Failure to Diversify or Over Concentrate a Portfolio Could be Fraud

Failure to diversify a client’s portfolio can be a form of stock fraud. In order to protect a client’s assets, the broker should vary the types of stock purchased. Stock fraud through over concentration strips the client of the protection diversification affords.

The most imperative shield against [...]]]> Failure to Diversify or Over Concentrate a Portfolio Could be Fraud

Failure to diversify a client’s portfolio can be a form of stock fraud. In order to protect a client’s assets, the broker should vary the types of stock purchased. Stock fraud through over concentration strips the client of the protection diversification affords.

The most imperative shield against risk is when investment holdings are diversified. Since some investments rise in value while others fall, diversification smoothes out some of the volatility of the overall return from a portfolio. Diversification may sacrifice some of the upside potential, but should be more than offset by the benefits of lower levels of risk.

Diversification is a strategy for managing a customer portfolio to limit risk. Instead of all the investments being concentrated in one market sector, investments are diversified among a variety of industry sectors and types of security.

Therefore, as it is less likely that all of the major sectors or specific types will be hit with a significant downturn at once the portfolio contains less risk.

It is a broker’s responsibility to advise clients to diversify their portfolio to reduce risk. Proper diversification is the foremost issue in all-efficient investments, especially when individual stocks are purchased.

When an investment portfolio or account is over concentrated in a particular security, type of security, or industry sector, the risk of loss in the account is increased. It is the broker’s obligatory duty to inform a client of risks and actions that attribute to these risks. Over concentration in an account that contains only one individual investment is easy to recognize. Accounts may also be over concentrated if they:

* Contain only common stocks (including mutual funds that invest in common stocks) rather than a mix of common stocks, preferred stocks, and debt instruments (bonds).

* Contain investments that are limited to one particular industry (such as telecommunications) or industry sector (such as health care or finance).

Brokers are obligated to carefully evaluate each client’s investment goals to provide for adequate portfolio diversification and not give up potential returns. If a broker places the vast majority of a client’s total investment holdings in one sector, and this sector declines significantly, the broker may be liable.

All investors are unique, and careful strategies must be employed to properly diversify a client portfolio. Failure to do so can result in negligence and malpractice liability when that portfolio sustains significant losses.

The cause of action for negligence or malpractice is based upon the duty owed by the broker to the customer and the breach of that duty, including the duty to exercise due care in connection with the account. This activity, whether accidental or not may still be considered negligent misrepresentations, especially if finances are lost.

Failing to properly diversify the customer’s account may also be considered negligent management of an account.

In general, reports have shown that:

* Smaller companies typically have higher risk of failure.

* Smaller-company stocks generally experience a greater degree of market volatility.

* Additional risks are also derived from foreign securities investments.

* Emerging markets typically have higher risk because they are underdeveloped markets.

The right level of diversification for a client depends upon a variety of factors, including the individual’s financial position and long and short term financial goals, and how the market is performing. Many portfolios are not properly diversified and therefore an extended risk is being taken.

-It was early on November 27, her daughter’s birthday, when Ana got the call from a social worker.

“Are you in the country legally?” the person asked.

“No, I’m undocumented,” Ana replied. She had applied for health insurance for her children, both U.S. citizens.

The worker paused for a moment and then [...]]]> Fearing New Law, Arizona Immigrants Forego Health Services

-It was early on November 27, her daughter’s birthday, when Ana got the call from a social worker.

“Are you in the country legally?” the person asked.

“No, I’m undocumented,” Ana replied. She had applied for health insurance for her children, both U.S. citizens.

The worker paused for a moment and then informed Ana that under a new Arizona state law she would have to report her to immigration authorities, although she did not want to.

Since the law was passed last month an estimated 700 individuals who applied for public benefits have been reported to federal Immigration and Customs Enforcement (ICE), according to ICE. It is unknown how many were applying for public benefits that their U.S.-born children are entitled to.

“I dug my own grave, but I wasn’t asking something for me, it was for my kids,” said the woman, 31, who asked that her real name not be used.

After they celebrated her daughter’s birthday, Ana and her family picked up and moved out of fear that immigration officials would come looking for them. Now, they all share a room at a neighbor’s house.

As stories like Ana’s spread in Arizona’s immigrant communities, the climate of fear is growing. The law’s impact is having a chilling effect on the provision of health services for a population of children and women that is already underserved. About one third of Arizona children have immigrant parents, according to a recent Pew Hispanic Center survey.

Children of undocumented immigrants are less likely to have health insurance than those born to legal immigrants or U.S. citizens. In 2007, nearly half of the children born to unauthorized immigrants were uninsured and 25 percent of those who were born in the United States were uninsured.

The new law’s impacts are emerging just as healthcare officials are urging undocumented people to get immunized against the H1N1. Meanwhile, implementation of the new law by state agencies is characterized by confusion.

“The situation is explosive. If the H1N1 virus reaches people and they are not going to the doctor or receiving services, what will happen?” said Alfredo Gutiérrez, editor of La Frontera Times and a former Democratic senator.

Ana had provided the state Department of Economic Security (DES) with all her information in an application for AHCCCS (Arizona Health Care Cost Containment System), the state subsidized insurance program. Under, the new law, HB 2008, DES employees are required to report anyone who is illegally in the country and tries to apply for public benefits.

The immigration status of a parent applying on behalf of a child is not supposed to keep the child from receiving the benefit, according to DES.

Ana believes the DES worker inquired about her status because she gave information about her husband’s employment and his real social security number. The number issued by the Social Security Administration was given to him when he was younger, so that his father, who is a legal permanent resident, could claim him as a dependent. But it doesn’t authorize him to work.

DES does not ask about people’s immigration status when they complete an application, but nothing in the rules indicate that their employees cannot inquire about it. Workers must file a report if someone admits to being in the country illegally.

Employees who don’t do that could face fines, lose their job and face up to four months in jail.

Undocumented immigrants like Ana wonder if immigration authorities will come looking for her. That depends on Homeland Security’s priorities, as set by Sec. Janet Napolitano. As Arizona governor, she opposed measures similar to HB 2008. ICE spokesperson Vinnie Piccard said his agency has improved the reporting system for state agencies in light of the new law.

