health is covered, contact us today.
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Tuesday, December 13, 2011
Wednesday, November 2, 2011
Mad About Homeowners Insurance Companies?
You're at a disadvantage when you have major house damage or a total loss of your home. You face a home insurance claim process that could easily stretch out for more than a year, require reams of paperwork and leave you exhausted.
Unless you've already run the gantlet of a major home insurance claim, you don't know what to expect.
Do you need umbrella insurance? Get it Here!
Fiorella Insurance, helps policyholders work through the insurance claim process and shows them how to recoup their losses. Most people don't learn anything about insurance until they have a loss.
Public adjusters work on behalf of policyholders to help people get all they're entitled to from insurance claims. Adjusters help evaluate damage and rebuilding costs, track the flow of insurance payments and amounts due, and work with home insurance companies to expedite their clients' insurance claims.
Saving on insurance
Here is a look at many of the things that can take people by surprise when they have a large home insurance claim:
1. A claim for a total loss of a house can cost less than rebuilding a damaged house.
Construction from scratch costs less per foot than construction for rebuilding. Often it's "easier" to fix your problem if your house is simply gone, rather than to try to repair the damaged sections of what's left.
When you start from scratch, you don't have to incorporate changes that exist with the building, so you have a clean slate. Also, it's often more costly to retrofit your old house to prevailing code than to start fresh.
2. If you have a mortgage, your insurance checks will be made out to both you and your mortgage bank.
Your mortgage holder is likely listed as a "loss payee" on your home insurance policy, so payments for rebuilding are issued to both you and your lien holder. And don't expect your mortgage holder to sign over the check to you.
Policyholders "have to endorse and send the check to the mortgage company, and it will sit in escrow until repairs are made. Mortgage banks typically release the funds back to you in three installments over the course of your reconstruction. Mortgage companies want to be sure your property is repaired before releasing payment to you. As a result, you may have to advance your own money for construction costs until the mortgage company verifies the repairs.
3. Don't cash any insurance checks marked "full and final settlement."
In some states, it's illegal for an insurer to issue a check like this. You don't want to cut yourself off from any funds you'd be entitled to if you later discover that not everything has been paid for.
4. Don't sign a release on your home insurance claim.
This takes the home insurer off the hook for any future payments on your claim.
Insurance companies ask the insured to do it when they think there's a problem or big dispute coming. The home insurance policy does not require the insured to execute a release, so why should you sign?
5. Don't let your insurance company replace your Pottery Barn stuff with Wal-Mart stuff.
The values of particular items are often disputed in home insurance claims. If you've bought expensive items, your insurance company may say it can replace them with very similar items from Wal-Mart or Target.
We battle back and forth with the company on your behalf. The insured is entitled to be paid for what he had -- not a knockoff version of it.
6. Many condo owners have no idea that they need their own home insurance policies.
They think that the condo association's policy covers their property. However, the association's policy covers only common areas, typically up to the walls of the condo. If you want your own space and belongings protected, you need an HO-6 home insurance policy. Otherwise, all your belongings, furniture, appliances and cabinets are uninsured.
Without an HO-6, you also may have no liability protection if you're sued for something that happens within your condo, like a slip-and-fall injury. If you need help with your home insurance, give us a call or contact us online.
Unless you've already run the gantlet of a major home insurance claim, you don't know what to expect.
Do you need umbrella insurance? Get it Here!
Fiorella Insurance, helps policyholders work through the insurance claim process and shows them how to recoup their losses. Most people don't learn anything about insurance until they have a loss.
Public adjusters work on behalf of policyholders to help people get all they're entitled to from insurance claims. Adjusters help evaluate damage and rebuilding costs, track the flow of insurance payments and amounts due, and work with home insurance companies to expedite their clients' insurance claims.
Saving on insurance
Here is a look at many of the things that can take people by surprise when they have a large home insurance claim:
1. A claim for a total loss of a house can cost less than rebuilding a damaged house.
Construction from scratch costs less per foot than construction for rebuilding. Often it's "easier" to fix your problem if your house is simply gone, rather than to try to repair the damaged sections of what's left.
When you start from scratch, you don't have to incorporate changes that exist with the building, so you have a clean slate. Also, it's often more costly to retrofit your old house to prevailing code than to start fresh.
2. If you have a mortgage, your insurance checks will be made out to both you and your mortgage bank.
Your mortgage holder is likely listed as a "loss payee" on your home insurance policy, so payments for rebuilding are issued to both you and your lien holder. And don't expect your mortgage holder to sign over the check to you.
Policyholders "have to endorse and send the check to the mortgage company, and it will sit in escrow until repairs are made. Mortgage banks typically release the funds back to you in three installments over the course of your reconstruction. Mortgage companies want to be sure your property is repaired before releasing payment to you. As a result, you may have to advance your own money for construction costs until the mortgage company verifies the repairs.
3. Don't cash any insurance checks marked "full and final settlement."
In some states, it's illegal for an insurer to issue a check like this. You don't want to cut yourself off from any funds you'd be entitled to if you later discover that not everything has been paid for.
4. Don't sign a release on your home insurance claim.
This takes the home insurer off the hook for any future payments on your claim.
Insurance companies ask the insured to do it when they think there's a problem or big dispute coming. The home insurance policy does not require the insured to execute a release, so why should you sign?
5. Don't let your insurance company replace your Pottery Barn stuff with Wal-Mart stuff.
The values of particular items are often disputed in home insurance claims. If you've bought expensive items, your insurance company may say it can replace them with very similar items from Wal-Mart or Target.
We battle back and forth with the company on your behalf. The insured is entitled to be paid for what he had -- not a knockoff version of it.
6. Many condo owners have no idea that they need their own home insurance policies.
They think that the condo association's policy covers their property. However, the association's policy covers only common areas, typically up to the walls of the condo. If you want your own space and belongings protected, you need an HO-6 home insurance policy. Otherwise, all your belongings, furniture, appliances and cabinets are uninsured.
Without an HO-6, you also may have no liability protection if you're sued for something that happens within your condo, like a slip-and-fall injury. If you need help with your home insurance, give us a call or contact us online.
Wednesday, October 19, 2011
Medicare In Florida
Out of the 18,000,000 residents of Florida, approximately 18% are enrolled in Medicare according to data from the Kaiser Family Foundation. These statistics mean that in Florida, Medicare is a subject of critical concern for nearly one out of five people. Most of these Medicare beneficiaries (63.8%) are age 70 or older and more than half of all Florida Medicare beneficiaries are women.
Florida Medicare beneficiaries may enroll in stand-alone prescription drug plans, Medicare Advantage plans, or Medicare Supplement (Medigap) plans. However, many residents are often unclear regarding the differences among these types of plans and gravitate towards whatever plan has been marketed to them. Stand-alone Medicare prescription drug plans, sometimes referred to as PDPs, are private insurance plans approved to provide drug coverage to people enrolled in either Medicare Part A or Part B. There is no coverage for hospitalization or medical services in a stand-alone PDP, only drug coverage. Each PDP has a list of drugs that it covers. This list is known as a formulary. Medicare mandates that a formulary must cover AT LEAST two drugs from each therapeutic category approved by Medicare. Formularies also determine how much you pay for a drug covered by the PDP plan. PDPs can cover different drugs so it is vital that you confirm that your drugs are covered before enrolling in a PDP plan.
Medicare Advantage plans are private health insurance plans available to people enrolled in Medicare Parts A and B. They provide hospitalization and medical benefits and, most often, include prescription drug coverage. However, as is the case with stand alone prescription drug plans, Medicare Advantage plans with drug coverage have formularies that determine which drugs they cover and which ones they do not cover. Always confirm your drugs are covered before enrolling in a Medicare Advantage plan. Some Medicare Advantage plans can be confusing because they offer a $0 monthly premium. Those insurance companies that offer this rate can do so because they receive a reimbursement rate from the government that enables them to remain profitable given their plan enrollees.
Medicare Supplement plans intend to cover the out-of-pocket expenses, or "gaps," associated with Medicare Parts A & B. In every state but Massachusetts, Minnesota, and Wisconsin, there are ten standard plan types from which to choose. Each of the plan types has a letter name: A, B, C, D, F, G, K, L, M, and N. Each plan covers different out-of-pocket expenses with plan F having the broadest coverage. Medicare Supplement plans do not include prescription drug coverage. However, you may enroll in a stand-alone prescription drug plan alongside a Medicare Supplement plan.
According to statistics from 2010, 32% of Medicare beneficiaries in Florida were enrolled in stand-alone prescription drug plans as compared to 29% in Medicare Advantage plans with drug coverage and 27% had prescription drug coverage from another source such as an employer plan. United Healthcare's 2010 statistics claimed that Florida had over 642,000 residents enrolled in a Medicare Supplement plan.
Florida Medicare beneficiaries may enroll in stand-alone prescription drug plans, Medicare Advantage plans, or Medicare Supplement (Medigap) plans. However, many residents are often unclear regarding the differences among these types of plans and gravitate towards whatever plan has been marketed to them. Stand-alone Medicare prescription drug plans, sometimes referred to as PDPs, are private insurance plans approved to provide drug coverage to people enrolled in either Medicare Part A or Part B. There is no coverage for hospitalization or medical services in a stand-alone PDP, only drug coverage. Each PDP has a list of drugs that it covers. This list is known as a formulary. Medicare mandates that a formulary must cover AT LEAST two drugs from each therapeutic category approved by Medicare. Formularies also determine how much you pay for a drug covered by the PDP plan. PDPs can cover different drugs so it is vital that you confirm that your drugs are covered before enrolling in a PDP plan.
Medicare Advantage plans are private health insurance plans available to people enrolled in Medicare Parts A and B. They provide hospitalization and medical benefits and, most often, include prescription drug coverage. However, as is the case with stand alone prescription drug plans, Medicare Advantage plans with drug coverage have formularies that determine which drugs they cover and which ones they do not cover. Always confirm your drugs are covered before enrolling in a Medicare Advantage plan. Some Medicare Advantage plans can be confusing because they offer a $0 monthly premium. Those insurance companies that offer this rate can do so because they receive a reimbursement rate from the government that enables them to remain profitable given their plan enrollees.
Medicare Supplement plans intend to cover the out-of-pocket expenses, or "gaps," associated with Medicare Parts A & B. In every state but Massachusetts, Minnesota, and Wisconsin, there are ten standard plan types from which to choose. Each of the plan types has a letter name: A, B, C, D, F, G, K, L, M, and N. Each plan covers different out-of-pocket expenses with plan F having the broadest coverage. Medicare Supplement plans do not include prescription drug coverage. However, you may enroll in a stand-alone prescription drug plan alongside a Medicare Supplement plan.
According to statistics from 2010, 32% of Medicare beneficiaries in Florida were enrolled in stand-alone prescription drug plans as compared to 29% in Medicare Advantage plans with drug coverage and 27% had prescription drug coverage from another source such as an employer plan. United Healthcare's 2010 statistics claimed that Florida had over 642,000 residents enrolled in a Medicare Supplement plan.
Monday, September 12, 2011
Auto Insurance Coverage in Florida
Getting cheap car insurance in Florida is easy, if you do your home work and shop around. By law, you are required to have insurance for your cars with a minimum coverage of $10,000 for personal injury protection or PIP and $10,000 for property damage liability or PDL.
