...for Medicare and Medicaid Services Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid, once called the Healthcare Financing Administration was signed into law on July 30, 1965 by President Johnson. The Medicare and Medicaid programs were created under the social security act to provide health insurance to people with disabilities, low income families, people 65 or older, or people with terminally ill disease. Medicare was once the responsibility of Social security administration, and Medicaid was once the responsibility of the Social and Rehabilitative Service Administration until in 1977 the Healthcare financing Administration was created administer both services. What led the production of these two health insurances was the belief in the 1940s that everyone is entitled to health insurance no matter what, but since then health care cost has risen drastically. Many health care providers are reluctant to offer services or the appropriate services to people with this type of insurance because only a set amount is covered and not all expenses are paid for. In America Medicaid and Medicare provide health insurance to millions of people every day, and it would be devastating if they failed and were no more, throughout this essay I will show shocking statics and facts on both of these health services and how they work. It is important for Americans to be knowledgeable on what our country’s health runs on and how financially Medicare and Medicaid affect...
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...Medicare is a national government-sponsored health insurance program in the United States of America. On July 30, 1965, President Lyndon B. Johnson signed Medicare into law in Independence, Missouri. Medicare offers health insurance for Americans aged 65 and older. It also provides health insurance to younger people with disabilities, end-stage renal disease, and ALS. Medicare is the primary insurer for 54 million Americans. Medicare is a single-payer health care program, covering all eligible beneficiaries under a single, publicly financed insurance plan. Government spending on Medicare in 2013 was $583 billion, or 14 percent of the federal budget (Centers for Medicare and Medicaid Services, 2014). Hospitals, healthcare providers, and suppliers participating in the Medicare program must meet minimum health and safety standards. The standards are defined in the Code of Federal Regulations, Title 42. The Centers for Medicare & Medicaid Services (CMS) defines Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that set the standards that health care organizations must meet to begin, and continue participating in Medicare. CMS currently has approved seven accrediting organizations that can accredit a heath care organization as having “deemed status”. The national accrediting organization surveys a health care organization and certifies that they satisfy the health and safety standards component of the Medicare certification (Centers for Medicare & Medicaid Services...
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...Medicare Fraud: The History, Incidence, Costs and Institutional Remedies INTRODUCTION In 1965, President Lyndon B. Johnson signed the Medicare Act into law. The purpose was to provide healthcare to individuals the age of 65 or older or individuals under the age of 65 diagnosed with specific medical conditions (Center for Medicare and Medicaid Services, 2013). The original intent was to provide immediate payment to those providing medical services for the less fortunate. The Medicare Act has since been revised to meet the current needs of the American population as well as the United States economy. In part, these revisions included identifying, combating, establishing punishment (criminal laws) and prevention for Medicare Fraud. This paper will provide a brief overview of the Medicare fraud history, incidence, costs and institutional remedies. MEDICARE FRAUD: HISTORY AND DEFINITION Fraudulent activities against the government were first addressed during the Civil War. The False Claims Act (qui tam statute), also known as the Lincoln Act, was passed during this time frame. The intent was to prevent the Union Army from being a victim of supplier fraud. Citizens were given, “the ability to file suits on behalf of the US government whenever they spotted fraud” (Medicare Fraud Center, 2015). The citizens were rewarded with a portion of the monetary fines (issued to the defendant) for addressing the crime. Currently, similar rewards remain in effect for reporting Medicare...
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...------------------------------------------------- medicare trust fund January 17, 2016 Charles gunter January 17, 2016 Charles gunter In 1965, United States instituted the most influential health program in our history. The Medicare and Medicaid program ensured that the aged, disabled, and poor had access to healthcare. The importance of a healthy society had finally made it to the mainstream and become a part of public policy. In this presentation, we will discuss the Medicare program. The Social Security Administration hosts the program and the “Centers for Medicare & Medicaid Services (CMS), a branch of the Department of Health and Human Services (HHS), is the federal agency that runs the Medicare Program” (Centers for Medicare & Medicaid Services, 2015). To enable these programs to work, funds must be allotted for services. The Medicare Trust Fund is one such vehicle. Currently, although suffering a few hits over the years, the Medicare Trust Fund has expanded and contracted through healthy and unhealthy periods (mostly healthy). Fortunately for the rapidly expanding American elderly population, the current state of the fund is promising. The fund has historically faced challenges and may continue to do so, but policymakers are faced with such a large aging (and voting!) population that the health of Medicare will always be top priority. Many factors that create challenge include fund solvency, fraud, and the growth of the population who fall within Medicare eligibility. Here...