“ICE will evaluate referrals to determine the individual’s immigration status and criminal history,” he said. “Top priority is given to aliens who pose the greatest threat to public safety, such as those with prior convictions for major drug offenses, murder, rape, robbery and kidnapping, burglary and other serious property crimes.”

But that doesn’t clarify matters for employees of Arizona agencies facing a new law and federal requirements to serve anyone regardless of immigration status. They are caught between a rock and a hard place.

“Everybody is afraid of the perception that they’re not complying with the state law,” said Tara McCollum, director of government and media relations for the Arizona Association of Health Centers. “Our centers are struggling with how to comply and still serve our patients.”

McCollum said the 16 centers and their 140 sites serve a large number of undocumented immigrants and have seen a patient drop off, fewer people going to get immunized and cancellations because of the fear.

“This is very sad because a lot of women are not receiving pre-natal care for their babies,” said McCollum. “There are people who desperately need healthcare and are not getting it.”

The centers are independent not-for-profit agencies that receive federal grants and some state funding. But they claim they should be exempt from the reporting requirements because they are meant to be a safety net mandated to provide services to anyone regardless of immigration status.

AAHC awaits a legal opinion by State Attorney General Terry Goddard on the impact of the law and whether the center will be required to report their clients.

The centers serve about 20 per cent of the uninsured population in Arizona. Often they’re the only option in rural areas.

“This is why this so problematic for us,” said McCollum. “These people don’t have any other choices,”

Among them there are women like Guadalupe, 29, who is two months pregnant but hasn’t visited a doctor. Her husband is legally in the United States but can’t afford to pay insurance for her second pregnancy in 10 years.

“It was an accident, we didn’t plan it,” said Guadalupe, who asked that her real name not be used because she is undocumented.

That’s part of the reason she doesn’t want to apply for emergency health care services she is entitled to under federal law.

“I never asked anything of the government, and my husband pays taxes,” she said. “With the new laws they have in place, you’re automatically a criminal.”

Guadalupe said she believes abortion is wrong but fears that will be her only choice. A regular delivery could cost her ,000 at a local hospital.

Rosie Villegas-Smith, director of the anti-abortion group Voces Por La Vida, has been in touch with women like Ana. She’s worried that many of them are not applying for an emergency services card, provided by AHCCCS, which would help them get pre-natal care.

“Republicans say that they’re pro-life, but they don’t realize that this affects those who are most vulnerable, like pregnant women,” said Villegas-Smith.

The Arizona Department of Health Services (ADHS) has received questions from politicians regarding pre-natal care under this new law.

“We feel we were already in compliance with this bill,” said Duane Huffman, chief legislative liaison for ADHS, who acknowledged the confusion regarding the new law.

HB 2008 doesn’t directly affect emergency services, immunizations, and Woman and Infant Care (WIC), a nutritional service. While there are concerns, programs like WIC have not reported a decrease in applicants, said Huffman.

But immigrant advocates think the law’s negative impacts are real and intentional.

“This law was designed to generate panic and for people to self-deport,” said Antonio Velazquez, director of the Maya-Chapin organization, which represents over 3,000 indigenous Guatemalans in metropolitan Phoenix. “But the truth is that they don’t have the funding or the personnel to enforce it.”

Proponents of HB 2008 argue that it was necessary to stop undocumented immigrants from fraudulently receiving welfare and healthcare insurance.

In a recent column published in the East Valley Tribune, Republican State Senator Russell Pearce claimed that undocumented immigrants receiving public benefits are one reason the ACHCCS budget has increased.

But AHCCCS statistics reveal few cases of fraud in the application process. In fiscal year 2009, the AHCCCS fraud unit investigated 215 cases, but there’s no break down of how many were related to undocumented immigrants. In 2009, the state insurance program grew by 214,000 new members. Before the new law, AHCCCS already had a system in place to check eligibility requirements, which include U.S. citizenship or permanent legal residence for at least five years.

“We are turning everybody into immigration agents,” said attorney Isabel Garcia, director of the Coalición de Derechos Humanos, a human rights organization in Tucson, “when the reality is that immigration is a complex area of the law.”

from The National Consumer Protection Technical Resource Center
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Insurance fraud investigator jobs are an important job within an insurance company because it is their duty to determine if a claim has been made under false pretenses. It is a career with a good future job outlook that can take you all over the world or allow you to [...]]]> Insurance Fraud Investigator Jobs – Careers Explained

Insurance fraud investigator jobs are an important job within an insurance company because it is their duty to determine if a claim has been made under false pretenses. It is a career with a good future job outlook that can take you all over the world or allow you to stay in your hometown if you desire. A variety of degrees, including criminal justice, can prepare you for this career. With so many career options and a great job outlook, choosing to become an insurance fraud investigator is a sensible choice. But just what does an insurance and fraud investigator do?

Unlike careers in art, education, health care and other fields, there may be some negative connotations to insurance fraud jobs. This is why it is important to have the right career information to determine if it is the right job for you. An insurance fraud investigator may be responsible for investigating disability claims where individuals say their mobility and/or quality of life is limited due to chronic pain. Since pain is hard to prove medically, much falls on the investigation of the investigator to determine if the individual is eligible for disability payments.

After getting their degrees, insurance fraud investigators might go to work for an insurance company full time. On the other hand, some insurance and fraud investigators may choose to work on a contract basis as a private investigator. When an insurance company has a case they want investigated, the insurance and fraud investigator will usually start with some background information such as personal contacts, addresses, previous claims (if any), and the nature of the current claim. Once the file has been reviewed, the investigator might even do some surveillance work to ensure that the individual has actually lost the functions they claim they have lost. This will involve the use of equipment such as video and still cameras.

Most insurance fraud jobs in this field require working with insurance lawyers or consumer fraud lawyers in the cases where an individual has been found to be providing fraudulent information. It is important to be accurate, professional, thorough and skilled to have success in this challenging and demanding criminal justice career.

