Maximizing Your Health Insurance Benefits: A Consumer's Guide to New and Traditional Plans

Front Cover
Greenwood Publishing Group, 1997 - Business & Economics - 204 pages

A comprehensive guide designed to help consumers understand the American health insurance system so that they can obtain the benefits to which they are entitled. Epstein explains the ins and outs of both new and traditional health insurance plans, including traditional individual and group policies, HMOs and other types of managed care plans, self-funded plans, Medicare, Medicare HMOs, Medigap, long-term care, COBRA, CHAMPUS, and Medical Savings Accounts.

Written by a nationally syndicated columnist, this useful volume also deals with special health insurance issues related to children, adults with special needs, and individuals who may need long-term care. In addition, Epstein provides valuable information for individuals who are in the process of changing jobs or making changes in their marital or family status, choosing a health insurance plan, or arranging long-term care--including placement in a nursing home or an assisted-living facility--for an aging parent. The book has a practical focus with a variety of tables and worksheets to help consumers establish a system for preventing health insurance problems, and for dealing with any health insurance problems that may arise. It also contains answers to common questions about health insurance, and provides a list of organizations that offer detailed information and advice in regard to specific health insurance problems.

 

What people are saying - Write a review

User Review - Flag as inappropriate

Brookline Doctor MAD DOG MILLIONAIRE a.k.a. Punyamurtula Kishore MD Pleads Guilty, Sentenced to Jail and Ordered to Pay $9.3 Million for Running Medicaid Kickback and False Billing Scheme
Dr. MAD DOG
to Surrender Medical License, Sentenced to House of Correction
BOSTON – A Brookline doctor MAD DOG MILLIONAIRE a.k.a. Punyamurtula Kishore MD has pleaded guilty, was sentenced to jail, and has been ordered to pay $9.3 million in restitution for running an intricate Medicaid fraud scheme involving millions of dollars in taxpayer funds, Attorney General Maura Healey announced today.
Dr. Punyamurtula Kishore, 64, along with his company Preventive Medicine Associates, Inc. (PMA), pleaded guilty on Monday in Suffolk Superior Court. PMA pleaded guilty to charges of Medicaid Kickbacks (8 counts), Medicaid False Claims (19 counts) and Larceny over $250 (11 counts). Dr. Kishore pleaded guilty to one count of Larceny over $250.
“Dr. Kishore orchestrated a complex kickback scheme to funnel a lucrative drug screening business to his laboratories and then billed taxpayers millions of dollars for those services,” AG Healey said. “This case exhibited blatant theft of state funds that were supposed to go toward care for some of our most vulnerable residents. This is fraud that undermines the integrity of our health care system.”
Today, Superior Court Judge Janet Sanders sentenced Kishore to 360 days in the House of Correction, with 11 months to serve and the balance suspended for 10 years. As a condition to his sentence, Kishore has also agreed to surrender his medical license. Judge Sanders also ordered Kishore and PMA to pay, jointly and severally, a total of $9.3 million in restitution.
Dr. Kishore previously owned and managed PMA, a network of 29 medical branches throughout Massachusetts, including physician office laboratories and one independent clinical laboratory. Based on the AG’s investigation, Dr. Kishore used bribes, or kickbacks, to induce sober house owners to send their residents’ urine drug screening business to his laboratories for testing. Residents were typically screened three times per week.
A urine drug screen may be billed to MassHealth by a physician if the screen is medically necessary. Drug screens generally are billed to the MassHealth program for approximately $100 to $200. Dr. Kishore manipulated his business relationships with sober house owners to illegally obtain tens of thousands of drug screens paid for by MassHealth for sober house residents who were never treated by PMA providers.
In September 2011, Dr. Kishore and PMA were indicted, and individually charged with Medicaid Kickbacks (8 counts), and Medicaid False Claims (8 counts). In November 2013, Dr. Kishore and PMA were indicted on additional charges of Medicaid False Claims (11 counts) and Larceny over $250 (11 counts) for billing MassHealth for millions of dollars in drug screens using the names of PMA physicians and nurse practitioners who were not actually treating the patients or determining the drug screens to be medically necessary. State regulations require that the services must be medically necessary and the provider must be physically present and actively involved in the treatment of the member.
Two other individuals previously pleaded guilty to one count of Medicaid Kickbacks in connection with their involvement in Dr. Kishore’s scheme to defraud MassHealth. In June 2012, Damion Smith, 42, of New Jersey, president of Fresh Start Recovery Coalition, was sentenced to two years in the House of Correction suspended for two years with probation. Carl Smith, 69, of Dorchester, manager of New Horizon House, pleaded guilty in January 2015 and was sentenced to two years in the House of Correction suspended for two years with probation.
The case against Thomas Leonard of Malden, the part owner and manager of the Marshall House, a sober house located in Malden, is ongoing. John Coughlin of Carver, president of Gianna’s House Inc., which operates several sober houses located in Wareham, New Bedford
 

Selected pages

Contents

THE BASIC TOOLS
7
HEALTH INSURANCE PLANS
65
MEDICARE AND MEDICARERELATED PROGRAMS
113
SPECIALIZED SITUATIONS
137
The Future of Health Insurance in America
173
Ten Frequently Asked Questions about Health Insurance
177
Sources of Information and Advice on Specific Health Insurance Problems
185
GLOSSARY
193
INDEX
201
Copyright

Common terms and phrases

Popular passages

Page 14 - CHAMPUS The Civilian Health and Medical Program of the Uniformed Services, a federally funded health insurance program for the dependents of active-duty and retired US military personnel.
Page 9 - While it's not necessary to read the chapters in this book in the order in which they're presented, Part I (Chapters 1 , 2, and 3) serves as an introduction to technical terms and general issues.

About the author (1997)

RICHARD EPSTEIN writes a nationally syndicated newspaper column, Insurance TroubleShooter, as well as a health insurance column for Exceptional Parent Magazine. With a BA degree from Brooklyn College, a masters from the New School for Social Research, and additional post-graduate work at the New School and at Columbia University, Epstein began researching the health insurance maze 15 years ago, when his spinal arthritis became so severe that he required an electric wheelchair for mobility. He found that many of the rules that insurance companies followed seemed illogical and, at times, almost incomprehensible.

Bibliographic information