MediGap Advisors fills Need for Seniors

December 10, 2012

Last Friday I was featured as a guest on a nationally syndicated talk show where we discussed Social Security, Medicare and the fiscal cliff.  No doubt the US faces challenges today when it comes to social welfare programs and individuals face a variety of challenges when figuring out what to do to solve their individual health care issues.

MedigapBelow is an interview I had with a leading provider of Medigap coverage.  Perhaps this will help…

  • Define for my audience what you do and how they will benefit from contacting you?

We help individuals who are on or about to qualify for Medicare choose among the many options for insuring their health.  We offer instant quotes and information on Medicare supplement, Medicare Advantage, and Part D prescription drug plans.  We show them how to save money on their healthcare expenses, and how to get the most from Medicare.

  • If someone were to visit your website, what would they come away with that provide them value?

Everything they want to know about Medicare, Medicare supplement, and Part D prescription drug plans.  They can get instant quotes on plans, details on coverage available in their area, and information on when the open enrollment period are.

  • Share a bit of your background and help my readers know at a deeper level who you are…

I am president of Medigap Advisors.  I have been helping individuals get the best value in health insurance for over 25 years. I believe in free-market consumer-driven healthcare solutions including HSAs and HRAs, and greater healthcare price transparency.  In my blogs and other writings I share strategies for lowering healthcare and health insurance costs, ideas for improving our healthcare system, and techniques and lifestyle strategies for optimizing personal health.  I was also founder and publisher of The Paleo Diet Newsletter, and like to show people how they can avoid medical expenses in the first place through lifestyle changes.

  • The fiscal cliff gets a lot of press – how do you see your product’s potential moving into 2013?

Medicare is a government program that has a major impact on our society, and enables seniors to live in dignity, as many experience increasing health problems as they age.  However, the program is not financially stable, and government efforts to control costs are leading to doctor shortages and increased costs for Medicare beneficiaries.  We keep our clients informed on ways to protect themselves from the risks that healthcare costs impose, and how to make the most of their Medicare.

  • From a business perspective, what do you see are the three most pressing issues that businesses face in 2013?
  1. Obamacare may reduce options for Medicare beneficiaries if funding is cut for Medicare Advantage plans.  These plans provide Medicare coverage through private companies.  Unlike original Medicare, Medicare Advantage plans have a maximum out-of-pocket which limits how much someone may have to pay for their medical care.

  2. The baby boomers are retiring, with 10,000 per day turning 65.  This is going to place increasing burdens on our healthcare system, with doctor shortages likely.

  3. Growing government debt and the retirement of the baby boomers will continue to put serious strains on our nation’s economy.  Growth in inflation will impact those on a fixed income harder than others.

  • If you were to define the two most important services you offer, what would they be and how do you help you clients with them?

1)    We help people compare the health insurance options available to them, and help them find the plan that offers the best value.

2)    We then do our Annual Comprehensive Policy Review each year to make sure they continue to stay with the plan that offers the best value, as premiums and needs change.

3)    We show people additional ways to protect their financial situation through long-term care insurance and other financial products.

  • There are many providers of Supplemental coverage for Seniors – why you?

We are brokers, which means we can shop the market among the various insurance carriers, and help our clients find the best value for them.  We make the process easy – instant quotes are available on our websites, and helpful advisors can answer questions and help our visitors compare plans.  Everything is handled over the phone and via email – no salesperson will ever come to your house or place of business.

  • Assume this last question is directed to media – what one thing would you want media to know about you and your services that you feel would make a difference?

10,000 Americans are turning 65 every single day, and deciding how to insure yourself in retirement can be a confusing and complicated process.  Because you may only get one chance at open enrollment, understanding the difference between a Medicare Advantage and a Medicare supplement plan and which is right for you is critical.  We help our clients cut through the confusion, and we make the process easy.  All the information is on our website, friendly advisors are available to help, and no salesperson will ever come to your home or business.

For more information about Medigapadvisors visit here:  http://www.medigapadvisors.com/


Dr. Janet Johnson Hunter Pleads Guilty to Medicare Fraud…what was she thinking?