Galileo’s Lawyer: Courtroom Battles in Alternative Health, Complementary Medicine and Experimental Treatments “Galileos Lawyer is an insider’s view of the alternative health care field as told from the perspective of the legal battles involving the most popular and controversial complementary and alternative health care practitioners. •Go inside the courtroom during the government’s attempts to shut down a cancer clinic which was saving hundreds of terminally ill patients, and see how the US Congress came to the clinic’s rescue; •Meet a group of New Jersey Chiropractors who sued the government for “racketeering” for employing an illegal extortion scheme; •Watch the nutritionists battle the dietitians over dietary supplements; and •Find out why naturopaths are prosecuted for practicing medicine without a license. Galileo’s Lawyer is a living history about the struggles between medical maverics, their patients, and the government.” Richard Jaffe is a health care litigator and counselor with a primary focus on cutting-edge medical/legal issues. He represents practitioners, companies and health related organizations in complex health care matters throughout the United States, especially legal cases brought by federal and state government agencies. He has extensive experience in Medicare and insurance fraud defense, FDA litigation, professional licensure and criminal and civil scheduled drug prescribing problems, including medical marijuana and OxyContin. He also has …
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Recent years have seen plenty of investment in the health care system, the police force, education and other important public arenas. There is no doubt that there has been a lot of improvements made but there has also been a huge amount of waste. Now that sums [...]]]> Reductions In Public Spending Will Increase The Cost Of Fraud

Recent years have seen plenty of investment in the health care system, the police force, education and other important public arenas. There is no doubt that there has been a lot of improvements made but there has also been a huge amount of waste. Now that sums that can be measured in trillions have been pumped into the decimated economy in order to bail out the failed banking sector there is grave concern that investment into the already inadequately funded fraud regulatory system will be severely cut.

Barristers’ and solicitors’ income from criminal work has been eroded over recent years with the result that in some cases they have refused to act and accused parties have been allowed to walk free. This process is now hitting the forensic accountants who are essential for the proper outcome of most fraud cases. The Legal Services Commission in the UK intend reducing the money paid to experts by 20% in 2010, a disproportionate amount of the overall reductions in public sector funding they have been asked to make.

The police fraud squads and economic crime units are experiencing similar funding cuts. Given their administrative burden they seem to have less and less time for front end policing. This will result in the underfunding or even overlooking of the so called ‘non serious’ crimes that inevitably will include fraud. Commentators estimate the cost of fraud within the UK alone to be as much as billion, with the cost to the USA proportionally higher.

There is no way that approximately 450 full time police fraud officers can handle this level of economic crime? A lot of fraud is never reported for fear of publicity and is therefore not investigated. We will never really know how much. Loss due to fraud is a crime that is hidden beneath the surface of our daily lives and only that which is discovered, investigated and prosecuted is every fully counted. The rest passes by unnoticed.

The cunning thief can target a huge number of victims for just a couple of thousand pounds each. Together the fraud may be worth millions, but each individual loss represents a person with no power or resource to do anything. In some cases the victims band together to finance civil action, but in many cases they simply fade into the background.

There is a lot of excitement concerning the new National Fraud Reporting Center. Perhaps we will get a better understanding of the amount of fraud that is happening and then maybe we will see the resources put where they can be most effective in reducing the threat of fraud. Funding trained police fraud officers and fully capable forensic accountants to investigate and bring successful fraud prosecutions is the only answer and with the promised harsh cut backs in public funding set to rise it seems that the fraudster may still be safe for a while yet.

www.house.gov CampaignForLiberty.com As Washington continues debating healthcare reform the rest of the country is primarily concerned about jobs and the economy. It is still uncertain what policies will be implemented, but I am certain about one thing It will only further devastate our economy and our dollar. The leadership has come up with a proposal they are confident will be what they consider fiscally responsible, only to have it scored as nearly twice as expensive by the nonpartisan Congressional Budget Office. Estimates of past healthcare spending programs have been off by as much as 100 percent so there is no telling what the actual cost will be. The past century should have taught us one thing: that government intervention is expensive. Government programs lend themselves so easily to waste, fraud and abuse. Combine that with overall inefficiency and it all adds up to a hefty price tag for the taxpayer, with not much leftover for actual services. An outright takeover of an entire sector of the economy, especially one as important as healthcare, is something that we just cannot afford for the government to do right now. Not to mention the fact that it is completely unconstitutional. But Washington insists on torturing the numbers and tinkering around the edges rather than facing this truth. If healthcare reform does indeed pass, we should not be under the illusion that it will be free. The money to pay for it will have to come from somewhere. They say they will …
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As a well-practiced criminal defense attorney in Texas, Henry Wade of The Wade Law Firm has had a lot of criminal cases pass before him, both from his time as a lawyer and as a judge. And according to Wade, insurance fraud is, most simply put, making up an insurance claim [...]]]> What You Should Know about Insurance Fraud

As a well-practiced criminal defense attorney in Texas, Henry Wade of The Wade Law Firm has had a lot of criminal cases pass before him, both from his time as a lawyer and as a judge. And according to Wade, insurance fraud is, most simply put, making up an insurance claim when nothing actually happened.

From a young age, children are taught the value of telling the truth. In fairy tales, lies are distinguished with a growing nose, as in Pinocchio. And, no matter what story is, the “good guy” always emerges as the victor. Yet, somewhat instinctively, it seems like human nature to lie. Sometimes the lies are small and cause no harm. Other times the lie is drawn out and carefully planned, used for personal gain.

While the average person probably won’t ever get caught in such a scheme, the networks of people who do commit insurance fraud are costing companies millions of dollars every year, and are driving up premium rates for everyone. Instances of health insurance fraud, car insurance fraud and home insurance fraud are quickly on the rise.

Penalties for Committing Insurance Fraud

Insurance fraud is a crime on both the civil and criminal level, which means that not only will you have to pay hefty fines upon your conviction, but you can also be sentenced to complete a prison term. Medical insurance fraud, for example, is considered a federal crime.

The current administration is working to tighten the laws regarding insurance fraud. And, according to The Washington Post, by the end of 2009, President Obama is expected to sign an executive order that will center on eliminating government waste and fraud, particularly in Medicare and other benefits programs.

