It is the height of the hunger season in Sudan and the violence that has engulfed South Kordofan is hindering WFP’s efforts to reach hundreds of thousands of people in need of food assistance. As the security situation in South Kordofan state deteriorates, I would like to echo the UN Secretary General’s deep concern about the escalation in the conflict.

The Assurant Employee Benefits dental plan which is the brand name for prepaid (or DHMO) dental products provided by United Dental Care of Arizona. This dental plan offers individual and family dental benefits with attractive prepayment fees for you, your spouse and dependent children as defined by state law. * There are no deductibles and no yearly limits on services, and there are no claim forms to fill out. Your savings are in place when you visit a network dentist. You just show up for your dental appointment and make your payment – what could be easier? The dentists must meet the Plan’s standard of quality and service. All have agreed to provide dental care at an affordable price to its members. Since there is no waiting period for your dental services to begin, pre-existing dental conditions are covered and best of all, the dental plan services starts on the first day of next month if the application is received by the dental plan on or before the 20th of this month. Review the sample schedule and see how easy it is for you or your entire family to enjoy these quality dental services.

The United Nations World Food Programme (WFP) has delivered vital food assistance to more than 500,000 people affected by the conflict in Libya. The agency has provided food for civilians in conflict areas, internally displaced people, migrant workers, and vulnerable groups such as widows, orphans and the disabled.

On the 14 June, the United States (US) and the European Union (EU) met to discuss cooperation and collaboration on development assistance in the second US-EU High Level Consultative Group Meeting since the 2009 re-launch of the US-EU Development Dialogue.

Thousands of children in Africa are experiencing violence, exploitation and abuse on a daily basis. The situation is especially stark for children living and working on the streets.

It’s considered a rite of passage among young people – acting out their independence through heavy, episodic drinking. But a new University of Cincinnati study, the first of its kind nationally, is showing how binge drinking among adolescents and young adults could be causing serious damage to a brain that’s still under development at this age.

Marijuana is the most prevalent illicit drug used by teenagers and adults around the world. Nearly a third of high school students in the United States report smoking it, and most high schoolers say they have access to the drug. To many people, smoking pot is no big deal. They cite reasons such as: “it isn’t dangerous or addictive” and “everybody is doing it.

To combat a reported $60 billion lost to waste, fraud and abuse within the Medicare system, a bi-partisan group of U.S. senators and representatives led by Senators Mark Kirk (R-IL) and Ron Widen (D-OR) have introduced legislation to use existing “smart card” technology to protect Medicare beneficiaries. The Smart Card Alliance strongly supports the new Medicare Common Access Card Act of 2011 (S. 1551 and H.R. 2925).

Today’s USA Today newspaper has a prominent article on the Senior Medicare Patrol (SMP) program and the contribution of volunteers nationwide. Since 1997, over 68,000 SMP volunteers have educated 9.2 million people about Medicare fraud, received 87,000 complaints from beneficiaries, and saved Medicare and Medicaid $105.9 million.

Our California SMP program is also highlighted.

The California HealthCare Foundation (CHCF) has put together a series of 6 short, under 5-minute videos on what changes to expect from the Affordable Care Act in the next 2 years.

Some highlights of the changes happening by 2014 include:

• Government-funded health insurance (Medi-Cal) will expand to cover 2 to 3 million more Californians who can’t afford their own insurance today.
• No one will be able to be denied coverage by an insurance company for having preexisting conditions, or for any other reason.
• All Americans will be required to have health coverage, either through their work, through a public program, or by buying it on their own.
• Businesses will have to offer adequate coverage to their employees or pay a penalty if those workers end up using government-supported coverage. Small employers with mostly low-wage workers will be eligible for subsidies.
• State health insurance exchanges will help consumers shop for policies. Exchanges will help people learn if they are eligible for government-supported health care (like Medi-Cal) or subsidies to help pay for private coverage.

Watch the 6 short videos on the CHCFwebsite. The videos include:

1. An Overview
2. Insurance Market Reforms
3. Medicaid Expansion
4. New Employer Responsibilities
5. New Individual Responsibilities
6. Health Insurance Exchange

See our Health Care Reform section for information on how health reform affects Medicare.

Have you heard about last week’s arrests in a historic takedown by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Strike Force? This takedown happened in 8 cities and has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing. This is the highest amount of false Medicare billings in a single takedown in the HEAT Strike Force history.

Read the Department of Health and Human Services’ press release for more info.

Here are some highlights from the release:

• The schemes involved a variety of services, including: home health care, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment (DME).
• The fraudulent practices included submitting claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.
• Locations of those arrested include: Baton Rouge, LA; Brooklyn, NY; Chicago, IL; Dallas, TX; Detroit, MI; Houston, TX; Miami, FL; and Los Angeles, CA.

See our Medicare Fraud section for more info on common fraud schemes, and how to detect, report and prevent it.

Those interested in volunteering to put an end to fraud, check out our Senior Medicare Patrol (SMP) program. We are currently accepting new volunteers.

The National Hispanic Senior Medicare Patrol (NHSMP) has launched a new outreach and communications campaign, which includes a Spanish language public service announcement (PSA).  The PSA is currently being aired in South Florida through mid-September.

The PSA, titled El Fraude al Medicare es un Delito. Denúncielo. (Medicare Fraud is a Crime. Report It.), is part of the NHSMP’s Spanish language communications toolkit.  It was developed based on a needs assessment conducted to gauge the perceptions of the community and understand why they were underreporting Medicare fraud. NHSMP found that although a majority of seniors could identify Medicare fraud, they didn’t know how to report it or felt overwhelmed by their lack of English skills to communicate effectively.

