Medicare and Medicaid Law
Medicare is part of the Federal Government's Social Security Division and provides all United States citizens 65 years of age or older with long term care as well as coverage for the disabled. Eligibility is determined by various criteria set forth in the programs' policies. Whereas Medicaid, a federal and state program, ensures that individuals with lower incomes have access to health care. The criteria for Eligibility varies from state to state.
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State Medicaid Plan
Medicare and Medicaid Law - US
- Affordable Care Act
On March 23, 2010, President Obama signed into law the Affordable Care Act. The law puts into place comprehensive health insurance reforms that will hold insurance companies more accountable and will lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.
- Center for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. CMS is the federal agency that administers the Medicare program and monitors the Medicaid programs offered by each state.
- Conditions of Participation (CoPs) and Conditions for Coverage (CfCs)
CMS develops Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These minimum health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries. CMS also ensures that the standards of accrediting organizations recognized by CMS (through a process called "deeming") meet or exceed the Medicare standards set forth in the CoPs / CfCs.
- Department of Health and Human Services (HHS)
The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
- Medicaid - Overview
Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy – and stay healthy. Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services.
- Medicaid Insurance - Definition
Medicaid is the United States health program for eligible individuals and families with low incomes and resources. It is a means tested program that is jointly funded by the state and federal governments, and is managed by the states. Among the groups of people served by Medicaid are certain eligible U.S. citizens and resident aliens, including low-income adults and their children, and people with certain disabilities. Poverty alone does not necessarily qualify an individual for Medicaid. Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States.
- Medicare Insurance - Definition
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria. The program also funds residency training programs for the vast majority of physicians in the United States. Medicare operates as a single-payer health care system.
- My Medicare - United States Government
MyMedicare.gov is part of the Medicare.gov web site. MyMedicare.gov is an optional, free, and secure site designed to help you check the status of your eligibility, enrollment, and other Medicare benefits. It also allows you to access your claims information almost immediately after it is processed by Medicare and provides you with preventive health information 24 hours a day, seven days a week.
- Patient Protection and Affordable Care Act
This is the major health care reform bill, signed into law by President Obama on March 23, 2010. It would expand health care coverage to 31 million currently uninsured Americans through a combination of cost controls, subsidies and mandates. It is estimated to cost $848 billion over a 10 year period, but would be fully offset by new taxes and revenues and would actually reduce the deficit by $131 billion over the same period.
- Social Security Administration
We deliver services through a nationwide network of over 1,400 offices that include regional offices, field offices, card centers, teleservice centers, processing centers, hearing offices, the Appeals Council, and our State and territorial partners, the Disability Determination Services. We also have a presence in U.S. embassies around the globe. For the public, we are the “face of the government.” The rich diversity of our employees mirrors the public we serve.
- Social Security Law - Medicare
Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.
Organizations Related to Medicare and Medicaid Law
- American Seniors Association
Known nationally as "the conservative alternative to the AARP," the American Seniors Association works hard to fulfill its mission to provide seniors with the choices, information, and services they need to live healthier, wealthier lives. Our members' dignity and security matter most to us, and that's why thousands of Americans every year turn to the American Seniors Association for the help they need.
- National Association of State Medicaid Directors (NASMD)
The National Association of State Medicaid Directors (NASMD) is a bipartisan, professional, nonprofit organization of representatives of state Medicaid agencies (including the District of Columbia and the territories). Since 1979, NASMD has been affiliated with the American Public Human Services Association (APHSA). The primary purposes of NASMD are: to serve as a focal point of communication between the states and the federal government, and to provide an information network among the states on issues pertinent to the Medicaid program.
- National Family Caregivers Association
The National Family Caregivers Association educates, supports, empowers and speaks up for the more than 65 million Americans who care for loved ones with a chronic illness or disability or the frailties of old age. NFCA reaches across the boundaries of diagnoses, relationships and life stages to help transform family caregivers' lives by removing barriers to health and well being.
Articles on HG.org Related to Medicare and Medicaid Law
- Whistleblower Failure-of-Care Claim Settled for $38 MillionRecently, a whistleblower failure-of-care claim was settled against a nursing home chain for $38 million. Even nursing home abuse can be stopped with whistleblowing.
- Seven False Claims Act Lawsuits Settled for $98 MillionSeven whistleblower suits against Community Health Systems and associated entities was settled in August for $98 million.
- Medicare Conditional Payments Claimants Can Now File Private Cause of Action LawsuitsPrimary plan employers or carriers have to pay damages to both Medicare and individual lawsuits for failure to pay conditional payments.
- Three Convictions in Medicare Fraud CaseA federal jury recently convicted three people on charges related to Medicare fraud. The fraud took place during the time frame of 2006 - 2011. The defendants in the case operated a durable medical goods company out of the Los Angeles area.
- Health Care Industry the Target in Whistleblower LawsuitsThe United States Department of Justice has provided the public with some information regarding recent whistleblower cases. In one of the cases there have been allegations made against Health Management Associates.
- California Medical Equipment Supplier Found Guilty in $11 Million Medicare Fraud CaseThe owner of a California durable medical equipment firm was recently found guilty of Medicare fraud. The scheme resulted in more than $11 million dollars in fraudulent Medicare charges. Los Angeles false claims attorneys say that Medicare fraud is a problem that is continuing to grow, at the expense of taxpayers.
- What are Medicare and Medicaid and How Does One Qualify?Many of us have heard of Medicare and Medicaid, but never really understood what they were. Who is eligible for this coverage? What does it cover? Does it cost anything?
- How to Avoid Becoming the Victim of Medicare, Medicaid, or Healthcare Related FraudThe senior population in this country continues to grow, presenting even more viable targets for Medicare, Medicaid and other healthcare related frauds. As it stands now, this type of fraud costs the government billions of dollars each year. Help yourself avoid becoming a victim by learning what types of scams are out there, as well as what steps to take to avoid being victimized.
- The False Claims Act – Application of the Lincoln Law to the Health Care IndustryThe False Claims Act was originally focused on the defense industry during the Civil War. It was later expanded during the defense industry scandals of the 1980s. Now, the law is being applied liberally in the health care industry with very severe potential consequences for health care providers.
- Medical Director Compensation and ComplianceCompensation to medical directors has become a 'hot-button" compliance issue. If not properly structured and monitored, a medical director arrangement can become a major compliance problem. Health care attorney John Fisher discussed some of the recent cases addressing medical director compensation and what they mean to health care providers.
- All Health Care and Social Law Articles
Articles written by attorneys and experts worldwide discussing legal aspects related to Health Care and Social including: defective drugs, failure to diagnose, informed consent, medical law, medical malpractice, medication errors, pharmaceutical law, social security, social services law, surgical errors.