However, you should ask question regarding Florida’s “no-fault” insurance clause. It is actually a bit different in each state. Yet, in Florida, the no-fault policy really covers the medical bills. Usually, in a no-fault situation each driver’s medical expenses would be covered by their insurance policy. But, property damage will usually still be covered by the at fault party’s insurance. This is important to know when looking for insurance in Florida, as it may persuade you to carry higher limits than the required amount.
Florida has a large amount of aggressive drivers, and the seeing vehicles run a red light are common occurrences in the state. The traffic is heavy and often backed up; so road rage is also an issue. Still, the weather is still one of the biggest factors on the Florida highways. The frequent heavy rains and heavy winds can often make driving difficult. So, Florida drivers must stay alert. And, they need the peace of mind of knowing that they are covered.
There are insurance companies all over the state of Florida and insurance is easy to find. Small insurance companies may be known for the cheapest policies. However, larger insurance companies will tend to be more reliable and they will usually try to make sure that you are covered for any accident and you have coverage for bodily injuries.
The most important thing to remember is shop around. And, although you should look for cheap car insurance Florida, make sure that your insurance policy will keep you protected from whatever may arise.For the best rates in FL, click here.
However, you should ask question regarding Florida’s “no-fault” insurance clause. It is actually a bit different in each state. Yet, in Florida, the no-fault policy really covers the medical bills. Usually, in a no-fault situation each driver’s medical expenses would be covered by their insurance policy. But, property damage will usually still be covered by the at fault party’s insurance. This is important to know when looking for insurance in Florida, as it may persuade you to carry higher limits than the required amount.
Florida has a large amount of aggressive drivers, and the seeing vehicles run a red light are common occurrences in the state. The traffic is heavy and often backed up; so road rage is also an issue. Still, the weather is still one of the biggest factors on the Florida highways. The frequent heavy rains and heavy winds can often make driving difficult. So, Florida drivers must stay alert. And, they need the peace of mind of knowing that they are covered.
There are insurance companies all over the state of Florida and insurance is easy to find. Small insurance companies may be known for the cheapest policies. However, larger insurance companies will tend to be more reliable and they will usually try to make sure that you are covered for any accident and you have coverage for bodily injuries.
The most important thing to remember is shop around. And, although you should look for cheap car insurance Florida, make sure that your insurance policy will keep you protected from whatever may arise.For the best rates in FL, click here.
Wednesday, August 31, 2011
Reform Timeline for Medicare and Health Insurance
Prescription Drug Discounts:
Effective Jan. 1, 2011, under the health care reform legislation, enrollees who fall in the so-called "Part D donut hole," an annual gap in Medicare Part D prescription drug coverage, will get a 50 percent discount on covered non-generic prescription medications. Additional savings on both generic and non-generic prescriptions will be phased in over the next ten years until the "donut hole" is entirely closed by 2020.
Free Preventive Care for Seniors:
Effective Jan. 1, 2011, seniors who receive Medicare will become eligible for additional preventive services at no out-of-pocket cost. These services will include one wellness check each year and the development of personalized plans for preventing illness.
Improving the Quality and Efficiency of Health Care:
Effective Jan. 1, 2011, the legislation provides for a new Center for Medicare & Medicaid Innovation to begin testing ways of delivering care to patients to improve the quality of care and develop ways to reduce the cost of health care for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). By Jan. 1, 2011, HHS will present a national strategy aimed at improving the quality of government health care.
Preventing Unnecessary Hospital Readmissions:
Effective Jan. 1, 2011, the Community Care Transitions Program will aid high-risk Medicare recipients who have been released from the hospital by coordinating care and connecting patients to community services to avoid unnecessary readmissions.
Bringing Down Costs:
Beginning Oct. 1, 2011, the Independent Payment Advisory Board will begin developing and presenting proposals to Congress and the president to protect and improve benefits for enrollees and keep the Medicare Trust Fund alive and well. Its goal is to eliminate waste, find ways to reduce the cost of health care, improve health outcomes and make quality care more accessable for Medicare enrollees.
Increasing Access to Services:
Effective Oct. 1, 2022, the Community First Choice Option will allow states to offer home and community-based services as an alternative to institutional care to the disabled through Medicaid.
Community Health Centers:
Effective 2011, the new legislation allows for new funding to help communities build and expand community health centers and broaden the services they offer, with the aim of providing service to an additional 20 million patients across the U.S.
New Accountability for Insurance Companies
Reducing Premiums:
Effective no later than Jan. 1, 2011, at least 85% of all premiums paid into large employer plans must be spent on health benefits and care quality improvement. At least 80% of all premiums paid into individual and small employer plans must be spent on health services and quality improvement. The Affordable Care Act requires insurance companies to spend more on patients and less on administrative costs or return money to consumers through rebates.
Addressing Overpayments and Strengthening Prescription Drug Coverage
Effective Jan. 1, 2011, the new law will begin gradually eliminating overpayments to companies that provide Medicare Advantage. Currently, insurance companies receive, on average, more than $1,000 more per person than Medicare Part A. This results in increased premiums for recipients as well as increased costs overall. Medicare Advantage recipients will continue to receive their Medicare benefits, while insurance companies that provide high quality care will receive bonus payments.
2012 Health Care Reform Timeline for Improving Quality and Reducing Costs
Linking Quality of Care to Payment:
Effective Oct. 1, 2012, health care reform legislation will require the Value-Based Purchasing program (VBP) to begin offering financial incentives to hospitals to improve the quality of the care they provide. Performance reports will be available to the public and will include measurements of a hospital's effectiveness at treating heart attacks, heart failure and pneumonia. In addition, the reports will include information about a facility's surgical care, their rate of hospital-borne infections and patients' ratings.
Integrated Health Systems:
Effective Jan. 1, 2012, doctors will receive incentives to come together to form "Accountable Care Organizations" that will allow doctors to better coordinate patient care, improve the quality of care they deliver, help prevent illness and reduce unnecessary admissions. Organizations that effectively improve care and save money will be entitled to some of the money they have saved.
Reducing Overhead:
Beginning Oct. 1, 2012, the health care industry must begin working toward standardizing billing and adopting and implementing practices that ensure secure, confidential, electronic exchange of health information.
Narrowing the Health Care Gap:
Effective in March, 2012, federal health programs must begin collecting and reporting racial, ethnic and language data in order to aid in understanding and combating existing health disparities. This data will be reported to the Secretary of Health and Human Services to be used to identify and fight disparities in health care.
Expanding Access to Affordable Care
New Options for Long-Term Care:
Effective Oct. 1, 2012, the new health care reform legislation will create a voluntary long-term care insurance program to be known as CLASS that will provide monthly benefits to adults who become disabled.
For more information in Florida regarding health care and health insurance, click here.
Effective Jan. 1, 2011, under the health care reform legislation, enrollees who fall in the so-called "Part D donut hole," an annual gap in Medicare Part D prescription drug coverage, will get a 50 percent discount on covered non-generic prescription medications. Additional savings on both generic and non-generic prescriptions will be phased in over the next ten years until the "donut hole" is entirely closed by 2020.
Free Preventive Care for Seniors:
Effective Jan. 1, 2011, seniors who receive Medicare will become eligible for additional preventive services at no out-of-pocket cost. These services will include one wellness check each year and the development of personalized plans for preventing illness.
Improving the Quality and Efficiency of Health Care:
Effective Jan. 1, 2011, the legislation provides for a new Center for Medicare & Medicaid Innovation to begin testing ways of delivering care to patients to improve the quality of care and develop ways to reduce the cost of health care for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). By Jan. 1, 2011, HHS will present a national strategy aimed at improving the quality of government health care.
Preventing Unnecessary Hospital Readmissions:
Effective Jan. 1, 2011, the Community Care Transitions Program will aid high-risk Medicare recipients who have been released from the hospital by coordinating care and connecting patients to community services to avoid unnecessary readmissions.
Bringing Down Costs:
Beginning Oct. 1, 2011, the Independent Payment Advisory Board will begin developing and presenting proposals to Congress and the president to protect and improve benefits for enrollees and keep the Medicare Trust Fund alive and well. Its goal is to eliminate waste, find ways to reduce the cost of health care, improve health outcomes and make quality care more accessable for Medicare enrollees.
Increasing Access to Services:
Effective Oct. 1, 2022, the Community First Choice Option will allow states to offer home and community-based services as an alternative to institutional care to the disabled through Medicaid.
Community Health Centers:
Effective 2011, the new legislation allows for new funding to help communities build and expand community health centers and broaden the services they offer, with the aim of providing service to an additional 20 million patients across the U.S.
New Accountability for Insurance Companies
Reducing Premiums:
Effective no later than Jan. 1, 2011, at least 85% of all premiums paid into large employer plans must be spent on health benefits and care quality improvement. At least 80% of all premiums paid into individual and small employer plans must be spent on health services and quality improvement. The Affordable Care Act requires insurance companies to spend more on patients and less on administrative costs or return money to consumers through rebates.
Addressing Overpayments and Strengthening Prescription Drug Coverage
Effective Jan. 1, 2011, the new law will begin gradually eliminating overpayments to companies that provide Medicare Advantage. Currently, insurance companies receive, on average, more than $1,000 more per person than Medicare Part A. This results in increased premiums for recipients as well as increased costs overall. Medicare Advantage recipients will continue to receive their Medicare benefits, while insurance companies that provide high quality care will receive bonus payments.
2012 Health Care Reform Timeline for Improving Quality and Reducing Costs
Linking Quality of Care to Payment:
Effective Oct. 1, 2012, health care reform legislation will require the Value-Based Purchasing program (VBP) to begin offering financial incentives to hospitals to improve the quality of the care they provide. Performance reports will be available to the public and will include measurements of a hospital's effectiveness at treating heart attacks, heart failure and pneumonia. In addition, the reports will include information about a facility's surgical care, their rate of hospital-borne infections and patients' ratings.
Integrated Health Systems:
Effective Jan. 1, 2012, doctors will receive incentives to come together to form "Accountable Care Organizations" that will allow doctors to better coordinate patient care, improve the quality of care they deliver, help prevent illness and reduce unnecessary admissions. Organizations that effectively improve care and save money will be entitled to some of the money they have saved.
Reducing Overhead:
Beginning Oct. 1, 2012, the health care industry must begin working toward standardizing billing and adopting and implementing practices that ensure secure, confidential, electronic exchange of health information.
Narrowing the Health Care Gap:
Effective in March, 2012, federal health programs must begin collecting and reporting racial, ethnic and language data in order to aid in understanding and combating existing health disparities. This data will be reported to the Secretary of Health and Human Services to be used to identify and fight disparities in health care.
Expanding Access to Affordable Care
New Options for Long-Term Care:
Effective Oct. 1, 2012, the new health care reform legislation will create a voluntary long-term care insurance program to be known as CLASS that will provide monthly benefits to adults who become disabled.
For more information in Florida regarding health care and health insurance, click here.
Monday, August 1, 2011
Florida Auto Insurance Information
Florida Auto Insurance Information
Fiorella Insurance is pleased to provide auto insurance in Florida. We offer low cost auto insurance options online even if you have a less than perfect driving record, have never been insured before, have let your policy lapse, or have had your coverage suspended or revoked.