As more groups come together to rally against enforcing stricter laws, that would not allow people to so easily receive money on the basis of false claims. And the sentencing for these crimes has increased as well, with most of the convicted serving actual jail time.

Serious Criminal Offense

Even if you never have committed forgery, you can still end up paying for the money insurance companies mistakenly pay. According to the nonprofit group Coalition Against Insurance Fraud, an organization that prides itself as being a national clearinghouse of fraud information, million a year is stolen due to insurance fraud. This correlates to higher premium rates for every insurance policy holder.

If you find yourself being investigated or accused by an insurance company for fraud, or the police, you should contact an experience criminal defense attorney in your area who can help you gather the information you need and prepare you for any interrogations or court dates.

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A sad story in Miami, Florida regarding health insurance was recently brought to my attention. It highlights the flaws inherent in both public and private health insurance plans, and is an example of why healthcare reform is so important. A friend of mine has an ailing [...]]]> This Could Be Your Grandpa: Indirect Euthanasia Via Health Insurance?

A sad story in Miami, Florida regarding health insurance was recently brought to my attention. It highlights the flaws inherent in both public and private health insurance plans, and is an example of why healthcare reform is so important. A friend of mine has an ailing grandfather, named Benito Jimenez. Benito’s daughter, Maria Conroy cares for him 24/7, and has taken charge of navigating the complexities of his insurance coverage. Her 85-year-old father has Medicare, but also has a Medicare Advantage administered by Humana. This would seem like an ideal compromise of the government and corporations, which would allow them to provide the best healthcare possible. Instead, it’s only brought Maria and her family one frustration after another.

Benito suffers from various conditions, but his health recently took a turn for the worse. He has developed anemia, which decreases the amount of healthy red blood cells. Severe anemia prevents your body from pumping oxygen everywhere it’s needed, so it’s obviously an urgent concern, especially for senior citizens. His doctors aren’t sure where his internal bleeding is coming from, though Maria suspects that it’s related to a previous stomach ulcer that was caused due to Benito taking a large combination of medications daily. The recommended test is an endoscopy, generally considered a simple and safe procedure (as opposed to a colonoscopy, which is more invasive). Unfortunately, possibly due to Benito’s age, his gastroenterologist–part of his primary care doctor’s “team”–refuses to perform it himself, despite being able and certified to do so–Maria feels that he is most likely scared of a malpractice lawsuit. Maria begged him to allow her to sign a waiver removing his liability, but he refused to take the risk of doing it on an outpatient basis. That gastroenterologist further explained that he would be obligated to do any and all tests necessary to save Benito’s life if he was in a hospital setting.

After the gastroenterologist told them to go to the hospital (where the procedure would be performed at a higher cost to them, as well as their health insurance), Maria and Benito were kicked back to their primary care physician. Despite Benito’s hemoglobin level being a very low 8.5, they were told that he wouldn’t be referred to a hospital until his hemoglobin level was 7. She is unclear as to whether the doctor or the insurance company establishes this arbitrary rule. If they had investigated his medical history, a hemoglobin level of 8 had previously sent Benito to the hospital in need of a blood transfusion. In the infinite wisdom of Medicare and Humana’s reimbursement rules, they would not offer preventative treatment until he was in critical condition and needed even more medical care. This runaround was costly for Maria, both financially and emotionally. Benito was prescribed an increasing number of medications to mask his symptoms, but they produced other side effects and exacerbated his main problem (while also resulting in higher co-pays). She felt that the doctors were condescending and were more focused on preventing health insurance fraud than providing care. While Medicare fraud is relatively common, the preventative measures may have backfired. Honest, ethical patients and their loved ones don’t receive the care they need, because they are unaware of the loopholes. For example, a previous cardiologist of Benito’s once referred him to Baptist Hospital in Miami, in order for another specialist to examine him; however, his insurance company wouldn’t pay for a visit to that particular hospital. The cardiologist suggested that he pretend to faint somewhere in close physical proximity to the hospital or in the hospital lobby, so they would be forced to admit him and later discover what he actually needed. This suggestion shocked and dismayed Maria.

For too many doctors, the health insurance bureaucracy has changed their caring vocation into an impersonal business. Ideally, healthcare reform would change this, eventhough this story shows an negative example of government involvement in health insurance. The saddest part of Maria’s story is that Benito was present when a cardiologist, that his primary care doctor urged him to consult with, shockingly informed Maria, as if he wasn’t capable of understanding or wasn’t listening, that further investigation would be pointless due to his frail condition–or at least, not enough of a sure thing to avoid the risk of lawsuits. They indirectly, but essentially told her, in front of him, that he should go home, medicate the symptoms and wait to die. Again, their fear of malpractice judgments and desire to bill Humana and the federal government (thereby making up for decreased funding that cut reimbursement rates) for as many procedures as possible overtook their oath to “do no harm”. It seems as though they prefer to wait until someone is in critical condition to provide preventative care, which results in their needing even more medical care. Meanwhile, Benito’s condition was far from terminal. A previous gastroenterologist agreed to perform an outpatient procedure, but his insurance was only willing to cover the specialist recommended by his primary care doctor. As opposed to working together for the benefit of the patient, that doctor steered them to the uncooperative gastroenterologist described above. Since the outcome was unsuccessful, Maria eventually managed to get her father’s initial gastroenterologist covered under his health insurance plan; however, the delay was detrimental to his care. Benito’s anemia is now critical: this lessens the chances of success of an outpatient endoscopy and might mean that he’ll need a hospital stay, after all.

In Maria’s own words, the health insurance industry has enacted its own “cash for clunkers” program. Only in this case, the so-called “clunkers” are older Americans being sent to the junkyard. There’s a lot of fault to go around: Medicare stretches its budget to the limit and has bureaucrats making coverage decisions, while for-profit insurers like Humana have CEOs and shareholders that also demand a reduction in costs. The patients themselves–our parents, grandparents, siblings, children, partners, and friends–are lost in the midst this battle, even though they should be the most important factor of all. Some opponents of the public option claim that it will lead to the forced euthanasia of seniors, while others believe those claims are overblown. Nevertheless, indirect euthanasia is already happening right now; this is a case in point. Healthcare reform is a complicated issue, and it’s deeper than greater availability of affordable health insurance. That won’t matter if, after paying premiums and/or taxes for decades, your insurance won’t give you the care you need most. I don’t claim to know what proposal will work best, but Maria says that the current system is broken and that we urgently need healthcare reform of some kind. “Everybody doesn’t have a family member to be an advocate,” she adds. “I worry about how many elderly people fall through the cracks without someone to find the loopholes to work the system for them.”

