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Challenges of healthcare fraud in the united states
Challenges of healthcare fraud in the united states
Medicare and Medicaid difference bartleby
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Two of the largest government funded insurance groups are Medicare and Medicaid. Between the two, they service upwards of 40% of the total American population(2010 & 2012, KFF). However, the two programs offer various similarities and differences. Medicare is a federal government-sponsored healthcare program primarily for seniors; Medicaid is for low-income families and is managed by both the state and federal governments. By performing a SWOT analysis on each program, it is possible to compare the two.
Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.
Medicaid is an assistance program. Medical bills are paid from federal, state and local tax funds. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines.
A SWOT analysis is an examination of an organization’s internal strengths and weaknesses, its opportunities for growth and improvement, and the threats the external environment presents to its survival (Harrison, 2010). Generally, the information gathered for the analysis is organized into matrix form, howe...
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...ue to be manageable. Additionally, the Medicaid system leaves much open room for users to commit fraud undetected. Medicare would be a more ideal system if costs were based like those of the Medicaid system; many times the Medicare population are on limited incomes, so small co pays and lower medical costs would be more ideal.
In conclusion, both systems function to serve a large portion of the American population. In order to continue functioning as successful systems, it would be ideal for the systems to merge and offer the best of each to all of the covered population. Additionally, this would eliminate the confusion of the two separate systems, and reduce the need for some users to be covered under both. This would also provide the preliminary support base to offer greater support for the systems. Lastly, it would offer a standardized system across the board.
Michigan also has a Medicaid program that is available to all low-income adults that are permanent residents of Michigan. This Medicaid program is subject to an income and asset test (MDCH, 2014). If the person does not pass the income and asset test, they may still qualify but will have to pay a deductible before benefits would start (MDCH, 2014). This is called the Medicaid “Spend-down” Program (MDCH, 2014).
Medicare and Medicaid are one of important government programs. According to Medicaid.gov site, there are more than 4.6 million low-income seniors enrolled in Medicare and about 8.3 million people that are enrolled in both Medicare and Medicaid. Anyone that enrolled with Medicare and limited income and resources are eligible to get assistance paying for their premiums and out-of-pocket medical expenses from Medicaid. Not only does Medicaid cover additional services, but, services covered by both programs are first paid by Medicare with Medicaid in the difference up to the state’s payment limit (Medicaid.gov, 2015) .
In 1965 President Johnson signed both Medicare and Medicaid programs into law (Nile, 2011). According to Medical news today, “Medicare is a social insurance program that serves more than 44 million enrollees as of 2008” (MediLexicon International Ltd, 2011, para2). It cost about $432 billion or 3.2% of GDP, as of 2007(par2).Medicare is broken down into parts, Part A is hospital Insurance Part B is medical Insurance, and Part D is Medicare prescription drug coverage (medicare.gov). Like we previously stated Medicare is a health insurance for people who are 65 and older, people under 65 with certain disabilities, and people of any age with End- Stage Renal Disease. Medicaid is a joint federal-state program of medical assistance for low income persons (Benefit.gov). It is administered by the Illinois Department of Human Services (DHS) and Illinois Department of Public Aid (IDPA). Medicaid serves about 40 million people as of 2007; it cost $330 billion, or 2.4% of GDP, in 2007.(par.2) “In Illinois you may be eligible for Medicaid if you are a child, pre...
Medicare has four parts A, B, C, and D. Medicare Part A covers inpatient hospitalization, skilled nursing centers, hospice and some home health services. Medicare Part B covers some services not covered by Part A. Typically there is a premium charged for this coverage. Part B Covers medical supplies and outpatient visits. Medicare Part C, also known as Medicare Advantage plans are offered by private insurance companies which are in contract with Medicare. Medicare Part C provides you benefits from Part A, Part B and usually covers prescription drugs. This plan will cover most services. Last is Medicare Part D, Part D is a prescription drug program offered by private insurance companies. Part D allows drug coverage to the original Medicare plan. (Medicare.gov, 2016)
I mentioned Medicare and Medicaid a few paragraphs above. With both of these aid’s being government funded programs, there’s differences between them. Medicare has certain contributors that help others in need pay for their bills. This fund is certainly for elderly people, and people with disabilities. The individuals that are covered by this plan only pay part of the expense out of pocket. While Medicaid is provided through federal and state funds. This type of coverage also helps elders, but helps kids under 19, parents, and parent’s dependent upon their children.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
What is a SWOT analysis? This concept involves assisting businesses to identify their strengths, weaknesses, opportunities and threats. It is often used to analyze an organization and its environment. Businesses find the analysis useful in assisting them to improve their business, establish goals and objectives.