We’ve provided some information below that we hope will be helpful in answering some of the more common questions we’ve received from our customers.
Mandatory Minimum Level of Coverage
Florida’s minimum coverage is $10,000 Personal Injury Protection (PIP) and $10,000 Property Damage Liability (PDL) as long as you have a valid Florida tag, even if the vehicle is in another state or inoperative. There are no exemptions in the law. Additionally, if you have been involved in an accident, or have been convicted of certain offenses, you may be required to purchase Bodily Injury Liability (BIL) coverage.
Frequently Asked Questions Regarding Florida Auto Insurance
What is “Personal Injury Protection” (PIP) insurance?
PIP is coverage that will compensate a loss due to injury regardless of who is charged with causing the crash. PIP applies to bodily injury to you, relatives who live in your home, and passengers who are not required to have PIP, as well as licensed drivers who drive your vehicle with your permission. PIP insurance also protects you if you are injured as a pedestrian or bicyclist as long as the injury is caused by a crash involving a motor vehicle.
What is “Property Damage Liability” (PDL) insurance?
This coverage pays for damages you or members of your family cause (and are liable for) to other people’s property in a crash involving a motor vehicle.
What is “Bodily Injury Liability” (BIL) insurance?
Bodily Injury Liability coverage pays for serious and permanent injury or death to others when you cause a crash involving your automobile. Your insurance company will pay for injuries up to the limits of your policy and provide legal representation for you if you get sued. In particular, your company pays for injuries caused by you or members of your family who live with you, even if they were driving someone else’s vehicle. It may also cover others who drive your automobile with your permission. This coverage also provides you with legal defense in the event you are sued by the injured party.
What if I fail to keep insurance on my vehicle that I have registered in Florida?
The Department of Highway Safety and Motor Vehicles is authorized to suspend your driving privilege, including your vehicle tag and registration, for up to three years or until proof of Florida insurance is provided, whichever is first.
If my driving privilege is suspended because I am not properly insured, is there a penalty to reinstate my license?
Yes. A reinstatement fee of $150 up to $500, for subsequent violations, must be paid and you must provide proof of current Florida insurance.
What if you’re currently driving without coverage?
For a more detailed view of how your policy will look, fill in out instant quote tool online here.
Fiorella Insurance is pleased to provide auto insurance in Florida. We offer low cost auto insurance options online even if you have a less than perfect driving record, have never been insured before, have let your policy lapse, or have had your coverage suspended or revoked.
We’ve provided some information below that we hope will be helpful in answering some of the more common questions we’ve received from our customers.
Mandatory Minimum Level of Coverage
Florida’s minimum coverage is $10,000 Personal Injury Protection (PIP) and $10,000 Property Damage Liability (PDL) as long as you have a valid Florida tag, even if the vehicle is in another state or inoperative. There are no exemptions in the law. Additionally, if you have been involved in an accident, or have been convicted of certain offenses, you may be required to purchase Bodily Injury Liability (BIL) coverage.
Frequently Asked Questions Regarding Florida Auto Insurance
What is “Personal Injury Protection” (PIP) insurance?
PIP is coverage that will compensate a loss due to injury regardless of who is charged with causing the crash. PIP applies to bodily injury to you, relatives who live in your home, and passengers who are not required to have PIP, as well as licensed drivers who drive your vehicle with your permission. PIP insurance also protects you if you are injured as a pedestrian or bicyclist as long as the injury is caused by a crash involving a motor vehicle.
What is “Property Damage Liability” (PDL) insurance?
This coverage pays for damages you or members of your family cause (and are liable for) to other people’s property in a crash involving a motor vehicle.
What is “Bodily Injury Liability” (BIL) insurance?
Bodily Injury Liability coverage pays for serious and permanent injury or death to others when you cause a crash involving your automobile. Your insurance company will pay for injuries up to the limits of your policy and provide legal representation for you if you get sued. In particular, your company pays for injuries caused by you or members of your family who live with you, even if they were driving someone else’s vehicle. It may also cover others who drive your automobile with your permission. This coverage also provides you with legal defense in the event you are sued by the injured party.
What if I fail to keep insurance on my vehicle that I have registered in Florida?
The Department of Highway Safety and Motor Vehicles is authorized to suspend your driving privilege, including your vehicle tag and registration, for up to three years or until proof of Florida insurance is provided, whichever is first.
If my driving privilege is suspended because I am not properly insured, is there a penalty to reinstate my license?
Yes. A reinstatement fee of $150 up to $500, for subsequent violations, must be paid and you must provide proof of current Florida insurance.
What if you’re currently driving without coverage?
For a more detailed view of how your policy will look, fill in out instant quote tool online here.
Friday, July 29, 2011
WellCare, United, others cheat Fla. kids program
MIAMI -- Four private health insurers who wrongly claimed they spent millions on patient care in the state's children's health care program also provided coverage to patients in Florida's controversial Medicaid privatization program.
AmeriGroup Florida, Inc., Vista Health Plan, United Healthcare and WellCare were required to spend at least 85 percent on medical services under the State Children's Health Insurance Program in an effort to ensure for-profit companies are not lining their pockets with state funds instead of spending it on patient care.
If an insurer spends less, it must refund 50 percent of the shortfall to the state. Florida health officials should have received $3.1 million in refunds between 2003 and 2007, according to a report by the Department of Health and Human Services' inspector general.
The Associated Press obtained the insurers names as part of a public records request.
United Healthcare spokesman Tyler Mason said in an email that all participating plans with the state program provide quarterly reports for review to ensure payment accuracy and reconcile any issues based upon the contracted Medical Loss Ratios agreement.
The investigation comes as Florida is poised to expand a five-county Medicaid program statewide. Health advocates have criticized the state's lax oversight of the for-profit companies in the Medicaid pilot program, especially as news comes that the same insurers erred in other Florida health programs. Patients in the pilot complained they couldn't get appointments and were denied medications.
AmeriGroup, Vista and WellCare eventually dropped out of the Medicaid pilot, claiming they couldn't turn a profit. United is serving patients in Duval, Baker, Clay and Nassau counties after exiting Broward.
But after Gov. Rick Scott signed bills expanding the program statewide, experts say these companies and others will be clamoring for lucrative state contracts.
Supporters say the bills injected sorely needed accountability into the program, including a yearly, independent audit.
The bills don't require plans to spend certain percentages on patient care and administrative costs, but instead require them to repay profits over 5 percent to the state. To make sure you're covered correctly, have the lowest health rates in the state, contact us here.
Read more: http://www.miamiherald.com/2011/07/27/2333356/wellcare-united-others-cheat-fla.html#ixzz1TV77diGR
AmeriGroup Florida, Inc., Vista Health Plan, United Healthcare and WellCare were required to spend at least 85 percent on medical services under the State Children's Health Insurance Program in an effort to ensure for-profit companies are not lining their pockets with state funds instead of spending it on patient care.
If an insurer spends less, it must refund 50 percent of the shortfall to the state. Florida health officials should have received $3.1 million in refunds between 2003 and 2007, according to a report by the Department of Health and Human Services' inspector general.
The Associated Press obtained the insurers names as part of a public records request.
United Healthcare spokesman Tyler Mason said in an email that all participating plans with the state program provide quarterly reports for review to ensure payment accuracy and reconcile any issues based upon the contracted Medical Loss Ratios agreement.
The investigation comes as Florida is poised to expand a five-county Medicaid program statewide. Health advocates have criticized the state's lax oversight of the for-profit companies in the Medicaid pilot program, especially as news comes that the same insurers erred in other Florida health programs. Patients in the pilot complained they couldn't get appointments and were denied medications.
AmeriGroup, Vista and WellCare eventually dropped out of the Medicaid pilot, claiming they couldn't turn a profit. United is serving patients in Duval, Baker, Clay and Nassau counties after exiting Broward.
But after Gov. Rick Scott signed bills expanding the program statewide, experts say these companies and others will be clamoring for lucrative state contracts.
Supporters say the bills injected sorely needed accountability into the program, including a yearly, independent audit.
The bills don't require plans to spend certain percentages on patient care and administrative costs, but instead require them to repay profits over 5 percent to the state. To make sure you're covered correctly, have the lowest health rates in the state, contact us here.
Read more: http://www.miamiherald.com/2011/07/27/2333356/wellcare-united-others-cheat-fla.html#ixzz1TV77diGR
Monday, July 25, 2011
Florida Consumer Chief Backs Double-Digit Hikes for Allstate
Florida’s consumer advocate says Allstate’s two Florida home insurers are among the state’s best run and deserve double-digit rate increases along the lines they have requested.
The Allstate units, Castle Key Insurance Co. and Castle Key Indemnity Co., which insure 266,000 homes, are seeking average rate increases of 31.2 percent and 35.7 percent, respectively. With their 800 agents, the two companies represent the fourth and sixth largest home insurers in the state.
At a recent public hearing, the insurers found unexpected support from the state’s Office of Insurance Consumer Advocate. Steve Alexander, actuary for the consumer office, said that out of the 47 Florida-exclusive insurers providing homeowners insurance in the state, the two Allstate insurers are among the most efficient when it comes to costs. “They have some of the lowest expenses in the state, which I think is a real plus,” he said.
He also applauded their willingness to do business in Florida with all the risk that entails, when they could be earning a guaranteed quarter of a point on a one-year U.S. Treasury bond.
Alexander recommended that Castle Key Insurance Co.’s proposed 31.2 percent increase be reduced to 23.7 percent. He also recommended that Castle Key Indemnity’s proposed 35.7 percent increase be increased to 46.9 percent on the basis that it be phased in over a two year period
Within his recommendation, Alexander suggested that Castle Key receive no increases for debt service or contingency fees, he did recommend a profit component of 10 percent, which is slightly higher than the nine percent sought by the companies. He also recommended a 1.5 percent factor for general expenses and a 5.1 percent factor for acquisition and overhead expenses.
Bonnie Gill, vice president for Castle Key, said double-digit rate increases are needed to shore-up the insurers’ claims paying ability in the event of single or multiple-year storms. She said that even without any recent major losses, the companies are not raising enough cash. At the same time, by law, the Florida Hurricane Catastrophe Fund is also scaling back the amount of reinsurance it can offer companies.
“With our ongoing losses since 2006, we don’t have enough money to cover claims,” Gill said, adding that the companies combined surplus dropped by three percent last year.
Gill said that due to the state catastrophe fund’s scaling back, the companies had to spend $143 million to secure $900 million in private reinsurance, a price tag that represented more than half of the companies’ annual premiums.
OIR Actuary Bob Lee noted that Castle Key used the new AIR-12 hurricane model, which was recently approved by the Florida Commission on Hurricane Loss Methodology, which had an effect on the companies’ exposure.
Shantelle Thomas, senior actuary for Castle Key, defended the AIR model’s use. “We believe the new model is the best to date and that it should be considered in the rates,” she said.
Earlier this year, the Castle Key insurers announced they would no longer write new business. Thomas said the companies are considering a number of other underwriting changes depending on the results of the hurricane season, its loss experience, and a review of credits to policyholders for taking steps to strengthen their homes. To make sure you have the lowest insurance costs and best coverage, contact us here.