US Senator George LeMieux (R-FL) spoke on the Senate floor regarding health care reform proposals and the potential impact on the national debt. LeMieux discussed the need to address the billions lost in waste, fraud, and abuse. Senator LeMieux introduced the Prevent Health Care Fraud Act of 2009 a proposal aimed at reducing and eliminating fraud in the health care industry.
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Senator Lamar Alexander today made the following remarks on the floor of the U.S. Senate:

· “What Senator McCain is basically saying with his amendment is, don’t cut Grandma’s Medicare to pay for someone else’s insurance.”

· “If you find savings by cutting waste, fraud and abuse in Grandma’s [...]]]> Health Plan Will Cut Grandma?s Medicare By Half A Trillion

Senator Lamar Alexander today made the following remarks on the floor of the U.S. Senate:

· “What Senator McCain is basically saying with his amendment is, don’t cut Grandma’s Medicare to pay for someone else’s insurance.”

· “If you find savings by cutting waste, fraud and abuse in Grandma’s Medicare, spend those savings on Grandma. Medicare’s trustees have said to us that there are trillion in unfunded liabilities for the Medicare program, and that the program will start going bankrupt between 2015 and 2017. According to the Medicare trustees, ‘We need timely and effective action to address Medicare’s challenges.’ I don’t think the Medicare trustees were thinking that the timely and effective action we could take to keep Medicare from going broke was to take 5 billion out of it and spend it on some new program.”
Click to learn more…

· “Rather than take my word for it, let’s go to a Wall Street Journal headline: `Some Health Premiums to Rise.’ That means the cost of your insurance is going up. So my question is, why would we spend .5 trillion over ten years, cut Medicare, raise taxes and run up the debt to raise some Americans’ health care premiums? I thought the whole exercise was to lower the cost of health care premiums.”

· “This bill is historic in thinking we could take a system that affects almost all Americans and change it all at once. Why don’t we instead go step by step to re-earn the trust of the American people? Republicans will be making those proposals on the Senate floor this month and next month and as long as it takes to get real health care reform. Cutting Grandma’s Medicare by half a trillion dollars and spending it on a new program at a time when Medicare is going broke is not real health care reform.”

Full Alexander remarks:

Mr. KYL. Mr. President, I ask unanimous consent that during the 30 minutes controlled by the Republicans, we be allowed to engage in a colloquy.

The ACTING PRESIDENT pro tempore. Without objection, it is so ordered.

Mr. KYL. Mr. President, I will begin by making some comments about the amendment Senator McCain, my colleague from Arizona, has filed. This is an amendment that, as the minority leader just said, will protect America’s seniors. It will disallow the Medicare cuts this bill includes.

The economist Milton Friedman famously said, “There is no such thing as a free lunch,” and that applies to health care as well. There is no such thing as free health care. Someone has to pay. Since this bill is a .5 trillion bill, the first question is, Who pays? The first answer to who pays is, it is America’s seniors, because about half of the cost of the bill is allegedly paid for by cuts to Medicare.

Let me break down a little bit more specifically than the Republican leader did exactly what that means. This is about 0 billion in Medicare cuts as follows: 7.5 billion from hospitals who treat seniors; 0 billion from Medicare Advantage, which is the insurance program that provides benefits to seniors which will be cut more than in half as a result of this 0 billion reduction; .6 billion from nursing homes that treat seniors; .1 billion from home health care for seniors; and .7 billion from hospice care, one of the most cruel cuts of all. Obviously, with cut this dramatic there is no way to avoid jeopardizing the care seniors now enjoy, and seniors know this. That is why they have been writing our offices and attending townhall meetings to let us know they disapprove of this. I quoted from two letters constituents of mine from Arizona sent asking to please not cut their Medicare Advantage Program. This has been called the crown jewel of the Medicare system, and many of them rely on Medicare Advantage for dental care or vision care or hearing assistance they have come to rely on. They are not buying the claims that somehow or other we can make /2 trillion cuts in Medicare without somehow hurting their care. They know better than that, and they are right. The care they have been promised will be compromised to pay for this new government entitlement under the bill.

Finally, many are wondering what happened to the promise that they get to keep the care they have. We all heard the President say that many times: If you like the care you have, you get to keep it. That is simply not true. There are 337,000 Arizonans who are Medicare Advantage patients. They like what they have. Yet we know, according to the Congressional Budget Office, that the benefits they have under Medicare Advantage are going to be cut by more than half. They are saying: What happened to the policy I like? I am not going to be able to keep it if this bill passes.

This is why the McCain amendment must pass. If our Democratic colleagues are not willing to protect Medicare, then I cannot imagine how the bill could otherwise be made acceptable since it starts with the commitments that Congress and the President have made to our senior citizens.

Perhaps one of the reasons why there are different numbers from one side of the aisle to the other is that sometimes we are not talking apples to apples. We are talking apples to oranges, and perhaps both numbers are correct in their context. The Senator from Tennessee used the number .5 trillion when the program is fully implemented. That is a very important statement. The other side will argue it is only 1/2 trillion for the first 10 years of the program. That is a correct statement. But it is .5 trillion for the first 10 years of total implementation of the program. What is the reason for the difference? For the first 4 years, money is being collected, but very few benefits are going out. The benefits start after year No. 4. So if we take the first 10 years of the program, we are collecting money to pay for it over the entire 10 years, but almost all of the benefits only occur during the last 6 years. Naturally, we have collected more money than we have paid out. But when we take the first 10 years of full implementation, it is as my colleague from Tennessee noted, a cost of .5 trillion. That is how sometimes we get somewhat different numbers.