The PSA is posted on Youtube. We encourage you to share it, post it on your webpage and help get the word out on how to stop and prevent Medicare fraud and abuse. For additional Spanish resources, see the available educational outreach and communications tools on the NHSMP webpage. You can also see our Medicare Fraud resources section for additional Spanish materials.

A provision in the 2010 federal health care reform law calls for changes in Medigap policies that essentially shift the burden of health care costs more onto the hands of beneficiaries. Several members in Congress have come to the unsubstantiated conclusion that because some Medigap plans (the most popular ones, C and F) cover most of the costs Medicare doesn’t — hence this insurance is referred to as MediGAP, beneficiaries use more services than they need. Therefore, they claim that Medicare pays more health care costs for these beneficiaries than others. To to help reduce these costs and hence the federal deficit, Congress has asked the National Association of Insurance Commissioners (NAIC) to propose changes to these Medigap plans so that beneficiaries pay more out-of-pocket for their health care.  The Congressional Budget Office estimated in March that such changes could save the government $53 billion in Medicare spending over a decade by strengthening incentives “for more prudent use of medical services.”

Yet despite this request, as written in the health care reform law, an unlikely group of health insurance regulators, insurers and consumer advocates are raising opposition to these Medigap changes. In several interviews with reporters, Bonnie Burns, our Training and Policy Specialist who also serves on the NAIC, points out some substantial flaws or blind spots in Congress’ thinking. First, she strongly questions the idea that beneficiaries need an incentive not to use services. After all, physicians are the ones who order services, not the beneficiaries. Also, although some studies have found that seniors with Medigap policies use more Medicare services, they may be sicker than the average Medicare beneficiary, which is why they bought Medigap coverage in the first place.

“To suggest that Medicare beneficiaries overutilize services on a whim because they don’t have ‘skin in the game,’ is pretty disturbing,” says Burns, as quoted in a recent article on Kaiser Health News.

Second, Mary Beth Senkewicz, Florida’s deputy insurance commissioner, who chairs the NAIC’s senior issues committee, which includes the Medigap group, questions the legality of making changes that apply to Medigap policies beneficiaries have already purchased. The policies are contracts between the insurer and the beneficiary which contain certain promises of coverage. When state regulators require changes in insurance, those typically apply to future policies only, not to existing ones as well.

Similar to Burns’ point of Medicare beneficiaries not being directly responsible for their higher health costs noted above, several members of this group have also suggested that Medigap policies are not responsible for Medicare’s growing costs. These carriers, the Medigap plans, only pay for services that Medicare deems to be medically necessary. Those determinations are not made by the Medigap insurance company.

In Conclusion

Some of Congress’ proposed Medigap changes dramatically shift costs onto seniors, leaving members of diverse interest groups concerned for good reasons. Medigap insurance has long been a product that has worked well for many benficiaires, currently 7 million, which comprise about 1/6 of the population with Original Medicare. These policies have helped maintain beneficiaries’ peace of mind, knowing that they have coverage for the gaps in Medicare. Putting this coverage in jeapordy may not be the best or even a mediocre move to help save some money to help the federal budget deficit, especially when savings aren’t even a guaranteed outcome.

For more information on this issue, see the following articles:

• Changes to Medigap Plans Meet Resistance
• Lawmakers Propose Cuts to Medicare and Medigap Coverage

Did you know that by calling a special 1-800 number you may qualify to receive $500 from the American Opportunity Act?  By providing your Social Security number, date of birth and other personal information, in just 4 weeks you will receive a Visa Check card ready to be loaded with money.  Sound too good to be true?  Well it is!

Scam artists are continually misusing real information in an effort to steal beneficiaries’ money and their personal information.  There is no program called the American Opportunity Act that just gives away money.  But as part of the American Recovery and Reinvestment Act, parents and students can qualify under the American Opportunity Tax Credit to pay for college expenses.

We encourage people to never give their personal information out to strangers.  This type of information is used to not only commit identity theft but also to commit medical identity theft as well as stealing money from the health care system in the form of Medicare fraud. To learn more about our California SMP and how you can prevent Medicare fraud and abuse, see our Medicare Fraud section.

In October, we wrote to you about contract talks between Express Scripts, the company that manages the drug store network for us, and Walgreens.  We’re writing today with an update so that you have the very latest news affecting your clients. Despite ongoing talks, it appears the two parties won’t reach an agreement before the end of the year. Absent a last minute agreement, Walgreens will leave the network on January 1, 2012.

We will send one more mailing to employers by email and to members that have used Walgreens within the last 90 days. This mailing urges members to take action to move their prescriptions to another in-network pharmacy before December 31, 2011.

Last week Julie Schoen, our California Senior Medicare Patrol (SMP) Project Director, spoke on Medicare fraud on a statewide press teleconference hosted by California’s Department of Managed Health Care (DMHC). Both agencies, DMHC and SMP, are committed to protecting beneficiairies from the sometimes malicious and fraudulent practices of a few insurance agents. While most agents may be trustworthy, DMHC has reports of several who are trying to persuade seniors to switch from their current health plan to the Medicare Advantage (MA) plan they are selling even though it is not in their best interest, and sometimes even without their consent.

DMHC put together a helpful 2-page consumer alert (PDF) that summarizes 7 red flags to watch out for when being approached by an insurance agent, and 10 actions to take before signing up for any new health plan. See Medicare Fraud for more info on fraud. Also see Medicare’s Fall Open Enrollment to learn about your rights to switch MA and Part D plans or return to Original Medicare during Oct 15 through Dec 7.