The Allstate units, Castle Key Insurance Co. and Castle Key Indemnity Co., which insure 266,000 homes, are seeking average rate increases of 31.2 percent and 35.7 percent, respectively. With their 800 agents, the two companies represent the fourth and sixth largest home insurers in the state.
At a recent public hearing, the insurers found unexpected support from the state’s Office of Insurance Consumer Advocate. Steve Alexander, actuary for the consumer office, said that out of the 47 Florida-exclusive insurers providing homeowners insurance in the state, the two Allstate insurers are among the most efficient when it comes to costs. “They have some of the lowest expenses in the state, which I think is a real plus,” he said.
He also applauded their willingness to do business in Florida with all the risk that entails, when they could be earning a guaranteed quarter of a point on a one-year U.S. Treasury bond.
Alexander recommended that Castle Key Insurance Co.’s proposed 31.2 percent increase be reduced to 23.7 percent. He also recommended that Castle Key Indemnity’s proposed 35.7 percent increase be increased to 46.9 percent on the basis that it be phased in over a two year period
Within his recommendation, Alexander suggested that Castle Key receive no increases for debt service or contingency fees, he did recommend a profit component of 10 percent, which is slightly higher than the nine percent sought by the companies. He also recommended a 1.5 percent factor for general expenses and a 5.1 percent factor for acquisition and overhead expenses.
Bonnie Gill, vice president for Castle Key, said double-digit rate increases are needed to shore-up the insurers’ claims paying ability in the event of single or multiple-year storms. She said that even without any recent major losses, the companies are not raising enough cash. At the same time, by law, the Florida Hurricane Catastrophe Fund is also scaling back the amount of reinsurance it can offer companies.
“With our ongoing losses since 2006, we don’t have enough money to cover claims,” Gill said, adding that the companies combined surplus dropped by three percent last year.
Gill said that due to the state catastrophe fund’s scaling back, the companies had to spend $143 million to secure $900 million in private reinsurance, a price tag that represented more than half of the companies’ annual premiums.
OIR Actuary Bob Lee noted that Castle Key used the new AIR-12 hurricane model, which was recently approved by the Florida Commission on Hurricane Loss Methodology, which had an effect on the companies’ exposure.
Shantelle Thomas, senior actuary for Castle Key, defended the AIR model’s use. “We believe the new model is the best to date and that it should be considered in the rates,” she said.
Earlier this year, the Castle Key insurers announced they would no longer write new business. Thomas said the companies are considering a number of other underwriting changes depending on the results of the hurricane season, its loss experience, and a review of credits to policyholders for taking steps to strengthen their homes. To make sure you have the lowest insurance costs and best coverage, contact us here.
Thursday, July 14, 2011
Feds Moving on Health Care Law, Gov. Scott Not Budging
Federal regulators charged with implementing the Affordable Care Act stated Monday they are trying to work with states to start up the law’s health care "exchanges" -- exchanges are one-stop consumer markets for buying insurance.
But they said they will install a federal health care exchange if a state refuses to set one up on its own.
The news carries weight for Florida, because Gov. Rick Scott, who first came onto the political scene as a staunch opponent of the federal overhaul of health care signed into law by President Barack Obama last year, is not moving from his stance that state agencies should not begin implementing the law.
The health care exchanges -- scheduled to be in place by January 2014 -- are touted as a more transparent way for individuals to compare health insurance policies’ coverage and prices online, over the phone or in person. They can be set up by the states themselves, done locally or regionally, or operated by a nonprofit, or can be done in partnership with the federal government.
States will be in charge of selecting plans in the exchanges, but they must meet minimum coverage and quality standards set forth by the federal Health and Human Services agency. Those standards are scheduled to be released later this year.
HHS officials said the guidelines for the exchanges give states enough flexibility to adjust the federal exchanges to their unique circumstances, but the final say on what plans qualify will remain in federal hands.
“In terms of setting up an exchange and meeting minimum standards, those would still apply,” said Steve Larsen, HHS director of the Center for Consumer Information and Insurance Oversight.
The proposals and claims of flexibility for states did not thaw Scott’s position on the law, or its implementation.
“As proposals, we are not about to change our policy to start implementing Obamacare,” Scott spokesperson Lane Wright said.
Under the law, states must get approval from HHS for their exchange plan by January 2013, but a conditional approval can be given if a state is on track to be ready to implement its exchange plan by January 2014.
Larsen held out hope that states would get on board and begin to lay the groundwork for the exchanges; he stated the federal government would be ready to step in and impose an exchange system if a state did not do so.
“If a state on January 2013 has not received approval or conditional approval, then we would be able to have an exchange in place by 2014,” Larsen said.
Yet most states are trying to avoid the federally imposed exchanges.
Two federal judges have declared the Affordable Care Act’s individual mandate, which imposes a tax or penalty on individuals who do not obtain health insurance, unconstitutional. One of those rulings came from a Pensacola judge in a lawsuit filed by Florida and 25 other states against the health care law. The Atlanta 11th Circuit Court of Appeals heard oral arguments in the case last month but has yet to issue a decision. In a separate lawsuit, the 6th Circuit Court of Appeals upheld the individual mandate as constitutional last month.
The issue will likely be settled by the U.S. Supreme Court, but in the interim, states opposed to the Affordable Care Act are caught between readying themselves for it, or counting on its cancellation by the courts.
“All we know is that a (federal judge) in Florida has ruled it unconstitutional, so we’re not going to be implementing it,” Wright said.
Scott stated in February, after the ruling in the Florida case, that he did not anticipate the law being upheld and he would not move to implement it until its legal fate was settled. He insisted that Florida would be ready if the law was deemed constitutional, despite the lack of preparation.
“I personally always believed it was going to be repealed. We are not going to spend a lot of time and money with regard to trying to get ready to implement it,” Scott said at the time. To make sure your coverage for your health is up to date and affordable. go to our site.
But they said they will install a federal health care exchange if a state refuses to set one up on its own.
The news carries weight for Florida, because Gov. Rick Scott, who first came onto the political scene as a staunch opponent of the federal overhaul of health care signed into law by President Barack Obama last year, is not moving from his stance that state agencies should not begin implementing the law.
The health care exchanges -- scheduled to be in place by January 2014 -- are touted as a more transparent way for individuals to compare health insurance policies’ coverage and prices online, over the phone or in person. They can be set up by the states themselves, done locally or regionally, or operated by a nonprofit, or can be done in partnership with the federal government.
States will be in charge of selecting plans in the exchanges, but they must meet minimum coverage and quality standards set forth by the federal Health and Human Services agency. Those standards are scheduled to be released later this year.
HHS officials said the guidelines for the exchanges give states enough flexibility to adjust the federal exchanges to their unique circumstances, but the final say on what plans qualify will remain in federal hands.
“In terms of setting up an exchange and meeting minimum standards, those would still apply,” said Steve Larsen, HHS director of the Center for Consumer Information and Insurance Oversight.
The proposals and claims of flexibility for states did not thaw Scott’s position on the law, or its implementation.
“As proposals, we are not about to change our policy to start implementing Obamacare,” Scott spokesperson Lane Wright said.
Under the law, states must get approval from HHS for their exchange plan by January 2013, but a conditional approval can be given if a state is on track to be ready to implement its exchange plan by January 2014.
Larsen held out hope that states would get on board and begin to lay the groundwork for the exchanges; he stated the federal government would be ready to step in and impose an exchange system if a state did not do so.
“If a state on January 2013 has not received approval or conditional approval, then we would be able to have an exchange in place by 2014,” Larsen said.
Yet most states are trying to avoid the federally imposed exchanges.
Two federal judges have declared the Affordable Care Act’s individual mandate, which imposes a tax or penalty on individuals who do not obtain health insurance, unconstitutional. One of those rulings came from a Pensacola judge in a lawsuit filed by Florida and 25 other states against the health care law. The Atlanta 11th Circuit Court of Appeals heard oral arguments in the case last month but has yet to issue a decision. In a separate lawsuit, the 6th Circuit Court of Appeals upheld the individual mandate as constitutional last month.
The issue will likely be settled by the U.S. Supreme Court, but in the interim, states opposed to the Affordable Care Act are caught between readying themselves for it, or counting on its cancellation by the courts.
“All we know is that a (federal judge) in Florida has ruled it unconstitutional, so we’re not going to be implementing it,” Wright said.
Scott stated in February, after the ruling in the Florida case, that he did not anticipate the law being upheld and he would not move to implement it until its legal fate was settled. He insisted that Florida would be ready if the law was deemed constitutional, despite the lack of preparation.
“I personally always believed it was going to be repealed. We are not going to spend a lot of time and money with regard to trying to get ready to implement it,” Scott said at the time. To make sure your coverage for your health is up to date and affordable. go to our site.
Monday, July 11, 2011
Florida Homeowners Coverage Problems Resolved?
It is the biggest gamble - homeowners insurance in Florida time at the helm of state government, one still condemned as reckless, irresponsible and a disaster waiting to happen.
Indeed, average property insurance premiums in Florida have fallen 16 percent since the Legislature approved a Crist-led reform package in the governor's first month in office in 2007.
And Citizens, the state-run insurer that is now Florida's largest insurer, has seen its reserves more than triple, making it more able to pay off storm damages.
The changes are dramatic when contrasted with what confronted the state just a few years ago, when runaway insurance costs were considered the No. 1 problem facing Florida.
From 2003 to 2006, average property insurance premiums nearly doubled, going from $949 to $1,635 annually, according to the state Office of Insurance Regulation.
More double-digit increases were forecast in 2007 and beyond as insurance companies sought to make up for nearly $40 billion in losses from eight hurricanes and four tropical storms that hit Florida in 2004 and 2005.
To make sure your florida homeowners coverage is up to date, please contact us here.
Indeed, average property insurance premiums in Florida have fallen 16 percent since the Legislature approved a Crist-led reform package in the governor's first month in office in 2007.
And Citizens, the state-run insurer that is now Florida's largest insurer, has seen its reserves more than triple, making it more able to pay off storm damages.
The changes are dramatic when contrasted with what confronted the state just a few years ago, when runaway insurance costs were considered the No. 1 problem facing Florida.
From 2003 to 2006, average property insurance premiums nearly doubled, going from $949 to $1,635 annually, according to the state Office of Insurance Regulation.
More double-digit increases were forecast in 2007 and beyond as insurance companies sought to make up for nearly $40 billion in losses from eight hurricanes and four tropical storms that hit Florida in 2004 and 2005.
To make sure your florida homeowners coverage is up to date, please contact us here.
Wednesday, July 6, 2011
Key aspect of auto insurance laws in Florida
Florida like the rest of the 50 states in the country has its own set of insurance laws which must be followed by all the citizens who drive on its roads. Firstly, vehicle owners should purchase auto insurance only from those providers who are authorized to sell insurance in Florida. Secondly, those who move from another state to Florida are not allowed to hold on to the same policy while driving on the Florida roads. In fact, everyone must carry sufficient insurance coverage as mandated by the laws in Florida. The specific limits which are mandatory for vehicle owners in Florida are $10,000 for physical injury to one person in a car accident, $10,000 for property damage during car accident as per the liability on the guilty driver and $20,000 for physical injury to more than one person in the car accident.
