Latest news with #Medicare-related
Health Line
29-07-2025
- Health
- Health Line
What Is A Medicare Advocate?
A Medicare advocate can help you understand Medicare and your rights under the various plans. They can also help with coverage, enrollment, appeals, and eligibility for other programs. It is important to have an unbiased source to turn to for help navigating Medicare, and a Medicare advocate can fill this role. A Medicare advocate can help both beneficiaries and their caregivers even before someone becomes eligible for Medicare. They can help them decide on the type of coverage they need, guide them through the enrollment process, and ensure they get all the benefits to which they are entitled. They can also help them feel empowered to make confident healthcare decisions. Medicare and Medicare Advocates Medicare is available to most people age 65 and over and to some people under age 65 with specific medical conditions. Medicare can be a complex area to navigate. Having knowledgeable people and organizations to help you is vital to ensuring you get the best care. Advocates can help: bridge the gaps between Medicare beneficiaries and healthcare professionals and facilities find the right plan for your inpatient and outpatient care needs get answers to questions relating to your plan benefits, coverage, out-of-pocket costs, and limits raise appeals to coverage decisions make sense of complex Medicare rules and regulations empower you with information on your rights under Medicare Who are Medicare Advocates? Local and state-specific organizations may advocate for Medicare beneficiaries. You can contact your state office to find the services available to you. However, one of the main places to get information and access advocate services is through the State Health Insurance Assistance Program (SHIP). State Health Insurance Assistance Program (SHIP) SHIPs offer free, impartial Medicare advice and counseling. They are federally funded by the Administration for Community Living, and its Office of Healthcare Information and Counseling (OHIC) manages SHIP on its behalf. SHIPs work with individual state offices and local agencies to create community-based counselor networks that can provide help in person and over the phone. They also use multimedia sources to educate people about Medicare. You can find your regional SHIP center using their office locator tool or by calling 877-839-2675. Medicare contacts and self-help toolkits The Center for Medicare Advocacy offers many self-help toolkits on Medicare coverage, appeals, and rights. If you need further help and advice, here are some of the avenues available to you. The Medicare beneficiary ombudsman The Medicare Beneficiary Ombudsman can help with Medicare-related complaints, grievances, and information. The service ensures your rights and protections are upheld and that your concerns are addressed. If you are experiencing difficulties with Medicare or your plan, you can contact Medicare at 800-633-4227 (TTY: 877-486-2048), who will forward your query to the Medicare Beneficiary Ombudsman. The beneficiary and family-centered care quality improvement organization (BFCC-QIO) The BFCC-QIOs are there to review Medicare complaints and monitor your care quality. BFCC-QIOs aim to improve Medicare's overall service quality and can help you: lodge an appeal raise and complaint or grievance review your care quality review the medical necessity of procedures, items, or services Livanta or Acentra administers the BFCC-QIO on Medicare's behalf. Which one will depend on the state in which you live. Livanta administers BFCC-QIO in the following areas: California Nevada Arizona Nebraska Kansas Iowa Missouri Minnesota Wisconsin Illinois Indiana Michigan Ohio West Virginia Virginia District of Columbia Maryland Pennsylvania Delaware New Jersey New York Hawaii Northern Mariana Islands American Samoa Guam Puerto Rico Virgin Islands Acentra administers BFCC-QIO in the following areas: Alaska Washington Iadho Oregon Montana North Dakota South Dakota Wyoming Utah Colorado New Mexico Texas Oklahoma Louisiana Arkansas Mississippi Tennessee Kentucky North Carolina South Carolina Alabama Georgia Florida Maine New Hampshire Massacheusetts Connecticut Rhode Island Vermont State survey agencies State survey agencies oversee and inspect Medicare and Medicaid healthcare facilities. They also investigate complaints to ensure the facilities are adhering to health and safety criteria. State survey Agencies can help if you have concerns about inappropriate or unsafe conditions in a hospital, hospice, nursing home, or home health agency. You can also contact them about the treatment or services that you or someone else received or did not receive in a healthcare setting, including but not limited to: abuse neglect mistreatment Contact your State Survey Agency for more information. About Medicare Medicare is a type of government-funded health insurance that provides medical benefits to people ages 65 and older. Some people under age 65 may qualify for Medicare, including: those with a disability who have been getting Social Security disability benefits for 2 years people with a disability pension from the Railroad Retirement Board (RRB) those with amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD) and receive dialysis or have undergone a kidney transplant How is Medicare funded? Taxes, premiums that you pay for some parts of Medicare, investments, and other funds that Congress authorizes fund Medicare. Medicare can be your primary insurer, or you can use it alongside another health insurance plan. What are the different parts of Medicare? Here's how the different