Heritage Wealth Planning

My man Jae Oh at Maximize Your Medicare reports... This is a problem. a. Human error and administrative problems can affect any program with > 20MM enrollees. ... b. Upcoding is when an MA carrier intentionally reports an inflated risk score of an enrollee to the CMS. That leads to more $ from the CMS to be paid to the carrier. That extra $ comes from the Hospital insurance and Supplementary Trust Funds, i.e. taxes. The effect is that those trust funds have less $ today, in part due to excessive $ being paid from taxpayers to MA carriers. If this upcoding is intentional, it is fraud. very simple. c. There have been cases when carriers have been fined for this practice, there are whistleblower lawsuits that have alleged this activity. d. The flip side is that carriers are required to pay 80% of the $ it receives in the form of claims paid. e. This would be very hard to prove, after the fact, because the outcome has the element of randomness involved (the hurricane was forecast to hit New Orleans, but swerved west, and hit Texas, this happens in every forecasting exercise, including the risk scoring involved here). Tough stuff. See more

Getting ready to publish! Book number 4... You Can RETIRE on SOCIAL SECURITY!

My man Jae Oh, points out this insanity regarding Medicare/Medicaid rules... "The very first sentence of this article is wrong. Medicaid eligibility is determin...ed by the state of residence. Part D subsidies (Extra Help) are determined by the federal government. That means that you may be ineligible for Medicaid, but still be eligible for Extra Help. Bummer that this incorrect, incomplete information exists in the media. #imaxyourmedicare