The auto insurance laws in Florida also include a Financial Responsibility Law. As per this law, all the drivers in the state of Florida should carry sufficient insurance coverage for a few more risks. These risks include DUI citation and revocation of license as a result, car accident that results in injuries and involves the insured driver, suspension of the license of the driver due to too many points brought up against the driver and revocation of license for habitual violation of traffic laws.
Also, the rental cars operating in Florida must have the minimum protection as mandated by the insurance laws in the state. If the credit card of the insured driver or the insurance policy for the car doesn’t cover the rental for the car, the rental agreement copy must be present in the vehicle all the time. This copy should also highlight the insurance coverage that is in place for the rental car. As per the laws in Florida car rental companies have to offer the minimum coverage for liability insurance and this has to be offered at a reasonable price to the customer. Florida being a no fault state means that under the no-fault conditions, personal injury protection doesn’t have to be purchased or carried by the drivers.
The car insurance for comprehensive coverage and collision coverage aren’t required either. There isn’t any provision that mandates insurance against accidents caused by uninsured motorists. Although these provisions aren’t really mandated by law, they are recommended for the sake of the drivers especially when trapped in unforeseen situations. To make sure your auto coverage is low in Florida, contact us here.
The auto insurance laws in Florida also include a Financial Responsibility Law. As per this law, all the drivers in the state of Florida should carry sufficient insurance coverage for a few more risks. These risks include DUI citation and revocation of license as a result, car accident that results in injuries and involves the insured driver, suspension of the license of the driver due to too many points brought up against the driver and revocation of license for habitual violation of traffic laws.
Also, the rental cars operating in Florida must have the minimum protection as mandated by the insurance laws in the state. If the credit card of the insured driver or the insurance policy for the car doesn’t cover the rental for the car, the rental agreement copy must be present in the vehicle all the time. This copy should also highlight the insurance coverage that is in place for the rental car. As per the laws in Florida car rental companies have to offer the minimum coverage for liability insurance and this has to be offered at a reasonable price to the customer. Florida being a no fault state means that under the no-fault conditions, personal injury protection doesn’t have to be purchased or carried by the drivers.
The car insurance for comprehensive coverage and collision coverage aren’t required either. There isn’t any provision that mandates insurance against accidents caused by uninsured motorists. Although these provisions aren’t really mandated by law, they are recommended for the sake of the drivers especially when trapped in unforeseen situations. To make sure your auto coverage is low in Florida, contact us here.
Tuesday, July 5, 2011
Seniors caught between cancer and the cost of treatment
Seniors caught between cancer and the cost of treatment
Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.
New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.
For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher co-payment for drugs than for some other medical services.
Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.
For more on cancer, see:
Seniors fear cancer and Alzheimer’s
Health update: New 'virtual' colonoscopy
Costly Provenge gets Medicare seal of approval
Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.
New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.
For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher copayment for drugs than for some other medical services.
Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.
For more on cancer, see:
Seniors fear cancer and Alzheimer’s
Health update: New 'virtual' colonoscopy
Costly Provenge gets Medicare seal of approval
WASHINGTON BUREAU -- The U.S. Government Accountability Office (GAO) says Internal Revenue Service (IRS) top managers must do more to ensure smooth implementation of the Patient Protection and Affordable Care Act (PPACA).
IRS officials are not doing enough to ensure on-time and on-target implementation of the 47 PPACA provisions that it will be responsible for complying with through 2018, James White, a GAO director, writes in a report summarizing the GAO's findings.
“While implementation for some provisions is years away, making improvements to the planning process now would reduce risks and might minimize future problems,” White says.
To ensure compliance, the IRS “must improve aspects of its planning, particularly at an agencywide or strategic level,” White says.
The RS has defined strategic-level goals and project plans in multiple documents but has not integrated the goals or plans, White says.
White says the GAO has given briefings to members of Congress and their staff on its findings, starting June 8, in response to lawmakers' concerns that the IRS would not be able to properly implement PPACA provisions on their effective dates.
In its briefings, GAO officials have said that the IRS management team has not developed a timeline for developing performance measures and collecting associated data.
The IRS also has not provided a cost estimate for all of PPACA, and the risk management framework does not assure that all risks, especially strategic-level risks, are identified and analyzed, White says.
The GAO is recommending that the commissioner of Internal Revenue move to define program goals and develop a project plan in one document that effectively integrates all aspects of the program.
The GAO also is recommending that top IRS managers document a schedule for developing performance measures that link to program goals and develop a more complete cost estimate that is consistent with the GAO Cost Estimating Guide.
Top managers also should modify and document the IRS risk management approach, to have more assurance that all risks, including strategic-level risks for the program, “are identified and analyzed, and that mitigation options are assessed,” White says.
The GAO acknowledges that the IRS management team has generally followed leading practices in planning to implement the PPACA provisions, White says.
The GAO also acknowledges that top IRS leadership has been involved; that cost estimates for information technology projects have specified ground rules and assumptions, data sources, and supporting calculations; and that work has started on compliance controls.
White notes that risks are being identified and analyzed at the individual project level.
OTHER COVERAGE THE IRS ROLE IN IMPLEMENTING PPACA FROM NATIONAL UNDERWRITER LIFE & HEALTH:
IRS Gives Nonprofit Plans, Hospitals More Time to Comply with PPACA
PPACA: IRS Starts to Design Health Plan Quality Research Fee
PPACA: IRS Looks at Group Health Definitions
IRS Might Issue ACO Guidance
PPACA Stars at IRS Budget Hearing
To make sure you are up to date on this and all medicare information, contact us at here
Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.
New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.
For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher co-payment for drugs than for some other medical services.
Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.
For more on cancer, see:
Seniors fear cancer and Alzheimer’s
Health update: New 'virtual' colonoscopy
Costly Provenge gets Medicare seal of approval
Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.
New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.
For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher copayment for drugs than for some other medical services.
Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.
For more on cancer, see:
Seniors fear cancer and Alzheimer’s
Health update: New 'virtual' colonoscopy
Costly Provenge gets Medicare seal of approval
WASHINGTON BUREAU -- The U.S. Government Accountability Office (GAO) says Internal Revenue Service (IRS) top managers must do more to ensure smooth implementation of the Patient Protection and Affordable Care Act (PPACA).
IRS officials are not doing enough to ensure on-time and on-target implementation of the 47 PPACA provisions that it will be responsible for complying with through 2018, James White, a GAO director, writes in a report summarizing the GAO's findings.
“While implementation for some provisions is years away, making improvements to the planning process now would reduce risks and might minimize future problems,” White says.
To ensure compliance, the IRS “must improve aspects of its planning, particularly at an agencywide or strategic level,” White says.
The RS has defined strategic-level goals and project plans in multiple documents but has not integrated the goals or plans, White says.
White says the GAO has given briefings to members of Congress and their staff on its findings, starting June 8, in response to lawmakers' concerns that the IRS would not be able to properly implement PPACA provisions on their effective dates.
In its briefings, GAO officials have said that the IRS management team has not developed a timeline for developing performance measures and collecting associated data.
The IRS also has not provided a cost estimate for all of PPACA, and the risk management framework does not assure that all risks, especially strategic-level risks, are identified and analyzed, White says.
The GAO is recommending that the commissioner of Internal Revenue move to define program goals and develop a project plan in one document that effectively integrates all aspects of the program.
The GAO also is recommending that top IRS managers document a schedule for developing performance measures that link to program goals and develop a more complete cost estimate that is consistent with the GAO Cost Estimating Guide.
Top managers also should modify and document the IRS risk management approach, to have more assurance that all risks, including strategic-level risks for the program, “are identified and analyzed, and that mitigation options are assessed,” White says.
The GAO acknowledges that the IRS management team has generally followed leading practices in planning to implement the PPACA provisions, White says.
The GAO also acknowledges that top IRS leadership has been involved; that cost estimates for information technology projects have specified ground rules and assumptions, data sources, and supporting calculations; and that work has started on compliance controls.
White notes that risks are being identified and analyzed at the individual project level.
OTHER COVERAGE THE IRS ROLE IN IMPLEMENTING PPACA FROM NATIONAL UNDERWRITER LIFE & HEALTH:
IRS Gives Nonprofit Plans, Hospitals More Time to Comply with PPACA
PPACA: IRS Starts to Design Health Plan Quality Research Fee
PPACA: IRS Looks at Group Health Definitions
IRS Might Issue ACO Guidance
PPACA Stars at IRS Budget Hearing
To make sure you are up to date on this and all medicare information, contact us at here
Tuesday, June 28, 2011
Take Care Of Your Health With Blue Cross Blue Shield of Florida
It's time to take charge of your health! Schedule an appointment with your health care provider to discuss what preventive health services you need and when you need them.
You may also want to start a campaign in your community (i.e. a faith-based setting, workplace, school, or civic group) to encourage others to make an appointment for a check-up or health screening on National Women's Check-Up Day (the day after Mother's Day each year) or National Men's Health Week (the week before Father's Day each year).
Why are Check-Ups Important?
Regular health exams and tests can help find problems before they start. They also can help find problems early, when your chances for treatment and cure are better. By getting the right health services, screenings, and treatments, you are taking steps that help your chances for living a longer, healthier life. Your age, health and family history, lifestyle choices (i.e. what you eat, how active you are, whether you smoke), and other important factors impact what and how often you need services and screenings.
To make sure you have the most savings in health insurance, contact us at www.fiorellainsurance.com or call us toll free.
You may also want to start a campaign in your community (i.e. a faith-based setting, workplace, school, or civic group) to encourage others to make an appointment for a check-up or health screening on National Women's Check-Up Day (the day after Mother's Day each year) or National Men's Health Week (the week before Father's Day each year).
Why are Check-Ups Important?
Regular health exams and tests can help find problems before they start. They also can help find problems early, when your chances for treatment and cure are better. By getting the right health services, screenings, and treatments, you are taking steps that help your chances for living a longer, healthier life. Your age, health and family history, lifestyle choices (i.e. what you eat, how active you are, whether you smoke), and other important factors impact what and how often you need services and screenings.
To make sure you have the most savings in health insurance, contact us at www.fiorellainsurance.com or call us toll free.
Wednesday, April 13, 2011
Real Miami Vice on Healthcare reform and Medicare Fraud. Find More information on Medicare Supplements and Medicare Fraud at www.fiorellainsurance.com
By Tom Brown
REUTERS
MIAMI — If Peter Budetti gets his way, the criminals who gorge on the U.S. healthcare system, bilking the government out of billions of dollars a year, will soon be on a much leaner diet.
As Washington's point man on healthcare fraud, the 66-year-old Budetti knows there are no quick fixes to a mind-boggling mess that ranks as one of America's top crime problems. But he has been working to develop new technological tools and a comprehensive, long-term strategy to rein in fraud since his appointment as director of Program Integrity at the Centers for Medicare and Medicaid Services (CMS) last year.
Although fraudsters have had the run of the place for some two decades, life is about to get "an awful lot tougher" for them, Budetti told Reuters in a recent interview. He promised new measures to curb waste and fraud in Medicare and Medicaid, the massive federal programs that provide healthcare for America's elderly and poor, will soon pay big dividends.