As long as we are clear about what we are talking about, one thing is crystal clear: Whether it is 1/2 trillion or .5 trillion, we are talking real money. Somebody has to pay for it. If America’s seniors are being asked to pay for half of it, that is not fair to America’s seniors, given the commitment we have made to them. That is the point of the McCain amendment. Protect Medicare, protect America’s seniors. We can do that with the simple amendment Senator McCain has which is send the bill back to committee — it would only take 1 day — and send it back here without those Medicare cuts in the bill.

Mr. ALEXANDER. I see the Senator from Idaho here. I wish to hear his observations on this. If there is any issue in this entire health care debate that symbolizes why we on the Republican side want to change the debate to a step-by-step approach to reducing the cost of premiums, it would be the Medicare issue. As the Senator from Arizona said, what we need to do about Medicare is make it solvent as quickly as we can, as effectively as we can. The Senator from Kansas said the other day that the proposal to take 5 billion from grandma’s Medicare and spend on it some new program is like writing a check on an overdrawn account in a bank to buy a big, new car. There is a lot of truth to that.

The President said earlier this year something I agree with. He said this health care debate is not just about health care. It is about the role of the Federal Government in the everyday life of Americans. He is exactly right about that. This health care debate, which we are beginning this week, is not just about health care. It is about the stimulus package, about the takeover of General Motors. It is about the trillion dollar debt. It is about the Washington takeovers. It is about too much spending, too much taxes, too much debt. The Medicare provisions in this bill are a perfect symbol of that. That is why Senator McCain is right. What he is saying is, don’t cut grandma’s Medicare and spend it on some new program. If you can find some savings in the waste, fraud, and abuse of grandma’s Medicare, spend on it grandma. Make sure those of us who are older and those of us who are younger and looking forward to Medicare can count on its solvency.

Later this week we will talk more about premiums going up. There was a lot of discussion yesterday because, according to the Wall Street Journal, some health premiums would rise. For people who get their insurance from large employers, this bill won’t make much difference. And for small employers, if you get your insurance from a small employer, it won’t make much difference. If you are going to the individual market to buy insurance yourself, your premiums will go up, except we are going to get some money from somewhere to help pay part of your premiums, at least for about half of Americans who are in the individual market. Where are we going to get that money? From grandma. We are going to get it from Medicare. So that is what is wrong with this bill. And what is right about the McCain amendment is, it says simply, don’t cut Medicare. If we find savings, which we hope we can in Medicare, we should spend it on making Medicare solvent.

I wonder if the Senator from Idaho is hearing from seniors in his State about the proposed 5 billion cuts to Medicare and how they feel about taking that money and spending it to create a new program?

Mr. CRAPO. I thank the Senator from Tennessee. Very definitely we are hearing from seniors in Idaho who see through this. It is very clear to the folks in Idaho that what we are seeing is a proposed massive growth of the Federal Government by over .5 trillion, when fully implemented, that is to be funded on the backs of American taxpayers and senior citizens through cuts in Medicare. In fact, in addition to those who have contacted me who are seeing their health benefits lost, I have also been contacted by a number of the providers. We are talking about those who are in home health care or hospice health care, skilled nursing facilities or hospitals and the like.

They make a very interesting point. Their point is that not only will senior citizens — in Medicare Advantage in particular — literally be losing their benefits dramatically, but that other senior citizens who are in traditional Medicare will also be losing access and quality of care. How is that the case? We know from the details of this bill that we are going to see major cuts in hospice care, home health care, skilled nursing facilities, and hospitals.

The points made to me by those providers are that they have already gone through a series of very deep cuts, cuts to the point that in Idaho for home health care, we lost something like 30 percent of our facilities already. The way one of them explained to it me was that if you reduce the compensation we are receiving, then we have to reduce something in our budget. He said: We can’t just start taking bricks off of our buildings. What we will end up having to do is to reduce personnel. That would be the nurses and the doctors and the other care providers who are there to provide support for these individuals. We will have to reduce the number of rooms we operate or the facilities we provide. In the end, there will be a reduction of services and access available to senior citizens, including a reduction in the quality of the care they are able to be provided.

Mr. ALEXANDER. In discussing the Medicare cuts, another provision of the bill which we will be talking about this month and next month as we go through the health care debate is what about the problem of paying doctors and hospitals who see Medicare patients. They get paid about 83 percent of the rate they would be paid if they were seeing a private care patient. Every year Congress has to make an adjustment in something we did a few years ago which automatically cuts the amount of money that we pay doctors who are seeing Medicare patients.

That is a big problem for Medicare patients. Because if the doctors can’t be paid, they won’t see the patients, and Medicare patients may find themselves increasingly in the condition that Medicaid patients do, low-income Americans who are covered through the State program — that is our largest government-run program — where they are paid about 60 percent of what doctors who see private patients are paid and about half of Medicaid doctors won’t see new patients. I ask the Senator, does he see anywhere in this bill a provision for the /4 trillion that will be needed to pay doctors 10 years from now what they are making today? If it is not in the bill, where is that /4 trillion going to come from? Is it going to come from Medicare cuts, or will it come from adding to the deficit?

Mr. CRAPO. Obviously, it will come from cuts in Medicare or increased taxes or simply more debt on the Federal level.
The Senator raises a very interesting point. This question of fixing the compensation rates for physicians in Medicare is a huge question, one which we have been fighting for for a number of years to try to find a solution to, as each year we delay the expected cuts that will happen. I have talked about this factor in the context of being a budget gimmick in this bill. What do I mean by that? Those who say this bill reduces the deficit are able to say so only because it has about 0 billion of new taxes, about 0 billion of Medicare cuts, and a number of budget gimmicks that delay the implementation of the spending side of the bill or, in this case, don’t even include at all one of the major expenses that needs to be accommodated, and that is the fix for physician compensation. If any of those things were not in this bill, this bill would drive up the deficit tremendously.
What we are going to see, in addition to these fiscal impacts on the Federal Treasury in terms of huge increases in the debt or huge increases in more taxes, even more than we are talking about with this bill, is we are going to see the very real potential that access to medical care for seniors will be again reduced because of this factor.