January 5, 2010

For more than three years, Janet Johnson-Hunter, a licensed medical doctor and former owner/manager of a private ambulance transportation company, committed fraud.  Johnson-Hunter, late this past year, pled guilty to conspiring to conceal material facts in connection with the delivery of payment for health care benefit, items and services according to a news release from the US Attorney’s office.

Johnson-Hunter changed medical records and ordered employees to change records to indicate patients’ needs to ride in an ambulance, when they did not, in order to be reimbursed by Medicare or Medicaid, according to a federal criminal information complaint was filed Nov. 30.   According to numerous EMT’s and billing staff, Johnson-Hunter, directly and through subordinates, directed employees to re-write medical records which indicated that patient-beneficiaries could sit upright, stand, walk or ride in a wheelchair.  The loss to Medicare/Medicaid = $400,000.

WHAT WAS SHE THINKING?

First I should say, it is not for me to point the finger.  I am not here to pass judgment, that is not mine to pass.  Rather, I’d like to explore the WHY this would or did happen.  As a business ethics speaker, I know that EVERY CHOICE HAS A CONSEQUENCE!  I have lived those words and spent time in federal prison as a result of my past misdeeds.  While I am not proud of that fact, it is a fact nonetheless.  The one thing I am able to do, as a result, is look at choices from a unique perspective.

NEED:  I can’t identify the need directly.  One would assume that to change records in order to increase billing or reimbursement from Medicare would driven by a need for money.  Seems obvious, but Bernie Madoff surely did not need the money, yet he effected one of the largest frauds in US history.  So what’s the need here?  Perhaps those who know Dr. Johnson-Hunter could help with that piece of the puzzle.  FEEL FREE TO COMMENT.

OPPORTUNITY:  It is of little doubt that any system can be manipulated.  If one person can take advantage of a system, one might say that there is a material weakness.  In this case, Janet Johnson-Hunter did not do this alone.  Rather, she used her power and influence to cause others to change records and thus deceive Medicare.  Now…a fair question is: will the Federal Government go after those who admitted to changing records or have they been given immunity from prosecution.

RATIONALIZATION:  This area is most troublesome.  Here’s a reality check…a 50 year old female medical doctor knows better.  You can’t live for half a century and earn a medical degree without having some clue that choices have consequences.  This is especially true when you involve others in the fraud.  You have to know that someone somewhere is going to reveal the truth.

Why would Dr. Janet do this..?  Perhaps that will come out as people comment.  For now, let me restate the obvious:  EVERY CHOICE HAS A CONSEQUENCE.  When you hear the words, “You will reap what you sow” let me state from experience – THEY ARE VERY TRUE.

Likely, Dr. Janet will spend time in federal prison (as did I some 15 years ago for a similar crime).  Prison is no fun as Dr. Janet will soon find out.  But, the question she has to face now, especially now since her misdeeds are brought to light, is what choices will she make now that prove redemptive in the future.

A wise man once said to me:  “You’ve made a big mistake, BUT YOU ARE NOT A MISTAKE!  The choices you make today will define your life in the future and the legacy you leave for your two sons.  MAKE THOSE CHOICES WISELY!”

Comments are welcome


Kansas City Internal Medicine doctors turn away Medicare enrollees, sparking ethics debate

November 4, 2009

medicare eldersHere’s a question for you: If you had a service to provide — and someone asked you to provide it for free, or at a radically reduced price — would you do it?

No, right?

Now try this on for size: If you were a doctor, and someone asked you to provide a service at a rate that didn’t reimburse you for the total cost of care, would you do it?

In nearly every line of business, one maxim holds true: “If you can’t pay, we don’t play.” So, why should doctors be viewed any different?

That’s the question doctors at Kansas City Internal Medicine, the largest private group practice in Kansas City, Mo., have been asking. For now, most of these doctors, who count 65 percent of their 70,000 active patients age 65 or older, have decided to stop accepting walk-in Medicare enrollees.