parts of Medicare work. Original Medicare Original Medicare comprises Part A and Part B. Part A covers inpatient care, and Part B covers outpatient medical services and limited prescription medications. An advocate can help you… understand Original Medicare's enrollment periods find the best time to enroll in Medicare Part B understand the out-of-pocket expenses associated with Original Medicare learn how to file a Medicare claim lodge an appeal about a claim or payment decision understand what's covered and what's not covered under Original Medicare Medicare Part D prescription drug plans Medicare Part D prescription drug plans cover take-home prescription medications. An advocate can help you… find out if you already have creditable coverage find the best time to enroll in a Part D prescription drug plan understand the prescription drug coverage you need look for Part D prescription drug plans available in your area Medicare Advantage (Part C) Medicare Advantage plans include all the benefits of parts A and B, often include take-home prescription medications, and also typically include coverage for extra benefits like fitness, vision, or dental. Private insurers administer Part D prescription drug plans and Medicare Advantage plans, so the additional benefits, costs, and plan availability can vary by insurer and location. Medicare supplement (Medigap) plans If you have Original Medicare, you can get a Medigap plan to cover some of the associated out-of-pocket expenses. Private insurers also administer Medigap plans. Summary Medicare advocates are available to help ensure you get the correct coverage and benefits and that your rights are upheld under Medicare. SHIP centers, which are available across the United States, can help with many Medicare-related queries. Other local agencies and organizations may also be accessible to offer help. You can contact your local state office for further information. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Yahoo
28-07-2025
- Business
- Yahoo
UnitedHealth investors may seek roadmap on costs as Hemsley takes center stage
By Sriparna Roy (Reuters) -UnitedHealth's newly returned CEO, Stephen Hemsley, will likely face investor scrutiny over the largest U.S. health insurance and services company's efforts to rein in the elevated medical costs behind the withdrawal of its annual forecast. Hemsley returned to the role in May following the abrupt departure of then-CEO Andrew Witty, who stepped down amid rising operational and financial pressures. The company's decision in May to withdraw its 2025 earnings forecast due to soaring medical costs and Medicare-related challenges sent its shares tumbling. So far this year, UnitedHealth's stock has plunged more than 40%, dragging down the broader managed care sector with it. "Investors will be looking for confidence that he (Hemsley) has got a handle on things and that he understands where things may have gone wrong and how they are going to correct it," said James Harlow, senior vice president at Novare Capital Management, which owns 46,333 shares of the healthcare company. Hemsley, who ran the company from 2006 to 2017, has promised to rebuild trust, telling shareholders last month that regaining their confidence is a top priority. The pressure is compounded by a federal investigation into UnitedHealth's Medicare billing practices. The company recently confirmed it was cooperating with both criminal and civil inquiries from the U.S. Department of Justice. These regulatory woes have only added to the uncertainty facing the insurer. Wall Street analysts have lowered expectations throughout this month. Analysts expect a profit of $4.48 per share for the second quarter, according to data compiled by LSEG. That compares with expectations of $5.70 per share in May, when the company suspended its annual profit forecast. UnitedHealth plans to establish "a prudent 2025 earnings outlook and offer initial perspectives for 2026," the company had said in June. "Ultimately, on Tuesday, what we'd expect is more clarity on the way would expect a strategy, a roadmap laid out," said Sahil Bhatia, managing director of life sciences at Manning & Napier. "I think one of the big issues over the last few months has been just the we would expect more consistent execution going forward after laying out that roadmap," Bhatia said. At least two investors said they anticipate UnitedHealth will reset its 2025 profit forecast in the range of $18 to $20 per share, far below the company's previous outlook of $26 to $26.50. This might be conservative but is an appropriate start for Hemsley's first call, said Jeff Jonas, portfolio manager at Gabelli Funds. UnitedHealth has previously built a reputation to guide conservatively and raise its outlook as the year progresses. But this time, investors warn, withholding guidance altogether would be damaging. "If they continue to not give an EPS outlook for 2025, that will be damaging," Harlow added. Apart from financial turbulence, the company has also faced reputational challenges. It has moved to ease prior authorization requirements after a public outcry following the killing of a UnitedHealth executive last December. The Optum unit, once a growth driver for UnitedHealth, has also emerged as a key area of concern. Last quarter, the company flagged "unanticipated changes" in its Optum business that impacted planned 2025 reimbursements. "Among all the overhangs, Optum Health remains the biggest concern," said Deutsche Bank analyst George Hill. UnitedHealth has also grappled with the fallout from a major cyberattack last year that disrupted claims processing across its Change Healthcare unit.