Let me give a couple of statistics. In their June 2008 report, the Medicare Payment Advisory Commission, or MedPAC, said that 29 percent of Medicare beneficiaries who were surveyed were looking for a primary care physician and had trouble finding one to treat them. In other words, about 30 percent of Medicare beneficiaries today are having trouble finding a physician who will take a Medicare patient. That is before the 5 billion of cuts and before simply not including physicians at all in this legislation.

A 2008 survey by the Texas Medical Association found that only 58 percent of the State’s doctors took new Medicare patients, and only 38 percent of the primary care doctors accepted new patients. Again, it is an example from MedPAC and from one State that indicates what we know is happening around the country; namely, that doctors in increasing numbers are no longer taking new Medicare patients, just as they have been doing with Medicaid patients for years. Yet we see these massive cuts to Medicare being proposed that will have the same impact on hospice care and home health service and skilled nursing facilities and hospitals, and we see that doctors are not even included at all, meaning they are projected now to receive major reductions. I think it is over 20 percent reduction in their compensation for taking Medicare patients.

The solution here to establishing a massive new Federal entitlement program is not to cut Medicare. I want to repeat something both the Senators from Arizona and Tennessee have already said that is critical. Reducing the Medicare budget by 4 billion, by any number, is something that has been encouraged in terms of trimming the growth path for Medicare. That is something this Congress has looked at in the past. But never was it intended by those who made these projections about needing to control the spiraling cost of Medicare that we address the fiscal circumstances in Medicare with the intended purpose of creating another new, massive Federal entitlement program that will grow the Federal Government by over trillion — we talked about the numbers; the full 10-year period is .5 trillion — and leave Medicare with these dramatic cuts, this loss of service and loss of benefits to the recipients, while they see this new government growth with a new government program. That was not in the mind of anybody who was asking us to deal with the solvency issues on Medicare, and it don’t think it was in the mind of anybody who asked that we have some kind of health care reform to deal with the rising cost of premiums.

Mr. ALEXANDER. Mr. President, how much time remains on the Republican side?

The ACTING PRESIDENT pro tempore. The Senator has 8 1/2 minutes.

Mr. ALEXANDER. Would the Chair let me know when 4 minutes remain.

The Senator from Idaho will conclude our remarks at that time.

The Senator from Idaho has made an important point, anticipating our Democratic friends will have the next 30 minutes and some other things they may be saying the rest of the day. There was a lot of talk yesterday about the CBO report about the effect of this .5 trillion proposal on premiums. Rather than take my word for it, let’s go to the news section of the Wall Street Journal of today which has the headline: “Some Health Premiums to Rise.”

That means going up. That means the cost of your insurance is going up for some Americans.

So my question is, why would we spend .5 trillion over 10 years, cut Medicare, raise taxes, and run up the debt to raise some health premiums? I thought the whole exercise was to lower the cost of health care premiums.

The article says: The analysis released Monday by the nonpartisan Congressional Budget Office and the Joint Committee on Taxation –We are supposed to pay some attention to these outfits as nonpartisan — painted a more complicated and uncertain picture. It said people who pay for their own insurance would see a higher bill, albeit for more generous benefits — That is the government-approved insurance you are going to be forced to buy. Unless they are lower earners who qualify for a new government tax credit.

Where is the money going to come from for those subsidies? It is going to come from grandma. It is going to come from Medicare. It is going to come from taxes. And it is going to come from increasing the debt.

Those are facts.

Employees of small firms — Says the Wall Street Journal — would effectively see their insurance premiums unchanged — So for small firms, we are going to spend .5 trillion over 10 years, cut Medicare, cut taxes, and run up premiums for millions of Americans, so your insurance will continue to go up at about the rate it already was. Why should we be doing that?
while workers at large firms would see something between unchanged and slightly lower premiums under the bill — Compared to what would already happen — according to the analysis.

We need to change the debate. We need to start over. Instead of this comprehensive 2,000-page bill that is full of taxes, mandates and, as a general effect, raises premiums and taxes and cuts Medicare, we should set a clear goal, reducing costs, and begin to go step by step toward that goal — reducing junk lawsuits against doctors, allowing health care to be purchased across State lines to increase competition, allowing small businesses to combine in health plans so they can offer more insurance to employees at a lower cost.

These three bills I mentioned have been offered and rejected so far by the Democratic majority. We should have more flexibility in health savings accounts, efforts at waste, fraud, and abuse, which are, in effect, Medicaid — the largest government program — and Medicare — the second largest — and more aggressive steps to encourage wellness and prevention.
One approach, the comprehensive 2,000-page bill, Washington-takeover approach, Americans are very leery of. In my respectful opinion, this bill is historic in its arrogance for thinking we could take a system that affects almost all 300 million Americans, 16 percent of the economy, and change it all at once.

Instead, why don’t we go step by step to re-earn the trust of the American people? Republicans will be making those proposals on the floor this month and next month and as long as it takes to try to see that we get real health care reform. Cutting grandma’s Medicare by /2 trillion and spending it on a new program at a time when Medicare is going broke is not real health care reform.

Mr. CRAPO. Mr. President, how much time remains?

The ACTING PRESIDENT pro tempore. There is 4 1/2 minutes remaining, Senator.

The Senator from Idaho.

Mr. CRAPO. Thank you, Mr. President. I wish to conclude with our time this morning by focusing on the larger picture a little bit, as my colleague from Tennessee has done in his concluding remarks.

When you ask Americans whether they want health care reform, the vast majority would say yes. When you ask them what they mean by that, the vast majority in the polls and in my personal experience are saying: We want to see the spiraling costs of health care and our health insurance brought under control and reduced, and we want to see increased access to quality health care for those who do not have access today and for those who have limited access today.

This bill fails on those two central points. What this legislation does, instead, is increase the size of government by .5 trillion of new Federal spending, establishing massive new Federal controls over the economy, and even creating a Federal Government insurance company. It increases taxes by about 0 billion, and not just on the so-called wealthy. The vast majority of these taxes are going to squarely hit those who President Obama said would not be hit: those who make less than 0,000 a year and, frankly, all the way down the income chain.

