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Harver Health Insurance Counter Fraud Group

Harver Health Insurance Counter Fraud Group

Communication

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  • Harver1_177_

    The issue on health insurance recently hugged the headlines not just in the US but also in some countries which recognized the need to address the health services that their populace need and expect from their employers and the government.

    Previously, health insurance was practically non-existent. Pension funds and provident funds were already in the consciousness of people as well as in the administration of institutions, whether private or public, for many decades. And yet, health is as important as one’s future retirement fund and present financial needs and is, in fact, closely related to both essential requirements for a healthy and productive working population. Hence, the rush to enact laws requiring all workers to acquire health insurance of some form has become a crucial issue.

    For us to understand what health insurance is all about and its foundational principles, consider some pointers to guide you decide whether having health insurance is really essential or not:

    • Ideally, health insurance is not state-sponsored medicine

    We hear activists declare that health insurance is a form of taxation or revenue- generating scheme of the state. Well, if some corrupt officials were to be given the hand that would be true as news of government funds being carted away by top-level officials flood the news daily today.

    However, as conceived and its ideal form, health insurance is a “plan whereby money is collected usually from the employer, the employee and the state and ...

  • The Affordable Care Act is already cutting health care costs, especially at hospitals that in the past provided charity care for uninsured, low-income patients. The reduction in charity care in states that have expanded their Medicaid programs with federal funds means the costs for this care are no longer being shifted to insured and self-paying patients, which makes health insurance more profitable for hospitals and insurers without increasing consumer costs.

    But this drop in costs is happening only in the states in about half of the nation that have expanded their Medicaid programs. The other states — mostly in the South and the Plains — have been involved in political struggles that have blocked expansion of health insurance for their poor residents.

    Expanding state-run Medicaid assistance programs has been called critical for the success of the new federal health care law. In states that haven’t expanded Medicaid, it is currently available to those who have incomes at or below the federal poverty line, which in 2014 is $11,670 for a single person and $27,910 for a family of four. In the states that have expanded their Medicaid programs, the eligibility level is 138%, or $16,104 for an unmarried person and $37,375 for a family of four.

    The federal health law was written with this expansion in mind, and it offers most people with incomes ranging from 138% to 400% of the federal poverty level the opportunity to be eligible for federal subsidies as they purchase heal...

  • Harver Health Insurance Counter Fraud Group Tokyo

    Now that the Obamacare transition has come into effect, it is important to understand some of the differences that are now at work. Understanding some of the changes can make it easier to get the greatest benefit from new policy changes that might affect you most. This can also help you to avoid potential negatives. For example, missing the important March 31 deadline can result in a fine of $95 or 1% of your total income (whichever number is greater).

    “For those that do not qualify for Medicaid, you will be required to pay your monthly premium fee to your selected insurance company in order to receive coverage,” said Jim Holm of EnhanceInsurance.com . “In some cases, customers will need to pay for their deductibles along with a set copay fee for doctor visits or a portion of the cost for the medical service.” This latter scenario is referred to as co-insurance, and customers will generally need to complete these payments before the insurance company can actually cover your medical costs. For most information on this, you can visit the federal government’s website at HealthCare.gov , a federal government website, and learn more about your options for each insurance plan. To find this information, located the section entitled “See plans before I apply.”

    Plan Choices

    Many industry experts recommend that you narrow down your potential choices to five comparable plans, and then go to the insurer’s official websit...

  • Report Says Probe Indicates Health Insurers may have Fleeced Taxpayers out of $70 Billion

    (NATIONAL) -- A year-long investigation by the Center for Public Integrity has revealed that health insurers may have fleeced taxpayers out of $70 billion in just five years.

    The report is posted on the Center's website by reporter Wendall Potter who says taxpayers should not assume their elected lawmakers in Washington will be outraged or even launching a federal probe about this.

    Potter:

    *"You would think members of Congress in both parties would be so outraged they’d be launching their own investigation and railing against the “fraud and abuse” they decry on the campaign trail.