If he's right, American taxpayers and even budget hawks will have reason to smile.
There are no official estimates for how much fraud costs but the National Healthcare Anti-Fraud Association (NHCAA), a watchdog group, cites information from the FBI that anywhere between $70 billion and $234 billion is lost annually. That ranges between 3 percent and 10 percent of the $2.34 trillion Americans spent on healthcare in 2008.
Just this week, the third-largest U.S. hospital operator, Tenet Healthcare Corp, sued the No. 2 operator, Community Health Systems Inc, which is trying to buy it, for Medicare abuse. Tenet accuses its unwanted suitor of admitting patients for needless stays and bilking the U.S. government and private insurers.
The Obama administration has committed significant resources to fighting healthcare fraud as it grapples with the untold damage it is doing to the economy along with concerns about deficits and runaway healthcare spending.
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But some fear the administration's focus on the issue may come as too little, too late after years of inaction, political missteps and bureaucratic incompetence.
Budetti, who is focusing as much on prevention as he is on detection, appears confident about clamping down on scammers. New computer programs and sophisticated "data detective" work are beefing up the arsenal of weapons to fight fraud, he said.
'A cancer that's now quite aggressive'
Thomson Reuters, an industry leader in healthcare data, estimates the cost of fraud at about $150 billion per year. The stakes are huge for taxpayers and the government, which spent $895.9 billion on Medicare, Medicaid and the Children's Health Insurance Program in fiscal 2009, the last year for which official figures are available.
"It's a cancer that's now quite aggressive," Malcolm Sparrow of the Kennedy School of Government at Harvard University said of fraud.
No state comes close to matching Florida as a haven for crooked healthcare businesses. Long known for its unsavory links with drug cartels, money launderers and swampland real estate deals, Florida is an obvious magnet for Medicare scammers since so many elderly Americans have retired to end their days in its famous sunshine.
As it happens, Florida is also leading a legal challenge by 26 states to overturn President Barack Obama's healthcare reform. And Republican Governor Rick Scott, a fierce opponent of the law, has a controversial past as chief executive of a healthcare corporation that paid a record $1.7 billion in fines for defrauding Medicare and other federal programs. Scott has emphasized that he was never charged with any crimes as chief executive of the giant Columbia/HCA hospital chain.
A senior federal agent highlighted Florida's role as "ground zero" for the crime in congressional testimony last month, saying it was now "accepted as a safe and easy way to get rich quick" in the state.
It has drawn in people from all walks of life, including high school dropouts now making millions of dollars a year, said Omar Perez, an agent with the U.S. Department of Health and Human Services' Office of Inspector General.
"In South Florida, Medicare fraud is not only perpetrated by independent, scattered groups, but also by competitive, organized businesses complete with hierarchies and opportunities for advancement," Perez said.
"The money involved is staggering. We see business owners, healthcare providers and suppliers, doctors, and Medicare beneficiaries participating in the fraud. We also see drug dealers and organized criminal enterprises defrauding the system."
It has never been difficult to become a provider under government healthcare programs, and the money has been notoriously easy too.
The Medicare system, which processes millions of claims daily and is one of the biggest drains on the federal budget, was set up on the assumption that providers, including doctors, medical equipment suppliers and home healthcare agencies, were all essentially trustworthy.
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Once fraudsters learn how to electronically submit payment claims, using a government-issued National Provider Identifier number and the appropriate Medicare or Medicaid beneficiary numbers and billing codes, government computers tend to cough up payments automatically.
"Our program has had vulnerabilities that we need to overcome at this point in time," said Budetti, a pediatrician and lawyer. "It has been relatively easy for providers and suppliers to get into the program, because most of them are law-abiding legitimate people," he added.
Sparrow describes the system as "a giant money machine."
"The crooks know now that these computerized payment systems are their best friend," he said. "They will study carefully the art of billing correctly, they will produce electronic transactions that are perfect on their face, but it's just a pack of lies."
New anti-fraud tools
Several little-noticed provisions of Obama's healthcare reform law, including some that took effect last month, will step up enforcement action against fraudsters.
They include risk-based screening of the people behind roughly 19,000 new requests to become healthcare providers under the Medicare system every month. Applicants who fall into a "high risk" category will be subject to fingerprinting and criminal background checks through the FBI, Budetti said.
Another new provision will allow U.S. Health and Human Services Secretary Kathleen Sebelius to clamp a temporary moratorium on new enrollments of providers and suppliers to government-run healthcare programs, whenever such a move is deemed necessary to fight fraud.
More importantly, Budetti said, the Medicare and Medicaid computer payment systems are being made far less vulnerable to fraud, thanks to new and smarter software programs and algorithms. And payments to the hundreds of thousands of providers and suppliers already in the system can now be suspended in cases involving credible allegations of fraud.
"We are in the process of taking advantage of modern technology and sophisticated analytic systems," he said. "We're going to be intervening in the claims payment process in a very new set of ways that hasn't happened before."
Critics of data mining say it has offered no "silver bullet" for fighting healthcare fraud in the past.
But David Nelson, director of strategy and market planning for a division of Thomson Reuters that specializes in the field, said "clinical intelligence building" was expanding rapidly, making data and Web analytics key to fraud prevention, detection, investigation and recovery.
"We find that our customers who are really seriously engaged in data analytics to detect fraud get back $3 to $12 for every dollar they invest," Nelson said.
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Skeptics like Harvard's Sparrow are wary of claims about information technology, especially after all the promises made about a decade ago about so-called "neural networks."
"Neural networks were introduced with a lot of marketing hype. The companies that promoted neural network algorithms said they work like a brain, that you won't have to think about fraud anymore," he said. "That didn't solve it," he added. "In fact most neural network algorithms didn't do any better than standard rule-based approaches."
Budetti, who has served in numerous healthcare positions in the government and private sector and worked recently on anti-fraud initiatives with the National Association of Insurance Commissioners in Washington, seems certain that "smart" computers can be used outsmart criminal gangs. "We will be able to run every (billing) claim through advanced technology screening by the middle of next year. Every claim will be subjected to a wide range of analytics all of the time and it will be a system that learns on top of itself," he said.
'It's set up to be ripped off'
Any effective use of technology would be more than welcome by officials like Timothy Donovan, a senior FBI agent who works closely with the interagency fraud prevention and enforcement team, known as the HEAT task force, in the Miami area.
The first HEAT team was established in Miami in 2007 but fraud strike forces have since been deployed in other cities as well. "It's just set up to be ripped off," Donovan said of the CMS payment system. "A law enforcement response to this is not the answer. It's not going to cure it," he said.
Fraud cases detected in Florida have typically involved multimillion-dollar schemes featuring bogus suppliers of wheelchairs, or other so-called durable medical equipment devices, and sham infusion therapies for the treatment of HIV and AIDS patients. Elaborate scams involving kickbacks and stolen identities have often been the norm. But less sophisticated ways of bilking Medicare and Medicaid, sometimes even involving medical services and equipment prescribed by dead doctors, have also been documented.
One recent trend, according to FBI agents who work the healthcare fraud beat, involved fictitious billings for prosthetic limbs. At first all the bills, and there were hundreds of them, involved prosthetic left arms. Then suddenly, the bills submitted were all for right-arm prostheses.
More recently the scammers have focused on home healthcare agencies and mental health services, along with rehab sessions and physical therapy.
"If it pays, they just latch into a code and keep billing it. If it's paying they just put the gas pedal to the floor," said Randall Culp, a senior agent in the FBI's Miami division.
Law enforcement officials note that less than 5 percent of all payment claims submitted to CMS have traditionally been subjected to rigorous audits involving any actual human intervention, and say prison sentences are too light.
As a deterrent, the Obama administration recently stepped up federal sentencing for healthcare fraud by up to 50 percent for crimes that involve more than $1 million in losses.
Sparrow, who once served as a policeman in Britain where he rose to the rank of Detective Chief Inspector, says a focus on law enforcement is also crucial.
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He said CMS and other government agencies had consistently taken a "quality control mindset" approach to healthcare fraud, failing to recognize it as a crime control problem above all else. "In a nutshell, that's the biggest thing they get wrong, and they get it wrong constantly," Sparrow said.
Patrick Burns of Taxpayers Against Fraud, a non-profit public interest watchdog group, is a big supporter of Budetti, who formerly chaired the organization's board of directors.
But Burns wonders whether Budetti can win the fight against a problem that he says has mushroomed totally out of control since 1993, when former Attorney General Janet Reno identified it as the No. 2 crime problem in America after violent crime.
The problem, as Burns sees it, is a weak U.S. regulatory environment and lack of financial commitment in Congress.
"I'm not sure it's a winnable war without putting more money into investigators," Burns said. "You have to have people on the street," Burns said. "The truth is that CMS doesn't have the resources and investigators to go out and rodeo all the fraud. It just doesn't."
The FBI does not disclose the number of agents working on healthcare fraud cases. But Congressman Henry Waxman, a California Democrat who has worked closely with Budetti on healthcare, said the Affordable Care Act had given CMS hundreds of millions of dollars and unprecedented powers.
"An astounding amount of money is lost through fraud and when we've got more cops on the beat and more personnel enforcing these laws and trying to prevent fraud, I think we will eliminate a lot of that absolute waste," Waxman said.
Senate Finance Committee Chairman Max Baucus said last month tougher enforcement was already starting to pay off with $4 billion recovered last year.
U.S. healthcare expenditures totaled $2.34 trillion, or 16.2 percent of GDP in 2008, the last year for which official figures are available. They are outpacing economic growth and projected to total $3.02 trillion, or $9,505 per person and 17.3 percent of GDP, by 2013.
There are no reliable estimates of the extent to which fraud contributes to those costs.
Every now and then, a big bust will make news, such as one last October involving a Miami-based chain of community health centers called American Therapeutic that was charged with billing for about $200 million in services that were either unnecessary or never provided to patients. But such successes are relatively few and far between.
Given the potential scope of the crime, and the low detection rates normally associated with white-collar crime, Sparrow said authorities may need to dismantle a $100 million billing scam on average every day to put "a serious dent" in the problem.
"We're seeing one once about every two months," he said.
REUTERS
MIAMI — If Peter Budetti gets his way, the criminals who gorge on the U.S. healthcare system, bilking the government out of billions of dollars a year, will soon be on a much leaner diet.
As Washington's point man on healthcare fraud, the 66-year-old Budetti knows there are no quick fixes to a mind-boggling mess that ranks as one of America's top crime problems. But he has been working to develop new technological tools and a comprehensive, long-term strategy to rein in fraud since his appointment as director of Program Integrity at the Centers for Medicare and Medicaid Services (CMS) last year.
Although fraudsters have had the run of the place for some two decades, life is about to get "an awful lot tougher" for them, Budetti told Reuters in a recent interview. He promised new measures to curb waste and fraud in Medicare and Medicaid, the massive federal programs that provide healthcare for America's elderly and poor, will soon pay big dividends.
If he's right, American taxpayers and even budget hawks will have reason to smile.
