Latest news with #SocialSecurityAct
Health Line
4 days ago
- Health
- Health Line
What Does It Mean to be Medicare Certified?
Medicare does not pay for services you receive from healthcare providers that are not Medicare certified. Providers can go through the process to become certified and bill Medicare for their services. According to the nonprofit KFF, there were 6,200 Medicare certified hospitals in the United States as of 2021. KFF also notes that there were 10,441 federally qualified health centers that were Medicare certified in 2021. It's important to make sure any services and treatments you receive are from a Medicare certified provider. What is Medicare certification? When a provider is Medicare certified, it means they agree to offer services at a quality level approved by Medicare. Medicare only pays for services and treatments that are provided by hospitals that voluntarily seek certification and receive approval from the Centers for Medicare & Medicaid Services (CMS). The Department of Health contracts with CMS to evaluate facilities' compliance with federal regulations. They use periodic on-site surveys for these evaluations. How do providers become Medicare certified? Each state may have a slightly different certification process. But the process always ends with the CMS, where a provider receives approval. State Survey Agencies Each process will include an initial assessment by a State Survey Agency. These are the agencies that perform periodic surveys of Medicare certified providers. The State Survey Agencies act on behalf of the CMS to perform these assessments under the agreements in Section 1864 of the Social Security Act (the Act). The state agencies do not have Medicare determination-making functions. These authorities are delegated to CMS regional offices. Process The acts that the State Survey Agencies perform for the CMS are referred to as 'the certification process.' This process includes: Identifying potential participants: The law guarantees Medicare beneficiaries that payment will only be made for health services provided by or furnished in entities that meet the requirements of the Act. Conducting fact-finding surveys and investigations: This may be referred to as 'the survey process.' It includes verifying how well the providers are complying with the conditions of participation (CoPs). Certifying and recertifying: Certifications are sent periodically to state or federal agencies regarding whether providers are qualified to participate in programs like Medicare. Explaining requirements: State agencies have the responsibility to advise providers and potential providers about applicable Federal regulations that enable them to participate in programs, such as Medicare. These agencies also advise the providers on maintaining the standard of healthcare consistent with the CoPs and conditions for coverage (CfCs). How do I find a Medicare certified provider? It's important to receive treatment from a Medicare certified provider. This is the only way Medicare will cover the services you receive. You can find the following types of providers near you using the Medicare search tool: hospitals doctors and clinicians nursing homes and rehab services hospice care inpatient rehabilitation facilities home health services long-term care hospitals dialysis facilities medical equipment and suppliers If you have Medicare Advantage, your insurer will typically have a list of in-network providers you can use. Summary A Medicare certified provider agrees to provide services that are of the quality approved by Medicare. Medicare will only cover services and treatments from certified providers. You can find providers near you using the Medicare search tool. Or if you have Medicare Advantage, your insurer can provide you with a list of in-network providers. 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.
Los Angeles Times
17-07-2025
- Health
- Los Angeles Times
Letters to the Editor: If we're expected to take Medicare fraud crimes seriously, Trump should be too
To the editor: Guest contributors Mehmet Oz and Kim Brandt are raising the flag regarding Medicare fraud ('Medicare fraud has gone global. It'll take a nationwide effort to stop it,' July 15). However, does Oz know President Trump has pardoned some of the biggest Medicare fraudsters? During Trump's first term, he granted clemency to at least 10 healthcare executives and doctors convicted of large-scale Medicare fraud schemes. In May 2025, Trump commuted the sentence of Lawrence Duran, who was convicted in 2011 for his role in a $205-million Medicare fraud scheme. Philip Esformes, a Florida healthcare executive convicted in 2019 of a $1.3-billion Medicare/Medicaid fraud scheme, would see his 20-year sentence end after just 4.5 years when Trump gave him a commutation in 2020. Salomon Melgen, a Florida eye doctor whose clinics defrauded Medicare of $42 million, was serving a 17-year sentence when Trump gave him a commutation. These are just a few of the people in the long list of healthcare fraudsters that Trump either pardoned or handed commutations to. So, Oz, I would suggest that you talk to the president about letting criminals who prey on the government programs that you are overseeing walk before taking any further steps in warning us about Medicare fraud. Pam Cwiklo, Camarillo .. To the editor: I applaud the Centers for Medicare & Medicaid Services for creating the Fraud Defense Operations Center in an attempt to diminish the incredible amount of fraud perpetrated against Medicare and Medicaid. However, the Trump administration should not be taking credit for 'changing that' process to make Medicare less vulnerable. It was the Health Care and Education Reconciliation Act of 2010 passed by President Obama that amended the Social Security Act, under which Medicare and Medicaid exist, to move from a 'pay and chase' model to proactively preventing payments. The Center for Program Integrity at CMS has been preventing payments from occurring for almost 15 years now. It is disingenuous to claim that the Trump administration is just now starting this effort without acknowledging steps taken previously. John Winkelman, Rancho Mission Viejo