Dr. David Wilt, an internist at the group, tells CNN: Medicare doesn’t reimburse physicians enough to cover the cost of care. Matters will only get worse, he adds, if a 21 percent cut in Medicare payments to physicians takes place in 2010.

Should physicians be allowed to turn away patients because their funding source is being reduced? On the flip side, does the government have the right in a free-market economy to dictate payment terms to physicians for the performance of services?

Share your comments here.


Texas D.O. – Daniel Andrew Maynard – Pays $253,000 to Resolve Allegations of False Health Care Claims!

May 2, 2008

As an ethics speaker, I am not sure why. Perhaps the US Attorney’s office didn’t have enough to convict. Whatever the reason, there was resolution in a case in the Northern District of Texas from a Texas D.O. – Daniel Andrew Maynard and the US Attorney’s office.

By entering into a settlement, Maynard admits no wrong-doing and denies all liability. However, the very fact that Maynard is paying over a quarter of a million dollars says something.

According to the US Attorney’s office, in February 2005, the Office of Inspector General for the Department of Health and Human Services (OIG), the Texas Health and Human Services Commission, Office of Inspector General (HHSC), and the Federal Bureau of Investigation referred allegations to the government that Maynard had inflated billings for thousands of physician evaluation and management services submitted to the Medicare and Texas Medicaid programs. The U.S. and Texas allege that on at least 32 separate days, Maynard billed both programs for patient encounters – that if provided as claimed – meant he spent more than 24 hours each day seeing and treating patients. Maynard claimed to have seen more than 100 patients on six of those occasions. The U.S. and Texas contend that contrary to Maynard’s claims, he could not have possibly furnished anything more than the most basic of physician services during those 32 days.

Hum…guess Maynard was a work-a-holic? While, again, according to the settlement there was no admission of wrongdoing, the fact remains that a substantial sum has been paid to correct what appears to be incorrect behavior.

Further, as part of the civil settlement, Maynard agreed to be permanently excluded from participation in Medicare, Texas Medicaid, and all other federal health care programs. Maynard previously pleaded, in October 2007, no contest to several Dallas County criminal counts charging him with delivery of a prescription or prescription form without a valid medical purpose.

According to a 2003 news release, Maynard has had issues with his medical practice. The news release stated: “Dr. Maynard’s office was raided by local, state and federal law enforcement officials based on information regarding non-therapeutic prescribing, medically unnecessary prescribing and possible patient harm, including deaths, as a result of his prescribing activity. The panel determined that Dr. Maynard had violated several provisions of the Medical Practice Act by failing to keep adequate medical records related to treatment of Intractable Pain Patients; failure to practice medicine in an acceptable professional manner consistent with public health and welfare; committing unprofessional or dishonorable conduct that is likely to deceive or defraud the public; and by prescribing dangerous drugs and controlled substances to persons who are known or should have been known to be a drug abuser.”

Every choice has a consequence. So far, Maynard should be pleased that the consequence was civil – not criminal. He may, by agreeing to a civil settlement, be able to keep his medical license. However, since he cannot participate in either federal or Texas state health care programs, his client base will likely be limited.

Feel free to share your comments!

Business Ethics Speaker – Chuck Gallagher – signing off…


Health Care Fraud – Mary Lou Hernandez Sentenced to Prison and Over $4 Million in Restitution!

April 9, 2008

Sometimes people get the idea that since the federal government is so big – it just can’t police itself and hence it is an easy target for crime. Yet, all to often, those who take advantage of this illusion are often caught and find that there is another branch of the government they get the opportunity to experience – the Bureau of Prisons.

That’s the case for Mary Lou Hernandez, owner of Angel Care Medical Supply, who was sentenced to 2 years in federal prison and ordered to pay $4,409,518 in restitution. Now, (not that I’m proud of this) but having spent time in federal prison, I know that the next two years for her will be life changing. Prison is no fun. But, facing a $4+ million bill when she gets out is daunting – especially for a convicted felon. How that will get repaid is mind boggling.