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...National Health Reform - Decreased Cost in Medicare and Medicaid: How Does it Impacts Nursing Home Care in New York State by Vina Aileen Bonner HCA 621 Utica College Fixing medical care and health insurance in the United States has been a public policy concern for about a century. Presidents such as Theodore Roosevelt, Harry S. Truman, John F. Kennedy, Richard Nixon, Jimmy Carter and Bill Clinton focused on the National Health Reform, but only President Barack Obama achieved the health care reform. Health care costs are increasing while the access to health care is declining. The occupationally based health insurance system is greatly stressed. Medicare and Medicaid are consuming more of the federal budget. According to the White House’s budget for U.S. Department of Health and Human Services (HHS), President Obama’s proposal would save nearly $360 billion in Medicare and Medicaid over the next 10 years: $56 billion would come through Medicaid reforms. Medicare is a federal health insurance program providing health care benefits to all Americans age 65 and over. Medicare is a significant part of the reason the national debt is soaring out of control. It is an open-ended program for provided for millions of senior citizens and people with disabilities. Medicare is growing faster than Social Security and more expensive in the next 25 years. Nationally, health care experts believe that as much as third of all health care spending – about $800 billion in...
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...doesn’t have universal health care, we refer to the Medicare and Medicaid system. Medicare is referred to as “the universal health insurance for elderly people” (Barr, 2011, pg.132). Medicare is a federal program that helps all people 65 years or older pay for healthcare. Those who qualify for Social Security benefits are automatically eligible for Medicare (Barr, 2011). When Medicare was passed in 1965, only 56 percent of elderly people have hospital insurance. It was a strong national consensus that none of the elderly in United States should face financial ruins because serious illnesses were seen as a threat to financial security of seniors (Barr, 2011). Due to that reason, Medicare was created to ensure financial stability. Not only does Medicare cover people 65 years and older, but it also covers individuals with certain disabilities, and individuals with End-Stage Renal Disease that requires dialysis or transplant (Medicare.gov). Unlike Medicare, Medicaid was not created as a program for all people who fall below that poverty line. It only covers certain subgroups of poor people (Barr, 2011). Medicaid provides medical benefits to groups of low-income people, some who may have no medical insurance or inadequate medical insurance, health care to children, pregnant women, parents, senior, and individuals with disabilities (Medicaid.gov). Medicare is made up of four different parts: part A, B, C, and D. Medicare part A is a service plan for hospital care. All people eligible...
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...Evolution of Medicaid Genesis65 HCS/310 April 19, 2010 Barbara Sinacori, RN, MSN, CNRN The Evolution of Medicaid Prior to 1965, the poor elderly in the United States were left with little options when it came to accessing and paying for preventative health related services. As a result, many of the poor in the U.S. went without routine health care or treatment for known illnesses. In response to this growing issue, the Federal government, under the direction of President Lyndon B. Johnson and in conjunction with state governments, established the Medicare program on July 30, 1965 through Title XIX of the Social Security Act (Centers for Medicare and Medicaid Services, 2010). Along with passage of the Medicare Bill in 1965, Congress also passed an insurance program known as Medicaid that would provide health care insurance for various groups of disenfranchised U.S. citizens. This paper will briefly discuss the evolution of the Medicaid program and examine how Medicaid has influenced the current health care system in the United States. The ever-rising cost of health insurance has prohibited many businesses from providing health insurance to their workers, effectively leaving millions of Americans uninsured or underinsured. According to the U.S. Census Bureau (2007), “The number of people without health insurance coverage [in the U.S.] rose from 44.8 million (15.3 percent) in 2005 to 47 million (15.8 percent) in 2006.” Medicaid is a program...