Yahoo
04-07-2025
- Business
- Yahoo
Social Security Garnishment Begins on July 24 for More Than 1,000,000 Beneficiaries -- Here's How You Can Legally Avoid It
President Trump has overseen a flurry of Social Security changes in his first five months in office. In less than three weeks, a 50% clawback rate on Social Security overpayments -- up from just 10% during Joe Biden's presidency -- will officially kick in. Social Security beneficiaries who've been overpaid have a number of options available that may be able to waive or reduce the amount they'll be required to repay. The $23,760 Social Security bonus most retirees completely overlook › For most retirees, their Social Security check is more than just income. It's a financial foundation that many would struggle to make do without. When the Social Security Act was signed into law nearly 90 years ago, its purpose was to provide for aging workers who could no longer do so for themselves. In 2023, the program was responsible for lifting an estimated 22 million people above the federal poverty line, 16.3 million of which were adults aged 65 and over, according to an analysis from the Center on Budget and Policy Priorities. In other words, Social Security is doing exactly what it was intended to do. There's pretty much nothing of greater importance for beneficiaries than knowing how much they'll take home each month from America's leading retirement program. But beginning later this month, a Social Security policy adjustment instituted under President Donald Trump can vastly change the monthly payout for more than 1,000,000 beneficiaries. Since President Trump was inaugurated on Jan. 20, there have been numerous changes to Social Security: Trump signed an executive order that'll eliminate the use of paper checks by Sept. 30, 2025. Personal identification methods were improved to reduce fraudulent activity. For instance, updating direct deposit information will need to be done in-person or online via a "my Social Security" account with two-factor authentication. Former Fiserv CEO Frank Bisignano was confirmed as the new head of the Social Security Administration (SSA). Based on suggestions by the Department of Government Efficiency (DOGE), which was created by the executive order of President Trump, the SSA is cutting 7,000 jobs and shuttering some of its offices to lower its administrative expenses. But arguably the two biggest adjustments have to do with garnishments of Social Security payouts to select beneficiaries. For instance, by "sometime this summer," according to a Trump administration official, a 15% garnishment is set to be reinstated on an estimated 452,000 retired-worker beneficiaries who are delinquent on their federal student loans. The other eye-popping change was the reinstatement of higher clawbacks on Social Security overpayments. In March, the SSA announced plans to reinstate a 100% clawback rate in instances where beneficiaries were overpaid, which would have been a sizable increase from the 10% clawback rate instituted during Joe Biden's presidency. However, backlash over the 100% garnishment rate coerced the SSA to lower its recovery rate to 50% of monthly benefits in an April announcement. Based on data from KFF and Cox Media group, nearly 2 million beneficiaries closed out fiscal year 2023 (the federal government's fiscal year ends on Sept. 30) owing money to the SSA via overpayment. Furthermore, the SSA's Office of the Inspector General reported a whopping $23 billion in uncollected overpayments at the end of September 2023. Collecting these overpayments fits with the Trump administration's theme of making federal programs more efficient and cutting down on perceived fraud. You might be wondering how these overpayments occur in the first place. Sometimes it's entirely the fault of the SSA due to various miscalculations, which results in beneficiaries receiving more than they're entitled. Other times it's the result of the recipient themselves not updating their information. For instance, non-blind disabled workers have the ability to earn up to $1,620 per month in wages and salary in 2025 without having their Social Security disability benefit halted. But if a disabled worker begins earning more than $1,620 per month and fails to update their income with the SSA, it can result in an overpayment (i.e., funds they shouldn't have received due to their income being above the threshold). Though it's been known since April 25 that the SSA, under the Trump administration, would more aggressively seek clawbacks of overpayments, there hadn't been a definitive timeline on when these garnishments would begin... until now. New communication from the SSA states: When we determine an individual receiving Title II benefits is overpaid, we send them a notice requesting a full and immediate refund and inform them of their right to request reconsideration or a waiver of recovery. We usually provide 90 days for the individual to request a lower rate of withholding, a reconsideration, or waiver. With an effective date of April 25 on the SSA's communication, it means the 90-day grace period is up as of July 24. The north of 1,000,000 beneficiaries who still owe the SSA following an overpayment can have up to half of their monthly check garnished starting on or shortly after July 24 until the