According to the facts, on November 16, 2006, Hernandez pleaded guilty to a 3-count Information charging her with conspiracy to commit Health Care Fraud, Health Care Fraud and violation of the Anti-kickback statute.

A Certificate of Medical Necessity (CMN) documents a beneficiary’s physician’s conclusion that durable medical equipment (DME) such as wheel chairs, hospital beds, ventilators and oxygen equipment is medically necessary and reasonable for the treatment of an illness or injury. Hernandez admitted that beginning in 2000, she paid between $800 and $1,000 in kickbacks to five San Antonio area physicians for each CMN. Hernandez also admitted to submitting false Medicare and Medicaid reimbursement claims for DME. The factual basis alleges that from January 13, 2001, to September 30, 2004, ACMS was overpaid $3,032,404.94 by Medicare and $1,377,114 by Medicaid.

Now, one would have to believe that Hernandez, while paid over $4+ million has spent the money. I doubt that she has it sitting in a savings account somewhere. Hence the issue of restitution is significant.

Every choice has a consequence. As a white collar crime and business ethics speaker, I speak from first hand experience about the truth about consequences. Reality is – no one escapes the consequences of their choices. While Hernandez may have looked good for a time and avoided the consequences – she did not avoid the consequences all together. Prison is no fun and Hernandez is facing two years in prison for her conviction. Serving time will prove to be a dramatic change from her prior activities. You do reap what you sow.

If anyone reading has any background on Hernandez or Angel Care Medical Supply – feel free to comment as I study the behaviors and backgrounds of those convicted of white collar crime.

White Collar Crime Speaker – Chuck Gallagher – signing off…


Former Healthcare CEO – Angela Edwards – Sentenced to Prison for Health Care Fraud!

March 18, 2008

To some it is easy to cheat the government. Years ago I taught courses on proper coding of medicare and medicaid billing. The courses were successful, but often, I would get people following the course to tell me an “inside” tip about how to circumvent the system in order to maximize the return – fraudulent coding in effect. My response – You’ll go to jail for that.

angela-edwards.jpg

The former Chief Executive Officer of Oasis Medical Clinic in Plainview, Texas, Angela Michelle Edwards, was sentenced today to 30 months in prison for health care fraud. Edwards admitted that from January 2002 through August 2005, she caused “up-coded” and improperly coded claims and diagnosis codes to be submitted to Medicaid, Medicare and private insurance companies in order to receive higher payments than those authorized by the payors. Even though she knew that only clinicians were authorized to make diagnoses and determine the level of a patient visit for payment purposes, Edwards personally changed bills submitted by the clinicians and taught her billing staff to routinely change bills by submitting claims for visits that were marked at higher levels than the ones indicated by the clinician and by adding patient diagnoses and procedures to the claims before they were submitted to the payors.

According to the US Attorney’s news release: Edwards admitted that she is personally responsible for the restitution in this case because: she caused Oasis to be overpaid; she caused poor banking and accounting records to be kept; she unlawfully took money f rom Oasis’ accounts for personal expenses during her tenure as CEO; and Oasis is now in bankruptcy. As a result of her actions, health care payors, including Medicare, Medicaid, Children’s Health Insurance Program and commercial insurance companies, paid Oasis $370,657 for fraudulent billings.

Not only did this fraud cost Edwards her freedom, but she also lost her license as a nurse since she was a convicted felon.

Every choice has a consequence. As a white collar crime and business ethics speaker, I speak from first hand experience about the truth about consequences. Reality is – no one escapes the consequences of their choices. While Edwards avoided the consequences for a time – they are not avoided forever. You do reap what you sow.

Perhaps Edwards will find her time in prison reflective so that she can use her talents in a productive way to help others upon her release.  Every choice has a consequence and good choices can yield positive results – even for convicted felons!

White Collar Crime Speaker – Chuck Gallagher – signing off…


$34 Million Dollar Payroll Tax Fraud By Texas Nursing Home Executive!