There are no official estimates for how much fraud costs but the National Healthcare Anti-Fraud Association (NHCAA), a watchdog group, cites information from the FBI that anywhere between $70 billion and $234 billion is lost annually. That ranges between 3 percent and 10 percent of the $2.34 trillion Americans spent on healthcare in 2008.
Just this week, the third-largest U.S. hospital operator, Tenet Healthcare Corp, sued the No. 2 operator, Community Health Systems Inc, which is trying to buy it, for Medicare abuse. Tenet accuses its unwanted suitor of admitting patients for needless stays and bilking the U.S. government and private insurers.
The Obama administration has committed significant resources to fighting healthcare fraud as it grapples with the untold damage it is doing to the economy along with concerns about deficits and runaway healthcare spending.
Advertise | AdChoices
Advertise | AdChoices
Advertise | AdChoices
But some fear the administration's focus on the issue may come as too little, too late after years of inaction, political missteps and bureaucratic incompetence.
Budetti, who is focusing as much on prevention as he is on detection, appears confident about clamping down on scammers. New computer programs and sophisticated "data detective" work are beefing up the arsenal of weapons to fight fraud, he said.
'A cancer that's now quite aggressive'
Thomson Reuters, an industry leader in healthcare data, estimates the cost of fraud at about $150 billion per year. The stakes are huge for taxpayers and the government, which spent $895.9 billion on Medicare, Medicaid and the Children's Health Insurance Program in fiscal 2009, the last year for which official figures are available.
"It's a cancer that's now quite aggressive," Malcolm Sparrow of the Kennedy School of Government at Harvard University said of fraud.
No state comes close to matching Florida as a haven for crooked healthcare businesses. Long known for its unsavory links with drug cartels, money launderers and swampland real estate deals, Florida is an obvious magnet for Medicare scammers since so many elderly Americans have retired to end their days in its famous sunshine.
As it happens, Florida is also leading a legal challenge by 26 states to overturn President Barack Obama's healthcare reform. And Republican Governor Rick Scott, a fierce opponent of the law, has a controversial past as chief executive of a healthcare corporation that paid a record $1.7 billion in fines for defrauding Medicare and other federal programs. Scott has emphasized that he was never charged with any crimes as chief executive of the giant Columbia/HCA hospital chain.
A senior federal agent highlighted Florida's role as "ground zero" for the crime in congressional testimony last month, saying it was now "accepted as a safe and easy way to get rich quick" in the state.
It has drawn in people from all walks of life, including high school dropouts now making millions of dollars a year, said Omar Perez, an agent with the U.S. Department of Health and Human Services' Office of Inspector General.
"In South Florida, Medicare fraud is not only perpetrated by independent, scattered groups, but also by competitive, organized businesses complete with hierarchies and opportunities for advancement," Perez said.
"The money involved is staggering. We see business owners, healthcare providers and suppliers, doctors, and Medicare beneficiaries participating in the fraud. We also see drug dealers and organized criminal enterprises defrauding the system."
It has never been difficult to become a provider under government healthcare programs, and the money has been notoriously easy too.
The Medicare system, which processes millions of claims daily and is one of the biggest drains on the federal budget, was set up on the assumption that providers, including doctors, medical equipment suppliers and home healthcare agencies, were all essentially trustworthy.
Advertise | AdChoices
Advertise | AdChoices
Advertise | AdChoices
Once fraudsters learn how to electronically submit payment claims, using a government-issued National Provider Identifier number and the appropriate Medicare or Medicaid beneficiary numbers and billing codes, government computers tend to cough up payments automatically.
"Our program has had vulnerabilities that we need to overcome at this point in time," said Budetti, a pediatrician and lawyer. "It has been relatively easy for providers and suppliers to get into the program, because most of them are law-abiding legitimate people," he added.
Sparrow describes the system as "a giant money machine."
"The crooks know now that these computerized payment systems are their best friend," he said. "They will study carefully the art of billing correctly, they will produce electronic transactions that are perfect on their face, but it's just a pack of lies."
New anti-fraud tools
Several little-noticed provisions of Obama's healthcare reform law, including some that took effect last month, will step up enforcement action against fraudsters.
They include risk-based screening of the people behind roughly 19,000 new requests to become healthcare providers under the Medicare system every month. Applicants who fall into a "high risk" category will be subject to fingerprinting and criminal background checks through the FBI, Budetti said.
Another new provision will allow U.S. Health and Human Services Secretary Kathleen Sebelius to clamp a temporary moratorium on new enrollments of providers and suppliers to government-run healthcare programs, whenever such a move is deemed necessary to fight fraud.
More importantly, Budetti said, the Medicare and Medicaid computer payment systems are being made far less vulnerable to fraud, thanks to new and smarter software programs and algorithms. And payments to the hundreds of thousands of providers and suppliers already in the system can now be suspended in cases involving credible allegations of fraud.
"We are in the process of taking advantage of modern technology and sophisticated analytic systems," he said. "We're going to be intervening in the claims payment process in a very new set of ways that hasn't happened before."
Critics of data mining say it has offered no "silver bullet" for fighting healthcare fraud in the past.
But David Nelson, director of strategy and market planning for a division of Thomson Reuters that specializes in the field, said "clinical intelligence building" was expanding rapidly, making data and Web analytics key to fraud prevention, detection, investigation and recovery.
"We find that our customers who are really seriously engaged in data analytics to detect fraud get back $3 to $12 for every dollar they invest," Nelson said.
Advertise | AdChoices
Advertise | AdChoices
Advertise | AdChoices
Skeptics like Harvard's Sparrow are wary of claims about information technology, especially after all the promises made about a decade ago about so-called "neural networks."
"Neural networks were introduced with a lot of marketing hype. The companies that promoted neural network algorithms said they work like a brain, that you won't have to think about fraud anymore," he said. "That didn't solve it," he added. "In fact most neural network algorithms didn't do any better than standard rule-based approaches."
Budetti, who has served in numerous healthcare positions in the government and private sector and worked recently on anti-fraud initiatives with the National Association of Insurance Commissioners in Washington, seems certain that "smart" computers can be used outsmart criminal gangs. "We will be able to run every (billing) claim through advanced technology screening by the middle of next year. Every claim will be subjected to a wide range of analytics all of the time and it will be a system that learns on top of itself," he said.
'It's set up to be ripped off'
Any effective use of technology would be more than welcome by officials like Timothy Donovan, a senior FBI agent who works closely with the interagency fraud prevention and enforcement team, known as the HEAT task force, in the Miami area.
The first HEAT team was established in Miami in 2007 but fraud strike forces have since been deployed in other cities as well. "It's just set up to be ripped off," Donovan said of the CMS payment system. "A law enforcement response to this is not the answer. It's not going to cure it," he said.
Fraud cases detected in Florida have typically involved multimillion-dollar schemes featuring bogus suppliers of wheelchairs, or other so-called durable medical equipment devices, and sham infusion therapies for the treatment of HIV and AIDS patients. Elaborate scams involving kickbacks and stolen identities have often been the norm. But less sophisticated ways of bilking Medicare and Medicaid, sometimes even involving medical services and equipment prescribed by dead doctors, have also been documented.
One recent trend, according to FBI agents who work the healthcare fraud beat, involved fictitious billings for prosthetic limbs. At first all the bills, and there were hundreds of them, involved prosthetic left arms. Then suddenly, the bills submitted were all for right-arm prostheses.
More recently the scammers have focused on home healthcare agencies and mental health services, along with rehab sessions and physical therapy.
"If it pays, they just latch into a code and keep billing it. If it's paying they just put the gas pedal to the floor," said Randall Culp, a senior agent in the FBI's Miami division.
Law enforcement officials note that less than 5 percent of all payment claims submitted to CMS have traditionally been subjected to rigorous audits involving any actual human intervention, and say prison sentences are too light.
As a deterrent, the Obama administration recently stepped up federal sentencing for healthcare fraud by up to 50 percent for crimes that involve more than $1 million in losses.
Sparrow, who once served as a policeman in Britain where he rose to the rank of Detective Chief Inspector, says a focus on law enforcement is also crucial.
Advertise | AdChoices
Advertise | AdChoices
Advertise | AdChoices
He said CMS and other government agencies had consistently taken a "quality control mindset" approach to healthcare fraud, failing to recognize it as a crime control problem above all else. "In a nutshell, that's the biggest thing they get wrong, and they get it wrong constantly," Sparrow said.
Patrick Burns of Taxpayers Against Fraud, a non-profit public interest watchdog group, is a big supporter of Budetti, who formerly chaired the organization's board of directors.
But Burns wonders whether Budetti can win the fight against a problem that he says has mushroomed totally out of control since 1993, when former Attorney General Janet Reno identified it as the No. 2 crime problem in America after violent crime.
The problem, as Burns sees it, is a weak U.S. regulatory environment and lack of financial commitment in Congress.
"I'm not sure it's a winnable war without putting more money into investigators," Burns said. "You have to have people on the street," Burns said. "The truth is that CMS doesn't have the resources and investigators to go out and rodeo all the fraud. It just doesn't."
The FBI does not disclose the number of agents working on healthcare fraud cases. But Congressman Henry Waxman, a California Democrat who has worked closely with Budetti on healthcare, said the Affordable Care Act had given CMS hundreds of millions of dollars and unprecedented powers.
"An astounding amount of money is lost through fraud and when we've got more cops on the beat and more personnel enforcing these laws and trying to prevent fraud, I think we will eliminate a lot of that absolute waste," Waxman said.
Senate Finance Committee Chairman Max Baucus said last month tougher enforcement was already starting to pay off with $4 billion recovered last year.
U.S. healthcare expenditures totaled $2.34 trillion, or 16.2 percent of GDP in 2008, the last year for which official figures are available. They are outpacing economic growth and projected to total $3.02 trillion, or $9,505 per person and 17.3 percent of GDP, by 2013.
There are no reliable estimates of the extent to which fraud contributes to those costs.
Every now and then, a big bust will make news, such as one last October involving a Miami-based chain of community health centers called American Therapeutic that was charged with billing for about $200 million in services that were either unnecessary or never provided to patients. But such successes are relatively few and far between.
Given the potential scope of the crime, and the low detection rates normally associated with white-collar crime, Sparrow said authorities may need to dismantle a $100 million billing scam on average every day to put "a serious dent" in the problem.
"We're seeing one once about every two months," he said.
Tuesday, February 1, 2011
Florida Federal Judge Declares Individual Mandate and the Reform Law Unconstitutional Appeal to Supreme Court Likely
PPACA Still the Law of the Land
Since the individual mandate is not effective until 2014, the court’s ruling has no immediate impact and does not affect ongoing implementation of the PPACA. Unless and until the Supreme Court decides otherwise, the law remains in effect.
CIGNA is continuing its PPACA implementation and remains compliant with those provisions already effective.
On Jan. 31, 2011, Florida U.S. District Court Judge Roger Vinson, declared the "individual mandate" of the Patient Protection and Affordable Care Act (PPACA) unconstitutional, ruling the government cannot require Americans to purchase health insurance starting in 2014. Vinson concluded that, "Because the individual mandate is unconstitutional and not severable, the entire act must be declared void."
The Department of Justice will appeal the decision in this case, which was filed in March 2010 by Florida and joined by 25 other states. The constitutionality of the individual mandate is expected to eventually be decided by the Supreme Court.