overpayment is settled. Based on the latest national survey of retirees by Gallup, a combined 86% rely on Social Security as a "major" or "minor" income source. Though clawbacks apply to all forms of beneficiaries (retirees, survivors of deceased workers, and workers with disabilities), garnishing up to 50% of monthly benefits could spell financial trouble for those who've been overpaid. The silver lining, if there is one to be found among beefed-up clawback rates, is that the SSA offers beneficiaries three ways to completely remove or potentially reduce how much they have to pay back -- and they're all completely legal. The ideal outcome for beneficiaries who've received too much from Social Security would be an overpayment waiver. Form SSA-632BK ("Request for Waiver of Overpayment Recovery") is a request to forgive the overpayment. If the overpayment wasn't your fault (this part tends to be important) and it would create a financial hardship to repay the added benefits you received, the SSA may approve your request and waive any liability. Just keep in mind you'll likely need to supply documentation demonstrating that repayment would, indeed, create a financial hardship. Overpaid beneficiaries can file Form SSA-561 ("Request for Reconsideration"), as well. This approach can work two different ways. For some, it's a way to appeal the claim they've been overpaid. You'll need to present evidence to the SSA that you haven't been overpaid, and if you reconsideration is successful, the SSA will waive any liability. SSA-561 can also be used by individuals who admit they've been overpaid, but disagree with the amount they'll need to pay back. If the SSA agrees, the amount you'll owe can be reduced. The third legal option available to beneficiaries is to file Form SSA-634 ("Request for Change in Overpayment Recovery Rate"). This is the preferred option for individuals who admit they've been overpaid, but who believe a 50% garnishment rate would create a financial hardship. Similar to the first option (SSA-632BK), it would require you to provide documentation of your income and qualified expenses to demonstrate your financial hardship. The SSA will aim to work with you on a reduced garnishment rate that settles your overpayment within 12 months, but the agency has been known to extend payment plans out to 60 months. With less than three weeks left before garnishments can begin, don't miss your opportunity to legally avoid or reduce what you'll owe if you're one of the more than 1,000,000 recipients who were overpaid. If you're like most Americans, you're a few years (or more) behind on your retirement savings. But a handful of little-known could help ensure a boost in your retirement income. One easy trick could pay you as much as $23,760 more... each year! Once you learn how to maximize your Social Security benefits, we think you could retire confidently with the peace of mind we're all after. Join Stock Advisor to learn more about these Williams has no position in any of the stocks mentioned. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy. Social Security Garnishment Begins on July 24 for More Than 1,000,000 Beneficiaries -- Here's How You Can Legally Avoid It was originally published by The Motley Fool Sign in to access your portfolio
Medical News Today
03-07-2025
- Health
- Medical News Today
What to know about the Medicare Beneficiary Ombudsman (MBO)
Medicare is a complex system. The Medicare Beneficiary Ombudsman (MBO) is a client advocate who provides support and information to help enrollees understand their options and navigate ombudsman works within an organization on behalf of its clients to help resolve grievances and improve the organization's functioning. The MBO fills this role for the Medicare Medicare, individuals have clearly outlined rights and protections. These include the right to fair treatment and clear information. The MBO works to ensure that these rights are more about the role of the MBO, a person's rights under Medicare, and where to direct complaints or inquiries related to of the MBOThe MBO position was established by Congress in 2003 through the Social Security Act § MBO's overarching goal is to be an expert in the field of healthcare and Medicare education and help enrollees in various duties of the MBO, as described in the Social Security Act, include:Assisting with issues: The MBO helps beneficiaries by processing complaints, grievances, and requests for information related to Medicare. It also provides assistance during coverage information: The MBO works with Medicare counseling programs to ensure that beneficiaries have access to information regarding their Medicare options and to Congress: The MBO reports to Congress on the functioning of the MBO position and makes recommendations on its improvement. It also identifies and flags potential issues with Medicare coverage or payment questions that may receive attention from the MBO include those related to appeals, enrollment concerns, and claims. Individual rights under MedicareAs Medicare beneficiaries, people have various rights and rights include:fair and courteous treatmentnondiscriminationprivacy of personal and medical informationaccess to care for medically necessary servicesaccess to clear information about coverage and treatment optionsanswers to Medicare questionsMedicare protections ensure that people with Original Medicare receive written notice if any items or services will not be covered under Medicare. This is called an Advance Beneficiary Notice (ABN) of a person receives an ABN, they have a few options:They can choose to receive the noncovered services and have the provider submit a claim to Medicare. In this case, they pay the costs up front. They can file an appeal if Medicare