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...Health Care System Evolution From the Medicare/Medicaid focus, I will attempt to break this down from the evolution of the old to the influence of the current or present systems. I would further consider the old concepts of supply and demand. Health care is no different. In early health care delivery, there was not much demand because there was not much known. In many instances, patients weren't as educated about healthcare and illnesses to know where to go to seek care. This is evident by the people using home remedies and other alternatives that prevented them from going to the doctor. Research was not available as much to the average patients or their families to educate them about the risk of not receiving treatment for certain conditions. When looking at doctors, they use to be just local folks who happened to be doctors, and they treated many conditions in their local offices without needing to file on Medicare/Medicaid. The people were their neighbors and the doctor and patients knew each other personally. Cost was not associated with this type of care. It was like doing a favor for neighbors and friends. Tools and supplies doctors used back then were less expensive. To make a long story short, there was not much patient care demand nor was there much cost. So there was not as much for Medicare/Medicaid to pay for. Finally, the people running Medicare and Medicaid trusted doctors more. If the doctor it stated it was needed, neither Medicare nor Medicaid...
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...Historical Legislation from 1965: Medicare and Medicaid Liliana Martinez Dr. Smith Grand Canyon University: HCA-460 3/7/13 Historical Legislation from 1965: Medicare and Medicaid The Medicare and Medicaid programs were signed into law on July 30, 1965 by President Lyndon Johnson ("Centers for Medicare," 2012). Before this decision was even taken into consideration, many other healthcare reforms had previously been introduced by earlier presidents, but failed to pass the Senate. Healthcare issues have always been on board for the United States, but during this time the elderly and the poor were desperately screaming for help. The government had no choice but to come up with a solution to their healthcare needs; these two populations were left with no options but to trust the government and their ideas towards solutions. These solutions are called Medicare and Medicaid, which at that time served more than 19 million individuals ("Key milestones in," 2006). After the implementation of these government health programs, almost yearly new premiums were added and adjusted to them. Medicare as previously stated is a government insured program provided for the elderly usually starting at the age of 65 and older along with certain younger people with disabilities. There are four different parts to the Medicare program. Part A deals with hospital insurance, this part helps cover inpatient care in hospitals, hospice, and skilled nursing facilities. The majority of the people...
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...Medicare and Medicaid Reimbursement for Primary Care Introduction The Social Security Act of 1965 created Medicare and Medicaid, which provides health care coverage for the elderly, poor, and disabled. Medicare has become the largest single payer health entity spending $57.9 billion in 1980, $271 billion in 2003, and $513 billion in 2010 (Social Security Administration, 2012). Whereas, Medicaid being state funded, its governance is state-specific for spending. There have been very few changes to The United States health care payment system since Medicare’s and Medicaid’s inception, until March 23, 2010, when President Barac Obama signed into law the Patient Protection and Affordable Care Act (ACA). The three main goals of the ACA are to: increase the access to health care for all Americans, increase their quality of care, and make this care affordable. Unfortunately, despite the ACA’s good intent, its scope was far reaching, glossed over current problems within health care, and created more issues. It is filled with contradictory verbiage that required multiple teams of lawyers to decipher (with many different interpretations), and changed health care reimbursement with unknown consequences. Description of Policy and the Legislation The ACA attempts to solve the reimbursement problems in several ways. The act established the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services, which is responsible for overseeing voluntary...
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...unsustainable growth in health care costs, there is general agreement on the need to eliminate unnecessary spending in health care--and among the leading candidates are fraud and abuse. Despite ongoing, concerted efforts, making meaningful inroads has not been easy."Fraud" refers to illegal activities in which someone gets something of value without having to pay for it or earn it, such as kickbacks or billing for services that were not provided. "Abuse" occurs when a provider or supplier bends rules or doesn't follow good medical practices, resulting in unnecessary costs or improper payments. Examples include the over-use of services or the providing of unnecessary tests. (Another area, "waste," refers to health care that is not effective, and will be the subject of a separate Health Policy Brief.)Endowed with new powers under the Affordable Care Act and the Small Business Jobs Act of 2010, the Centers for Medicare and Medicaid Services (CMS) has been adopting new tools to curb fraud and abuse in the Medicare and Medicaid programs. The new approach amounts to a paradigm shift from the earlier model, in which CMS paid providers first, then sought to chase down fraud and abuse after the fact--a process known as "pay and chase."This policy brief focuses on eliminating fraud and abuse in Medicare and Medicaid and explores the challenges involved in putting the new tools into place. | What's the background? | The true annual cost of fraud and abuse in health care is not known. In fiscal...