The Advertiser
02-07-2025
- Health
- The Advertiser
Doctors dispute billions being lost in Medicare fraud
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment.
The Advertiser
02-07-2025
- Health
- The Advertiser
Union says 'billions down the drain' in Medicare fraud
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says. The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023. They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place". In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings. The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said. The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says. The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023. They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place". In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings. The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said. The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says. The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023. They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place". In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings. The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said. The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says. The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023. They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place". In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings. The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said. The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said. AAP has approached federal Health Minister Mark Butler for comment.
Yahoo
09-06-2025
- Business
- Yahoo
5 Major Social Security Mistakes Boomers Can't Stop Making
Retirement planning is both complicated and high-stakes — a recipe for mistakes with major financial consequences. And sure enough, Business Insider reported that more than half of Americans over 65 earn less than $30,000 a year. As you plan your own retirement, watch out for these Social Security mistakes plaguing current baby boomers. Check Out: Read Next: Too many people reach their early 60s and think: 'I've been paying into the system for decades, I need to lock in my share!' Unfortunately, that leaves them with far lower lifetime benefits than if they'd waited. 'Filing early means locking in a permanent reduction in benefits, up to 30% if your full retirement age is 67,' explained Christine M. Parisi, senior wealth advisor at R.W. Rogé & Company. If you take benefits at age 62, you receive just 70% of your full retirement benefit. At 67, you collect 100%. Wait until 70, and you receive 124% of your full Social Security benefit. Learn More: Plan to continue working for a while? Hold off on taking Social Security — and not just to secure higher benefits. 'If your earnings exceed the annual limit, the Social Security Administration may withhold $1 in benefits for every $2 you earn over the threshold,' Parisi added. 'Benefits can also push your income higher for Medicare-related costs like IRMAA, meaning you could end up paying more in premiums.' Plus, combining your salary with Social Security can push you into a higher tax bracket. You can end up handing much of that money right back to Uncle Sam. If one spouse earned significantly higher income, or worked for many years longer, their benefits will be higher. Plan to optimize those, perhaps by having that spouse delay benefits while the family lives on earned income or distributions from retirement accounts before taking benefits. Parisi noted that different rules apply to surviving spouses. 'If your late spouse worked long enough to qualify for Social Security, you may be able to start collecting survivor benefits as early as age 60. Unfortunately, many don't realize this is even an option until it's too late.' First and foremost, when you planned your retirement income, did you account for taxes? You'll still owe income taxes in retirement, at least under current tax laws. 'A portion of Social Security benefits are taxable, up to 85%, based on your provisional income,' said Keith Hensley of Florida Financial Planning. Many states tax Social Security benefits as well. The upshot? You may need more money saved for retirement than you thought. Again, you may be better off working another year and delaying Social Security benefits. It may not be too late for a Roth conversion to make sense. If you have a year with lower income, consider taking the tax hit and converting some of your traditional retirement funds to Roth accounts, so they can compound tax-free and you can avoid paying taxes on withdrawals in retirement. If Social Security is your only — or your primary — plan for retirement income, expect stormy seas ahead. William Connor, CFA and CFP with Sax Wealth Advisors, added some historical context. 'Social Security was created as a safety net for older Americans. It was not designed as a primary source of retirement income, and won't replace your working income.' Instead, combine it with other sources of income such as retirement accounts, health savings accounts (HSAs), taxable brokerage accounts, real estate investments and perhaps part-time fun working gigs. The less you rely on Social Security income, the more comfortable and secure your retirement will be. More From GOBankingRates 3 Luxury SUVs That Will Have Massive Price Drops in Summer 2025 8 Common Mistakes Retirees Make With Their Social Security Checks How Much Money Is Needed To Be Considered Middle Class in Every State? This article originally appeared on 5 Major Social Security Mistakes Boomers Can't Stop Making Sign in to access your portfolio