    But I’m not holding out much hope. That’s because I know just how powerful and influential the health insurance industry is and how its lobbyists almost always get what they want out of Congress and the White House, regardless of who is sitting in the Oval Office."*

    The Center’s investigation called the "Medicare Advantage Money Grab" found here discovered that:

    • Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 to 2013, mostly over-billings, by manipulating or misusing a Medicare payment tool called a “risk score.”

    • From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for people in standard Medicare in more than 500 counties nationwide.

    • Federal health officials have ...

  • Image_177_

    If it works, the GoBe will be life-changing. But it’s a big if.

    The GoBe is a bracelet that looks like a small microplane has been affixed to a black watchband—the top of the microplane is a display, and its underside is a sensor. Through its “patented flow technology,” the GoBe promises to measure the wearer’s heart rate, calories burned, sleep, and stress levels. That’s all conceivable, given what the FitBit and other body trackers already measure. But the GoBe also promises something a little more sensational: Automatically tracking the calories of everything the wearer eats, through his or her skin.

    “We live in an age where people struggle with their diets and need simple ways to take control of their health,” Artem Shipitsyn, the CEO of GoBe’s parent company, HealBe, says in a video on the device’s Indiegogo campaign page. He says the technology would help “people like me live a healthy life with less effort.”

    The automatic calorie-tracking, which GoBe claims to do by reading glucose levels in cells, would revolutionize dieting—even the best calorie-counting apps today rely on manual food logging.

    “Tell it nothing. Know everything,” the soothing video narrator’s voice says over b-roll of people skiing and clicking on their smartphones.

    The premise was so lofty, in fact, that it didn’t take long for tech reporters, led by PandoDaily’s James Robinson, to attack.

    Let’s say GoBe does measure glucose levels without piercing the skin,...

  • Image_177_

    Advance directives clarify choices, guide family

    Pulmonologist Dr. Rick Blevins often sees patients and families grappling with a decision he says should have been made long before.

    Blevins treats many patients in the intensive care unit who won't survive. If they do not have advance directives, their families are left to make hard decisions that they may not have answers to.

    "It's a subject that comes up and (in the ICU) is the worst possible time for conversations to be initiated," Blevins said.

    Many times, the ICU patient is unable to make decisions for himself, so it falls on the family, Blevins said.

    The role of the family in that situation is to make the decision the patient would make, Blevins explained. But families don't always know or don't agree.

    Advance directives, such as living wills, provide instruction to families and especially health care providers on how the patient wants to be treated in the event of incapacity. Besides the living will, other common forms people complete are powers of attorney for health care that gives another person the authority to make health care decisions in the event of incapacity of the patient, and a form called Five Wishes, which provides not only instructions on medical care but also emotional care.

    Blevins said it can be difficult not only for families to have discussions about advance directives, but these conversations may not be happening in the doctor's office either.

    Doctors are encouraged to talk to thei...

  • WASHINGTON, DC - As law enforcement announced a nationwide sting against Medicare fraudsters today, a bipartisan group of lawmakers in Washington was putting the finishing touches on legislation aimed at making a significant dent in the problem.

    Federal law enforcement officials in Miami today announced the details of a multi-agency strike force operation that resulted in the arrest of 90 people nationwide for defrauding Medicare out of some $260 million.

    U.S. Senate Special Committee on Aging Chairman Bill Nelson (D-FL) and Ranking Member Susan Collins (R-ME), who have spent a great deal of time examining the problem of Medicare fraud and ways to curtail it, commended the actions announced today by federal officials while also saying that the crackdown illustrates the need to do more to stop Medicare fraud.

    Nelson and Collins, along with Sens. Tom Carper (D-DE) and Chuck Grassley(R-IA), have authored legislation to strengthen the government's hand in stopping Medicare fraud. The lawmakers plan to formally file the legislation on Thursday.

    "This is exactly why we're doing the legislation," said U.S. Sen. Bill Nelson (D-FL) who chairs the Senate Special Committee on Aging. "We've got to get the problem under control."