denies the can choose to receive the noncovered services without their provider submitting a claim. In this case, they pay the full cost up front and cannot file an can also choose not to receive the services. In this situation, they do not need to pay any of the functions of the MBO is to ensure that people receive fair treatment within the Medicare a person believes they have been treated unfairly or that their rights or protections have been violated, they may wish to consult the MBO for to contact the MBOThere are various ways to get in touch with the MBO. If a person has a question or concern related to Original Medicare, their first course of action should be to contact Medicare at 800-633-4227 (TTY: 877-486-2048).If a person has Medicare coverage through a private insurance company, such as a Medicare Advantage (Part C) plan or Part D prescription drug plan, they should reach out to a representative of their plan MBO also works closely with State Health Insurance Assistance Programs (SHIPs). If a person has questions about claims, appeals, enrollment, or complaints, the local SHIP can assist them in finding a resolution. Finally, if a person has not found a resolution to their inquiry through the above methods, they can contact Medicare and request that their concerns be directed to the MBO is a Medicare representative who works on behalf of Medicare enrollees to ensure access to information and resolve MBO also submits an annual report to Congress with recommendations on how to improve the role and functioning of the Medicare a person has a question or grievance regarding Medicare, they can contact Medicare by phone or speak with a representative from their local State Health Insurance Assistance Program (SHIP). If these avenues cannot help resolve the query, a person can request that their case be sent to the MBO.
India Today
02-07-2025
- Health
- India Today
20 states sue Trump administration over sharing Medicaid data with immigration
The Trump administration violated federal privacy laws when it turned over Medicaid data on millions of enrollees to deportation officials last month, California Attorney General Rob Bonta alleged on Tuesday, saying he and 19 other states' attorneys general have sued over the secretary Robert F. Kennedy Jr.'s advisers ordered the release of a dataset that includes the private health information of people living in California, Illinois, Washington state, and Washington, D.C., to the Department of Homeland Security, The Associated Press first reported last month. All of those states allow non-U.S. citizens to enroll in Medicaid programs that pay for their expenses using only state taxpayer unusual data sharing of private health information, including addresses, names, social security numbers, immigration status, and claims data for enrollees in those states, was released to deportation officials as they accelerated enforcement efforts across the country. The data could be used to help the Department of Homeland Security locate migrants in its mass deportation campaign, experts said. Bonta said the Trump administration's data release violates federal health privacy protection laws, including the Health Insurance Portability and Accountability Act (HIPAA).'This is about flouting seven decades of federal law policy and practice that have made it clear that personal healthcare data is confidential and can only be shared in certain narrow circumstances that benefit the public's health or the Medicaid program,' Bonta said during a news conference on Trump administration has sought to arm deportation officials with more data on immigrants. In May, for example, a federal judge refused to block the Internal Revenue Service from sharing immigrants' tax data with Immigration and Customs Enforcement to help agents locate and detain people living without legal status in the move to shore up the federal government's data on immigrant Medicaid enrollees appears to have been set in motion in May, when the Centers for Medicare and Medicaid Services announced it would be reviewing some states rolls to ensure federal funds have not been used to pay for coverage for people with 'unsatisfactory immigration status.'As part of the review, CMS asked California, Washington and Illinois to share details about non-U.S. citizens who have enrolled in their state's Medicaid program, according to a June 6 memo signed by Medicaid Deputy Director Sara Vitolo that was obtained by the AP. The memo was written by several CMS officials under Vitolo's supervision, according to sources familiar with the officials attempted to fight the data sharing request from Homeland Security, saying that to do so would violate federal laws, including the Social Security Act and the Privacy Act of 1974, according to the legal arguments outlined in the memo were not persuasive to Trump appointees at HHS, which oversees the Medicaid days after the memo was sent, on June 10, HHS officials directed the transfer of 'the data to DHS by 5:30 ET today,' according to email exchanges obtained by is 'aggressively cracking down on states that may be misusing federal Medicaid funds,' agency spokesman Andrew Nixon said in a statement. The agency has not provided details on DHS' role in the effort. Nixon also defended the legality of releasing the data to DHS.'HHS acted entirely within its legal authority – and in full compliance with all applicable laws – to ensure that Medicaid benefits are reserved for individuals who are lawfully entitled to receive them,' he said in the of Democratic members of Congress — in both the House and Senate — have sent letters to the involved agencies, demanding that data sharing cease and that Homeland Security destroy the information it has received so far. - EndsMust Watch