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...Health Care Spending in the United States Lisa Patti HCS/440 April 23, 2012 Caryn Callahan Introduction Heath care in the United States is costly and confusing. Many do not follow the facts, policies or cost the government has controlled in health care. This leads to obtaining the incorrect insurance that causes high out of pocket expenses to choosing no health insurance at all. In today’s society many cannot afford health insurance, in 2010 49.9 million people in the United States were without health insurance (Overview of the Uninsured in the United States: A Summary of the 2011 Current Population Survey, 2011). The issues that will be discussed are the level of current nation health care expenditures, whether spending is too much or not enough, where the nation should add or not, and why, and how the public’s health care needs are paid for and financed by various payers. The current level of national healthcare expenditures U.S. health care costs have risen rapidly in the past few years, imposing increased stress on families, businesses, and public budgets. Health spending is increasing more rapidly than the economy and workers' earnings. In recent years, insurance administrative overhead has been rising faster than other components of health spending, while pharmaceutical spending has increased more rapidly than spending on other health care services (The Common Wealth Fund, 2007). The national health care expenditure is a total amount spent in the United States...
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...University of Phoenix Material Health Services and Systems Matrix Choose at least seven services or systems from the following list: • Hospice care • World Health Organization (WHO) • Public health • Rehabilitation center • Department of Health and Human Services (DHHS) • Medicare • Centers for Medicare and Medicaid Services (CMS) • Center for Disease Control (CDC) • Health Maintenance Organization (HMO) • Occupational Safety and Health Administration (OSHA) • Joint Commission on Accreditation of Healthcare Organizations (JCAHO) In the following table, describe each of your choices and explain their functions and roles within the health care field. Your responses should total at least 50–75 words for each choice. |Service or System |Description |Function |Role | |Hospice Care |To care for a person who is in |To manage the pain and symptoms of |To make the patient as comfortable | | |their final stages of an incurable |the patient when other methods are |as possible who is facing the end | | |disease. |no longer working. |of life. | |Public Health |A science, which deals with |To monitor environmental and health|To educate people about the daily | | ...
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...Manazanares HCS 235 May 9, 2011 Ann Teske When entering the field of healthcare, it is highly important to understand specific terms in the industry to be successful. Knowing how certain policies, insurances, and medical care work together is imperative for an individual’s growth. Two major terms that should be looked at and completely defined are Medicare and Medicaid. These two programs supply insurance to millions. It is also significant to understand public health, ambulatory care, long-term care, and what it takes to actually become a physician working in the American medical field. First and foremost what is health? Health is an individuals’ well-being physically, mentally and socially. Improving one’s health and the health of people in same community all around the world is public health. Through education, promotion of healthy living and research for disease and injury prevention, public health is the intent to protect and improve community health. The many achievements of public health in the 20th century have improved the quality of life. There has been an increase in life expectancy, decline in child mortality, and removal and reduction of many transmissible diseases (Turnock, 2004). Public Health has made Americans realize the importance of a healthy lifestyle so illness may be minimized. When an individual does get ill they sometimes see a physician who has been through extensive education and training. Physicians are individuals...
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...determine what parts of the Affordable Care Act can apply to Puerto Rico and the impacting the Medicare, Medicare patient services and employees. Most of the people in the island think that the Affordable Care Act is giving more security and help to address the existing disparities in the healthcare system. With the new Patient Protection & Affordable Care Act, the insurance companies can no longer drop the coverage if one becomes sick, bill individual into bankruptcy because of an annual or lifetime limit, and they will not be able to discriminate against anyone with a pre existing condition. Most of the Medicare and Medicaid community suffers do to the imbalance in our healthcare system this situation affects the quality of care and places a financial strain on the government, individuals and families, employers and employees, and public and private providers. Most of the Medicare beneficiaries have to enroll in the MA program to help them to succeed and receive the adequate treatments without MA to help the disadvantaged seniors on the island, Puerto Rico's elderly citizens will be forced to turn to Mi Salud in larger numbers. Although Mi Salud is scheduled to receive an average of $690 million annually during the next five years, the widening deficit in MA funding is likely to create a net negative impact on federal funding for healthcare in Puerto Rico. The Health care Policies and Issues Ethical concerns and issues The Affordable Care Act (ACA) policies are intended...
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