Medicare Policy Summary

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Medicare Part A Mrs. Zwick has all three parts of Medicare. With part A Medicare will pay for the days she was in the hospital. She was admitted into the hospital and was there for five days. According to the official U.S. Government site for Medicare, “Medicare part A (Hospital Insurance) covers a semi private room, meals, general nursing and other services and supplies. This includes the care you get in an acute care hospital, a critical access hospital, inpatient rehabilitation facilities, long term care hospitals, inpatient care as part of a qualifying clinical research study and inpatient mental health care.” (2012) With Medicare A you can stay in the hospital up to 90 days for each benefit period. “A benefit period begins when…show more content…
COBRA generally requires that group health plans sponsored by employers with 20 or more employers in the prior year offer employees and their families the opportunity for a temporary extension of health coverage under the plan (called continuous coverage) in certain instances where coverage would otherwise end.”(Health plans) Mr. Davis would be allowed to continue his coverage with COBRA because the falls under the guidelines stated above. He was terminated from a factory job where he was covered by a group health insurance and the factory has more than 100 employees. That qualifies him for…show more content…
“Fraud and the abuse of healthcare services in the U.S. cost an estimate $125-$175 billion annually. This represents the second largest component of the 600-850 billion surpluses in healthcare spending. Examples of fraud and abuse range from intentional misrepresentation of services that result in higher payments, billing of unperformed services, the deliberate delivery of unnecessary and inappropriate services for the express purpose of receiving the payment.”(Foster, 2012) The high cost of frauds is affecting patients because they are being exposed to unnecessary test and procedures. Because of the high cost of frauds the patients that really need help, like Mr. Davis, ends up suffering due to diminished quality of care. They also may be targeted as a people that are frauding the government because of all the medical attention they need. People with chronic conditions are always at the doctors or needing some kind of procedures done. It is very difficult for the government to decipher whose claims are fraudulent and whose are real. The government needs to unite with the insurance executives and come up with a plan and a program to investigate frauds and recover some of the money that has been given out. If the government and the insurance executives work together they would be able to get a lot accomplished. The government can set regulations that will alert the insurance
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