Medicare and Medicaid are two of the United States largest broken systems, which must sustain themselves in order to provide care to their beneficiaries. Both Medicare and Medicaid are funding by a joint effort between the federal government and the local state government. If and when these governments choose to cut funding or reduce spending, Medicare and Medicaid take the biggest hit. Most people see these two benefits as one in the same, two benefits the government takes out of their pay check to help fund health care. While the government does deduct a sum from paychecks everywhere, Medicare and Medicaid are very two very different programs.
1. The two major differences between Medicare and Medicaid are who the plan is provided for and who is in charge of providing each plan. The majority of other differences stem from these two dissimilarities. Medicare is a health insurance plan for people over 65 years of age (also includes a few other smaller groups such as younger children with certain disabilities), while Medicaid is provided for citizens who cannot afford other healthcare insurance plans due to their low income. Because of this, Medicaid pays the providers less, so it is not uncommon that doctors will refuse to take patients who use Medicaid. Medicare, on the other hand, hardly ever negotiates prices, so doctors usually end up receiving what they charge. Medicare is completely
Medicare, established since 1966 is a single payer, national social insurance program administered by the federal government. It applies to those whom are 65 or older, younger people with disabilities, and people with permanent kidney failure. There are 4 parts to Medicare, Part A Hospital Insurance, Part B Medical Insurance, Part C Medicare Advantage Plans, and Part D Prescription Drug Coverage.
Clearly, the Medicaid program is ripe for a major overhaul, a task that the federal government has thus far been unwilling to undertake. I chose this topic because I believe that the Medicaid program can be rescued and revitalized by leadership; otherwise, it is likely to be eroded. Medicaid is a government-sponsored program whose objective is to provide patients with health assistance upon meeting specific criteria. Medicaid is an insurance program that is available for disadvantaged persons, including the elderly, who cannot afford health benefits because of low incomes or other factors. This program is subsidized by government funds and in many instances, will cover the costs of basic medical care as well as specialized testing and supplies. What are the problems with Medicaid and what should be done about them? This paper will look at 6 articles about the economics of Medicaid and analyze what should be done about this problem.
A SWOT analysis is simple exercise that could be implemented on multiple subjects including an individual or a whole corporation. The SWOT analysis is an operational tool for managing change, defining strategic direction and setting realistic goals and objectives according to Simoneaux and Stroud (2011). Discovering new opportunities and manage and eliminate threats that are present in the company and the surrounding market. SWOT is a valuable technique that leads to a better understanding of the strengths, weaknesses, opportunities and treats both internally and externally. The strengths and weakness are to be considered internal factors and opportunities and threats to be e...
Medicaid is an assistance program for low-income people regardless of age. A federally mandated program, Medicaid is run by state and local governments under the established federal guidelines. Income and resource levels are the primary means for each state to determine eligibility with the level varying from state to state. Eligibility is also affected by other factors such as age, whether you are pregnant, if you are blind or have other disabilities, and U.S. citizenship or lawful immigration status. Some states req...
Medicare is a national social insurance program, run by the U.S. federal government since 1966 that promises health insurance for Americans aged 65 and older and younger people with disabilities. Being the nation’s single largest health insurance program, covering a large population for a wide range of health services, Medicare's funding is a fundamental part of it sustainability. Medicare is comprised of several different parts, serving different purposes, some of which require separate funding. In general, people at the age of 65 and older who have been legal residents of the United States for at least 5 years are eligible for Medicare. Same is true with people that have disabilities under 65, if they receive Social Security Disability Insurance benefits. Medicare involves four parts: Part A is hospital insurance. Part B is additional medical insurance, that Part A doesn't cover. Part C health plans, also mostly known as Medicare Advantage, are another way for original Medicare beneficiaries to receive their Part A, B and D benefits. Medicare Part D covers many prescription drugs, some of which are covered by Part B. Medicare is a major operation, not only needing adequate administering but the necessary allocated funds to keep this massive system afloat.
A SWOT analysis is a measure tool to summarize a company’s internal and external aspects. By measuring the company’s strengths, weaknesses, opportunities and threats and looking for improving solutions by using the strengths and opportunities to improve on the weaknesses and take the necessary actions concerning any threats a company can survive in today’s world market.