In December 2010, a Virginia federal district court decided against the individual mandate, but didn't declare the entire law unconstitutional. Two earlier decisions in Virginia and Michigan found the mandate constitutional. Other cases are pending while several other lawsuits have been dismissed.
Under the PPACA, starting in 2014, individuals must be enrolled in a health insurance plan that meets basic minimum standards. Health care exchanges, also starting in 2014, will provide a new insurance marketplace where individuals and small businesses can buy qualified health benefit plans.
Next Steps
It's still unknown if the Supreme Court will agree to bypass the federal appeals courts and hear the appeal of one of the federal court decisions. It's likely to be some time before there's a final decision. For updated information as the case progresses, please visit www.fiorellainsurance.com.
For more information or to see if your health policy is current with health care reform visit us at www.fiorellainsurance.com
Since the individual mandate is not effective until 2014, the court’s ruling has no immediate impact and does not affect ongoing implementation of the PPACA. Unless and until the Supreme Court decides otherwise, the law remains in effect.
CIGNA is continuing its PPACA implementation and remains compliant with those provisions already effective.
On Jan. 31, 2011, Florida U.S. District Court Judge Roger Vinson, declared the "individual mandate" of the Patient Protection and Affordable Care Act (PPACA) unconstitutional, ruling the government cannot require Americans to purchase health insurance starting in 2014. Vinson concluded that, "Because the individual mandate is unconstitutional and not severable, the entire act must be declared void."
The Department of Justice will appeal the decision in this case, which was filed in March 2010 by Florida and joined by 25 other states. The constitutionality of the individual mandate is expected to eventually be decided by the Supreme Court.
In December 2010, a Virginia federal district court decided against the individual mandate, but didn't declare the entire law unconstitutional. Two earlier decisions in Virginia and Michigan found the mandate constitutional. Other cases are pending while several other lawsuits have been dismissed.
Under the PPACA, starting in 2014, individuals must be enrolled in a health insurance plan that meets basic minimum standards. Health care exchanges, also starting in 2014, will provide a new insurance marketplace where individuals and small businesses can buy qualified health benefit plans.
Next Steps
It's still unknown if the Supreme Court will agree to bypass the federal appeals courts and hear the appeal of one of the federal court decisions. It's likely to be some time before there's a final decision. For updated information as the case progresses, please visit www.fiorellainsurance.com.
For more information or to see if your health policy is current with health care reform visit us at www.fiorellainsurance.com
Wednesday, October 20, 2010
Who pays for COBRA coverage?
Beneficiaries may be required to pay for COBRA coverage. The premium cannot exceed 102 percent of the cost to the plan for similarly situated individuals who have not incurred a qualifying event, including both the portion paid by employees and any portion paid by the employer before the qualifying event, plus 2 percent for administrative costs.
For qualified beneficiaries receiving the 11 month disability extension of coverage, the premium for those additional months may be increased to 150 percent of the plan's total cost of coverage.
COBRA premiums may be increased if the costs to the plan increase but generally must be fixed in advance of each 12-month premium cycle. The plan must allow you to pay premiums on a monthly basis if you ask to do so, and the plan may allow you to make payments at other intervals (weekly or quarterly).
The initial premium payment must be made within 45 days after the date of the COBRA election by the qualified beneficiary. Payment generally must cover the period of coverage from the date of COBRA election retroactive to the date of the loss of coverage due to the qualifying event. Premiums for successive periods of coverage are due on the date stated in the plan with a minimum 30-day grace period for payments. Payment is considered to be made on the date it is sent to the plan.
If premiums are not paid by the first day of the period of coverage, the plan has the option to cancel coverage until payment is received and then reinstate coverage retroactively to the beginning of the period of coverage.
If the amount of the payment made to the plan is made in error but is not significantly less than the amount due, the plan is required to notify you of the deficiency and grant a reasonable period (for this purpose, 30 days is considered reasonable) to pay the difference. The plan is not obligated to send monthly premium notices.
COBRA beneficiaries remain subject to the rules of the plan and therefore must satisfy all costs related to co-payments and deductibles, and are subject to catastrophic and other benefit limits.
To go over your COBRA coverage or to see if you can save money by going to an individually underwritten medical insurance policy by Blue Cross and Blue Shield, please contact us at contact@fiorellainsurance.com or apply online at http://www.fiorellainsurance.com
For qualified beneficiaries receiving the 11 month disability extension of coverage, the premium for those additional months may be increased to 150 percent of the plan's total cost of coverage.
COBRA premiums may be increased if the costs to the plan increase but generally must be fixed in advance of each 12-month premium cycle. The plan must allow you to pay premiums on a monthly basis if you ask to do so, and the plan may allow you to make payments at other intervals (weekly or quarterly).
The initial premium payment must be made within 45 days after the date of the COBRA election by the qualified beneficiary. Payment generally must cover the period of coverage from the date of COBRA election retroactive to the date of the loss of coverage due to the qualifying event. Premiums for successive periods of coverage are due on the date stated in the plan with a minimum 30-day grace period for payments. Payment is considered to be made on the date it is sent to the plan.
If premiums are not paid by the first day of the period of coverage, the plan has the option to cancel coverage until payment is received and then reinstate coverage retroactively to the beginning of the period of coverage.
If the amount of the payment made to the plan is made in error but is not significantly less than the amount due, the plan is required to notify you of the deficiency and grant a reasonable period (for this purpose, 30 days is considered reasonable) to pay the difference. The plan is not obligated to send monthly premium notices.
COBRA beneficiaries remain subject to the rules of the plan and therefore must satisfy all costs related to co-payments and deductibles, and are subject to catastrophic and other benefit limits.
To go over your COBRA coverage or to see if you can save money by going to an individually underwritten medical insurance policy by Blue Cross and Blue Shield, please contact us at contact@fiorellainsurance.com or apply online at http://www.fiorellainsurance.com
Tuesday, September 28, 2010
Tropical Storm Nicole - September 27, 2010
With Tropical Storm Nicole upon us it is important to get together your policy information in the event you have damage and need to file a claim. Below is a list of Florida insurance companies and their respective claims phone numbers. Be sure to have your policy number ready if you need to call.
Homeowner Companies
American Integrity
866-277-9871
Frontline
877-744-5224
Tower Hill/ Royal Palm
800-216-3711
American Traditions
866-270-8430
First Protective/ Flood
888-486-4663
Tower Hill Flood
877-254-6819
ASI/ Ark Royal
866-274-8765
Fl. Penninsula
877-994-8368
United
800-861-4370
Bankers
800-627-0000
Hull/Geovera
800-678-4855
United Flood
800-637-3846
National Flood
800-759-8656
Universal
800-218-3206
Olympus
866-281-2242
Universal North America
866-999-0898
US Insurance Services
800-245-1505
St. Johns
877-748-2059
Citizens
866-411-2742
Southern Fidelity
866-772-4995
Sawgrass
877-853-4430
Tapco
888-437-0373
Cypress
888-352-9773
Landmark One
866-243-5163
Liberty
866-219-7100
Federated
800-293-2532
Auto Companies
AIC
800-841-5241
GMAC
800-468-3466
Safeco
800-874-7342
AIG/ 21st Century
888-244-6163
Infinity
800-334-1661
Travelers
800-252-4633
Progressive
800-274-4499
Bristol West
800-274-7865
As always, we are here to help in any way we can so please feel free to contact us with any questions.
Homeowner Companies
American Integrity
866-277-9871
Frontline
877-744-5224
Tower Hill/ Royal Palm
800-216-3711
American Traditions
866-270-8430
First Protective/ Flood
888-486-4663
Tower Hill Flood
877-254-6819
ASI/ Ark Royal
866-274-8765
Fl. Penninsula
877-994-8368
United
800-861-4370
Bankers
800-627-0000
Hull/Geovera
800-678-4855
United Flood
800-637-3846
National Flood
800-759-8656
Universal
800-218-3206
Olympus
866-281-2242
Universal North America
866-999-0898
US Insurance Services
800-245-1505
St. Johns
877-748-2059
Citizens
866-411-2742
Southern Fidelity
866-772-4995
Sawgrass
877-853-4430
Tapco
888-437-0373
Cypress
888-352-9773
Landmark One
866-243-5163
Liberty
866-219-7100
Federated
800-293-2532
Auto Companies
AIC
800-841-5241
GMAC
800-468-3466
Safeco
800-874-7342
AIG/ 21st Century
888-244-6163
Infinity
800-334-1661
Travelers
800-252-4633
Progressive
800-274-4499
Bristol West
800-274-7865
As always, we are here to help in any way we can so please feel free to contact us with any questions.
Tuesday, September 21, 2010
Under COBRA, what benefits must be covered?
Qualified beneficiaries must be offered coverage identical to that available to similarly situated beneficiaries who are not receiving COBRA coverage under the plan (generally, the same coverage that the qualified beneficiary had immediately before qualifying for continuation coverage). A change in the benefits under the plan for the active employees will also apply to qualified beneficiaries. Qualified beneficiaries must be allowed to make the same choices given to non-COBRA beneficiaries under the plan, such as during periods of open enrollment by the plan. To make sure your not paying too much on your health insurance, contact us at wwww.fiorellainsurance.com today.
Wednesday, September 1, 2010
Can individuals qualify for longer periods of COBRA continuation coverage?
Yes, disability can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours. To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must:
* Have a ruling from the Social Security Administration that he or she became disabled within the first 60 days of COBRA continuation coverage
* Send the plan a copy of the Social Security ruling letter within 60 days of receipt, but prior to expiration of the 18-month period of coverage
If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage. Plans can charge 150% of the premium cost for the extended period of coverage. For more information, visit us online at www.fiorellainsurance.com or call us at 772-283-0003.
* Have a ruling from the Social Security Administration that he or she became disabled within the first 60 days of COBRA continuation coverage
* Send the plan a copy of the Social Security ruling letter within 60 days of receipt, but prior to expiration of the 18-month period of coverage
If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage. Plans can charge 150% of the premium cost for the extended period of coverage. For more information, visit us online at www.fiorellainsurance.com or call us at 772-283-0003.
Wednesday, August 25, 2010
Is a flood covered under my homeowners policy?
No, a standard homeowners policy does not include flood coverage. Flood is an inexpensive yet separate policy that is underwritten through FEMA and the rates are standardized so no matter what company your policy is through, the premium is the same. If your property is not in a flood zone, rates are as follows:
Building/Contents Premium
$20,000/$8,000 $119
$30,000/$12,000 $150
$50,000/$20,000 $201
$75,000/$30,000 $237
$100,000/$40,000 $264
$125,000/$50,000 $284
$150,000/$60,000 $303
$200,000/$80,000 $333
$250,000/$100,000 $355
For more information, or to see if you are covered, contact us at www.fiorellainsurance.com
Building/Contents Premium
$20,000/$8,000 $119
$30,000/$12,000 $150
$50,000/$20,000 $201
$75,000/$30,000 $237
$100,000/$40,000 $264
$125,000/$50,000 $284
$150,000/$60,000 $303
$200,000/$80,000 $333
$250,000/$100,000 $355
For more information, or to see if you are covered, contact us at www.fiorellainsurance.com
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