    Senator Collins added, "For decades, the GAO has identified Medicare as being at high risk for improper payments. This is unacceptable. The loss of these funds not only compromises the financial integrity of the Medicare program, but...

  • Ba-bd813_book1__g_20140103114138_177_

    David Goldhill’s father died from an infection he contracted in a well-regarded New York hospital.

    That began a quest to investigate America’s health care system. In his book “Catastrophic Care: How American Health Care Killed My Father and How We can Fix It,” Goldhill reports that nearly 100,000 Americans die every year from hospital-borne infections.

    That’s more than double the number of Americans killed in car crashes and five times the number of those murdered.

    How did American hospitals miss the quality control revolution that affected the rest of the American economy?

    Goldhill contends that our current system drives “excess treatment, cost inflation and medical errors.” And he says the Affordable Care Act only worsens the perverse incentives and would raise the cost of care.

    He worries that the exchanges will reduce competition among insurers, the subsidies will make consumers less price-conscious and mandates will cause healthy people to drop insurance.

    The result may be less coverage at higher costs than the authors of the Affordable Care Act intended. He describes the health care system as “the Beast” that tolerates excess and careless medicine.

    “Bad health care is crowding out needed care,” he writes.

    His solution is to combine the liberal desire for universal health care with a conservative desire for market-oriented approaches.

    He calls for a national insurance safety net that covers health crises that are “major, rare and unpredicta...

  • 111_177_

    Proposed rate changes for 2015 individual health plans are all over the map, but most companies are keeping up with tradition by requesting increases in premiums.

    If approved, rate increases for 2015 individual health plans proposed by 12 insurance companies may affect most policyholders, whether they bought their plans through Washington Healthplanfinder’s online marketplace or in the outside market.

    Washington is one of the first states to see proposed rate changes for 2015 individual health-insurance plans.

    The proposed rate changes range from a decrease of 6.8 percent — from Molina Healthcare of Washington — to an increase of 26 percent from Time Insurance, a national company with relatively few Washington policyholders.

    Most rate-change requests, particularly from larger insurers, were in the middle ground, with most asking for increases from about 2 to about 11 percent.

    To anyone who has had individual insurance, premium increases are not surprising: Records show that, on average, insurers have proposed rate increases for individual plans from about 9 percent to more than 18 percent every year from 2007 to 2013. After review by the Office of the Insurance Commissioner, the average rate increases imposed were lower — in most cases, only slightly lower. But in one year, rate-increase requests were cut by more than 3.5 percentage points.

    With the exception of relatively few grandfathered plans, all individual plans were new in 2014 to comply with provisions o...

  • Savings_are_just_part_of_the_retirement_picture

    The Harver Group - Your Health Insurance Counter Fraud Services Tokyo

    7 tips to make retirement savings last

    Even if you were smart (or lucky) enough to have a comfortable retirement nest egg, you may still worry that it may not last you through what may be 30 years of retirement. As many retirees and pre-retirees saw in 2008, one unexpected financial disaster can devastate your life savings.

    And many others have discovered that even the best-laid plans for retirement can be ripped apart by an unanticipated medical crisis.

    Not to worry. We talked to financial planning firms, big and small, across the United States, and asked for their best tips to help retirees protect, preserve and grow their retirement savings.

    There are the easy ones, like once you turn 50 you can take advantage of the catch-up contributions to your 401(k) ($5,500) and IRA ($1,000). You can delay taking Social Security until you're 70 because each year you wait, your benefit will increase by 8%. Or you can increase your savings rate.

    "I see people putting away 1% or 3% of their salary," says John Sweeney, executive vice president of retirement and investing strategies at Fidelity Investments. "People have to realize that is probably not enough to maintain their lifestyle in retirement. We're talking about 10% to 15% of your current income."

    Besides increasing your savings, here are a few other tips:

    1. Have an emergency or "rainy day" fund outside of your retirement acco...

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