Insurance scams and Fraud

Dear Readers;

This week two cases have really hit home.  The first one, I just don’t get.

I’m taking out the names because it’s soooo crazy, and with the problems I’ve had with the blog, the damage to my car and the ARDC, we have full blown chilling of free speech.

Scam 1:  Insurance Fraud perpetrated by the insurance companies.

After your senior has paid all her or his life tons of money every month for health insurance, when a senior really needs to use it as they get closer to death, some hospital administrator comes to the elder in a hospital and asks them to sign a “waiver of benefits form”.  Of course, the administrator is looking for a dotty elder with little or no family or friends.  The elder is then kicked out of the hospital because “benefits have been terminated” because they signed the form!  They sign the form because they are ordered to do so.  Of course, they still need services, they need hospital care, but the administrator will explain, get this, “we have elected to put your case on a lower level of benefits for a period of time.”  Yeah right, so you will die because now you’ve gotten expensive in the hospital.  Go home and die.  Reminds me of Grisham book and movie “The Client” except the insurance company involved this time is a huge, major, company with the largest revenue in the US and about 11 million members.  I’d name them, so you could be warned, but the ARDC will probably say I’m lying because it’s too hard to believe.  Or maybe they will say I’m too mean to them.

Watch out for this one and if you have experience with this, plmk.  It’s like paying $20,000 for a car and then having the car dealer say “sign this form” and we pick up your car and will use it for you.  Just stay home.  We’ll let you know.

And, after I heard that outrageous story, it comes on the heels of this information from NASGA:

Physicians for a National Health Program
29 E Madison Suite 602, Chicago, IL 60602 ¤
Phone (312) 782-6006 | Fax: (312) 782-6007 | email: info@pnhp.org
© PNHP 2013

http://www.pnhp.org/news/2013/april/obama-administration-intervenes-to-give-715-billion-to-overpaid-for-profit-medicare-

Obama administration intervenes to give $71.5 billion to overpaid, for-profit Medicare Advantage plans

Physicians group decries ‘backroom Medicare giveaway’

FOR IMMEDIATE RELEASE, April 9, 2013

Contact: Mark Almberg, (312) 782-6006, mark@pnhp.org

Medicare’s costs will jump by $7.43 billion next year – the equivalent of $149 for each of the nearly 50 million beneficiaries in the program – due to an unprecedented intervention last week by the Obama administration in the way privately run, for-profit Medicare Advantage (MA) plans, which are also known as Medicare HMOs, are paid by the government, a national physicians group reported today.

The total cost to U.S. taxpayers will be $71.5 billion to $104.5 billion over the next decade….

Scam No. 2.  Perpetrated by a Guardian, brought to the attention of Judge JLS and she ignores it and does not want to hear it.

Sign up for medicare and one or two other insurances for a sick elder.  A cancer patient with $50,000 or more in billings per year of course is preferred.

Submit the bills to medicare and don’t tell them about insurance companies B and C.

Then you take the bills and submit them to insurance companies B and C and you’ve got a real cash cow going on.  Of course, it’s medicare fraud, but this probate judge didn’t want to hear about it from another relative!  Same old story, the relative, pipes up after it is discovered in the yearly accounting, and the court says, “madam, be quiet!”

Go figure.

JoAnne

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