It cuts Medicare by 4 billion. It puts a major new unfunded mandate on our States, which are already struggling in their fiscal budgets. As my colleague indicated, it causes the price of insurance premiums to go up for the individual market, to go up in the small group insurance market, and to be basically unchanged in the large insurance market, according to the CBO study.

By the way, one of the things that is not pointed out in that CBO study very much is in that large market, which it says will be the only part of the market that does not see insurance rates go up, one of the reasons is because their health care will go down. In other words, there is a tax on these larger, high-cost insurance premiums that is going to be either passed through and cause their insurance to go up or will be avoided by reducing the cost of their insurance and reducing coverage of the benefits in these policies. So one way or the other, all Americans are going to see their health care premiums go up or, in the large groups, see their health care premiums be held the same by reducing the quality of the insurance they have.

If you go back to those two reasons Americans wanted health care reform, did we see premiums go down? No. Did we see increased quality or increased access to care? Well, there are some who are going to get a subsidy in this program for this new massive Federal program. But at what price? Mr. President, .5 trillion, 4 billion of cuts in Medicare, the establishment of a major new government program that would essentially be funded on the backs of massive new tax increases, massive Federal tax increases, and Medicare cuts, and in the end we will still be in a system in which we are seeing spiraling increases in health care costs. To me, that is not the kind of reform we need. My colleague from Tennessee indicated there are a number of reforms on which we can find common ground that will reduce health care costs. There are a number of reforms on which we can find common ground that will help us to increase access to quality care. That is where our focus should be. That is why I stand here today in support of my colleague John McCain’s amendment, which is a motion to commit this legislation to the Finance Committee. As was indicated, it could be done in 1 day, to simply remove the Medicare cuts that are contained within it. Let’s fix that part of this bill, and then let’s work forward.

I see my time has expired. I encourage this Senate to focus closely on the legislation and to let us work together in a bipartisan fashion rather than speeding ahead and trying to pass legislation that has not had the opportunity for this kind of bipartisan effort to develop a good work product for the American people.

SONG COMPOSED BY DIDIER MANCHIONE ALL RIGHTS RESERVED SOCAN 2010 A SONG AGAINTS DRUGS

Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. [...]]]> Being Aware Of Insurance Fraud

Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not understand what health insurance fraud entails, though. With reports estimating health insurance fraud is a billion to over 0 billion industry per year, the topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and its consequences. By doing so, you are more able to recognize and fight fraud.

Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Essentially this means that you assert that you paid for certain medical procedures or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud is to conceal pre-existing conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may think that this is a small issue in comparison to your sister receiving treatment, it is actually very serious to your health insurance company and industry, and will result in fines and possible imprisonment if your are caught.

Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company’s investigation.

Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear – along with the money you have been paying in premiums.

The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember – it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.

Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. [...]]]> An Overview Of Insurance Fraud

Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not understand what health insurance fraud entails, though. With reports estimating health insurance fraud is a billion to over 0 billion industry per year, the topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and its consequences. By doing so, you are more able to recognize and fight fraud.

Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Essentially this means that you assert that you paid for certain medical procedures or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud is to conceal pre-existing conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may think that this is a small issue in comparison to your sister receiving treatment, it is actually very serious to your health insurance company and industry, and will result in fines and possible imprisonment if your are caught.

Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company’s investigation.

Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear – along with the money you have been paying in premiums.

The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember – it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.

Although many people blame health insurance Georgia carriers for the high costs of health insurance, there are many factors outside their control that result in high premium costs. One of the main reasons for high health insurance Georgia plan premiums is insurance fraud. This ends up costing approximately [...]]]> Reasons Why Health Insurance Georgia Policies is so High

Although many people blame health insurance Georgia carriers for the high costs of health insurance, there are many factors outside their control that result in high premium costs. One of the main reasons for high health insurance Georgia plan premiums is insurance fraud. This ends up costing approximately 3% of all health care spending, according to the National Health Care Anti-fraud Association. This means that over 0 million per day is lost to fraud annually. Therefore, each health insurance Georgia carrier has to employ an anti-fraud division, to try to recover their costs. This is also the reason for much of the administrative paperwork required when it comes to health insurance Georgia plans.

The most common type of health insurance fraud is billing for services that were not rendered. Some physicians’ offices will use their current patients’ health insurance Georgia plan information and bill for medical services that were not actually performed. They will then receive payment for these services.

Another common type of fraud when it comes to health insurance Georgia plans is charging insured patients more for the same services than uninsured patients are charged. This is illegal, but many people offer cash discounts to patients who do not have health insurance Georgia coverage. However, be aware that it is legal to provide a discount to a patient with financial hardship and without health insurance Georgia benefits. So it is a fine line that physicians’ offices need to walk.

A third type of fraud is charging for diagnostic tests or medical services that are not really necessary. Apparently, chiropractors are the guiltiest of this particular type of problem. Sometimes, a chiropractor will perform a computerized inclinometry, and bill the health insurance Georgia carrier for this test. However, often this test will not really affect the diagnosis or treatment of the patient. Therefore, it is deemed unnecessary according to medical standards.

One of the worst cases of fraud is when a bogus company advertises and offers health insurance Georgia policies at very low premiums and actually gets people enrolled in a company that has a name very similar to a legal, legitimate health insurance Georgia Company. However, this bogus company ends up not paying any claims or services, and is then impossible to locate. Apparently, from 2002 to 2004, 144 bogus companies like this were investigated. This resulted in a lot of expense. Be sure that you check with the national health insurance company association to make sure that the company you are buying your health insurance Georgia plan from is legitimate and authorized to do business in the state of Georgia.

Many customers are not aware of fraud that is done using their own health insurance Georgia plan because they do not understand how to read their Explanation of Benefits (EOB) paperwork. It would be helpful if consumers read these explanations of benefits carefully and reported any suspicious activity to their health insurance Georgia carrier.

It is very unfortunate that health insurance Georgia carriers have to spend so much time and money trying to uncover and protect them from health insurance fraud. This expense, of course, ends up being passed down to the consumer.