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Medicare Nation

How much would you pay out-of-pocket for a five day hospital stay on Medicare? The majority of people have no idea! The problem with Medicare is there is too much information. An overwhelming amount of information and not enough resources. Medicare Nation solves that problem by educating you on all things Medicare, because there are not enough resources out there! This podcast will educate you about the components of Medicare, the different categories of Medicare Plans and Medicare benefits. On other episodes I’ll interview expert guests in the health and wellness field, about diseases, Medicare issues and current changes to the Medicare program. Medicare Nation is dedicated to answering all your questions about Medicare. Expert information and insights regarding Medicare and you! Further information can be found on www.TheMedicareNation.com Don't Forget to SUBSCRIBE to the show! Give us feedback on Facebook! www.facebook.com/MedicareNation
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Now displaying: May, 2020
May 29, 2020

Hey Medicare Nation!

Medicare Nation

CMS Imposes a Civil Money Penalty against HUMANA!

CMS conducted an "Audit" of Humana's Medicare Operations from June 3, 2019 through June 21, 2019.

Humana failed to comply with Medicare requirements related to Part D formulary and benefit administration and coverage derterminations, appeals, and grievances in violation of 42 C.F.R. Part 423, Subparts C and M.

Humana's failures in these areas were systemic and adversely affected, or had the substantial likelihood of adversely affecting, enrollees.

CMS provided notice to Humana's CEO, Mr. Bruce Broussard, on February 28, 2020, that CMS imposed a Civil Money Penalty in the amount of ........

$257, 262!

Humana failed to properly administer the CMS "transition" policy. This means if you are enrolling in a new plan, and you take a prescription that is NOT on the new plan's formulary (drug list), the plan MUST allow you to "transition" by allowing you a 31 day supply of your prescription drug. 

This allows you time to speak with your doctor to see if there is an alternative prescription drug on the new plan ...... or......

you can request a "Formulary Exception."

This means your doctor is requiring you to take this medication, because it is the one that is stablizing or correcting your condition, and that you need to continue to take it.

If the drug is NOT on the new plan's formulary and they Approve the formulary exception, you WILL be charged a higher amount for taking a drug that is not on their formulary.

Humana has the right to appeal the decision by requesting a hearing.

The notice is signed by John Scott, Acting Director of the Medicare Parts C and D Oversight and Enforcement Group.

Medicare Nation

NEXT CMS Penalty is given notice to.........

SOLIS Health Plans out of Miami, Florida

On December 4, 2019, CMS gave notice to Mr. Daniel Hernandez - CEO of Solis Health Plans.

CMS imposed a CIVIL MONEY PENALTY of

$41,552.00!

CMS stated in their summary that Agents employed by SOLIS engaged in an aggressive marketing campaign that was conducted by a contractor provider clinic.

Solis Agents conducted a marketing presentation in a secluded area and enroll patients upon conclusion of the presentation.

CMS determined that Solis violated the communication and marketing requirements, which had the substantial likelihood of adversely affecting its enrollees.

Solis Failed to oversee and manage the marketing process to ensure its agents and brokers did not engage in inappropriate marketing practices including "misleading" beneficiaries.

Solis may request a hearing to appeal CMS's determination.

Both notices are signed by John Scott, acting director of the Medicare parts C and D Oversight and Enforcement Group.

Thank you for listening to Medicare Nation!

If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out!

If you have any questions, send them to Support@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

Diane Daniels

 

 

May 15, 2020

Hey Medicare Nation!

Medicare Nation

Today, I'm informing you about The Centers For Medicare & Medicaid Services Notice, given to Mr. Art Carlos, CEO of Delaware Life Insurance Company.

In a notice dated January 31, 2020, CMS notified Mr. Carlos that they were immediately imposing Intermediate "Sanctions" against Delaware Life Insurance Company.

CMS determined that Delaware Life Insurance Company is "in substantial violation of Medicare Advantage and Prescription Drug Plan requirements."

SIX specific violations were listed in the notice to Carlos.

LISTEN to the episode to learn about the violations and what you can do if YOU are a beneficiary under one of Delaware Life Insurance Company's Medicare Advantage Plan or Prescription Drug Plan.

www.TheMedicareNation.com

Thank you for listening to Medicare Nation!

If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation!

If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out!

If you have any questions, send them to Support@TheMedicareNation.com

If I can answer it in one email - I will personally answer you!

If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner.

Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show!

Thanks again for listening!

Diane Daniels

Medicare Consultant

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