HEALTH TRAIN EXPRESS
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Wednesday, June 10, 2015
The Impact of Aging on the HCFA, HHS, and CMS
Older Americans with five or more chronic conditions incurred an average of $5,300 in prescription drug costs in 2008, compared to $1,230 for those with no chronic conditions.MORE STATISTICS
20 percent of total U.S. population — The population of Americans age 65 and over in 2030 is projected to be 20 percent of the total U.S. population (72 million), compared to 13 percent in 2010.
One in six beneficiaries under 65 qualified for Medicare on the basis of permanent disability — One in six beneficiaries qualified for Medicare coverage in 2011 before turning 65 on the basis of permanent disability.
65 percent in HMO plans — Sixty-five percent of Medicare Advantage enrollees are in health maintenance organization (HMO) plans, followed by local preferred provider organizations (PPOs) and regional PPOs, 21 percent and 7 percent, respectively.
17 percent of adults aged 55 to 64 reported having unmet needs or delayed care — Medicare seniors reported similar rates of unmet needs or delayed care (8%) to adults aged 55 to 64 with private insurance plans (17%).
SUMMARY For the first half of FY 2012, we reported expected recoveries of about $1.2 billion consisting of
$483.1 million in audit receivables and $748 million in investigative receivables (which includes
$136.6 million in non-HHS investigative receivables resulting from our work in areas such as the
States’ shares of Medicaid restitution).
We reported exclusions of 1,264 individuals and entities from participation in Federal health care
programs; 388 criminal actions against individuals or entities that engaged in crimes against HHS
programs; and 164 civil actions, which include false claims and unjust-enrichment lawsuits filed in
Federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries
related to provider self-disclosure matters. Following are highlights of some of the significant
problems, abuses, deficiencies, activities, and investigative outcomes that are included in the
Semiannual Report for the first half of FY 2012.
Health Care Fraud Prevention
About 10 percent of money returned to the Medicare Trust Funds — About 10 percent of the $20.6 billion obtained from people or organizations that committed Medicare fraud and returned to the Medicare Trust Funds since 1997 was returned in 2011.
15 percent of Medicare household budgets — In 2010, health expenses accounted for nearly 15 percent of household budgets for Medicare beneficiaries, on average – three times more than non-Medicare households.