February 27, 2008

U.S. Attorney Richard Roper said in a recently issued news release, “This case is the one of the largest payroll tax fraud cases ever prosecuted in the U.S. Mr. Trebert admitted evading more than $34 million in payroll taxes – this is nothing short of egregious. Nursing homes should be safe havens for the elderly and vulnerable, not vehicles for criminals to commit fraud.”

Gary R. Trebert, age 57, pled guilty to two counts of an indictment that charged him with various offenses related to his operation of nursing homes in Texas and elsewhere. Co-defendant Larry Gordon May pled guilty to his role in the conspiracy in October 2007 and co-defendant Stephen Michael Ewing, a/k/a “Stephen Michaels,” is scheduled to go on trial March 3, 2008.

Trebert admitted that beginning in August 1999 and continuing though mid-May 2004, he, Stephen Michael Ewing and Larry May conspired together, and with others, to defraud the U.S. by impeding, impairing, obstructing, and defeating the lawful government functions of the IRS in the ascertainment, computation, assessment, and collection of the revenue, that is, nursing facility employees’ withheld income taxes, social security taxes and medicare taxes, and HHS in the administration of the Social Security Act and the Medicare and Medicaid programs.

As part of the conspiracy, Trebert and his coconspirators, using the names of sham corporate entities, obtained control of 70 licensed nursing facilities with thousands of patient beds and thousands of employees. In order to acquire control of these facilities, Trebert, Ewing and May used false statements and false and fraudulent documents including Applications for Nursing Facility License and Medicaid Contracts, Medicare Federal Provider Enrollment applications, ownership documents, IRS Employer Identification Number applications, Health Insurance Benefit Agreements, and Electronic Fund Transfer forms. Their falsifications included falsely identifying relatives as owners, operators, and managers of the nursing homes on the applications; failing to disclose staffing/payroll companies on nursing home applications; failing to disclose Ewing and May as the true owner/operators of nursing homes; and forging names of individuals on filed documents to divert responsibility away from the three defendants. Trebert and his co-conspirators used the false statements and documents to hide from HHS, state licensing and Medicaid agencies, and the IRS, the true control and management of the nursing facilities, their responsibility for more than $200 million in money derived from the nursing homes, and their responsibility for the nursing facilities’ residents.

More than 150 sham staffing/payroll entities, many with foreign business addresses at drop boxes in England and Austria, were created to file Form 941 employer withholding tax returns with the IRS, preventing the IRS from assessing and attempting to collect more than $34 million of unpaid payroll tax liabilities from Trebert, Ewing and May, and creating the appearance that these sham staffing/payroll entities employed more than 4500 nursing facility employees, when they did not. From time to time Trebert caused his coconspirator to fly to London in order to mail to the IRS the sham payroll/staffing companies’ false withholding tax returns.

Trebert admitted that he and his coconspirators diverted to themselves and their personal activities substantial sums of money derived from their nursing home operations and from the non-payment of employees’ withheld payroll taxes. Trebert also admitted that in April 2004, he attempted to evade and defeat the assessment and payment of more than $4,113,000 in withholding taxes taken out of employees’ pay at 42 nursing homes he and his coconspirators controlled.

“Evading employment taxes can have serious consequences for employers and their employees. Today’s guilty plea demonstrates that those who willfully attempt to undermine our tax system by playing fast and loose with the rules will be held accountable, regardless of how complicated a scheme they devise,” said Erick Martinez, IRS Special Agent in Charge for the Dallas Field Office.

In the plea agreement, Trebert will spend 8 years in federal prison. Needless to say, when sentenced, Trebert will also be facing substantial restitution – which he may not be able to repay.

Every choice has a consequence! Regardless of how well thought out, no one will escape the consequences of their choices. As a business ethics and white collar crime speaker, I know from personal experience that you reap what you sow. While Trebert and others got by with their scheme for 5 years, the reality is the consequences of their actions will be far greater than any benefit they received.

Your comments are welcome – as you might have been a victim of this massive scam. But let me leave you with this – before you make a choice consider what is the worst thing that could happen – feel what that would feel like – then make your choice. Trust me, the consequences to negative choices are far worse than any gain you can imagine!