The MetLife Study of Elder Financial Abuse

Crimes of Occasion, Desperation, and Predation Against America's Elders

The study is a follow-up of MetLife's 2009 "Broken Trust: Elders, Family, and Finances" and examines the prevalence and impact of elder financial abuse in America today. It demonstrates how these crimes continue to decimate incomes, impact the health and well-being of its victims, and fracture families. Yet it still is underreported, under-recognized, and under-prosecuted.

Key Findings:

• Instances of fraud perpetrated by strangers comprised 51% of articles related to elder financial abuse, followed by family, friends, and neighbors (34%), the business sector (12%), and Medicare and Medicaid fraud (4%).
• Medicare and Medicaid fraud resulted in the highest average loss per case in that category.
• Women were twice as likely as men to be victims of elder financial abuse, with most being between the ages of 80 and 89, living alone, and requiring some level of help with either health care or home maintenance.
• Nearly 60% of perpetrators were men, mostly between the ages of 30 and 59.
• Dollar losses over the holidays due to family, friends, and neighbor perpetrators were overall higher than any other category due to number of instances, although the highest average dollar loss per individual was from business perpetrators.

Methodology:

Data on elder financial abuse were obtained by examining articles from the National Center on Elder Abuse (NCEA) newsfeed gathered from April through June 2010 to compare it with the data in the 2009 MetLife Broken Trust Study. Data were also gathered between November 2010 and January 2011 to examine the impact of the holiday period on elder financial abuse. This newsfeed database tracks media reports of all types of elder abuse through Google and Yahoo alerts, which scanned billions of pages.

Source:http://www.metlife.com/mmi/research/elder-financial-abuse.html#methodology

Medical testing companies' Medicare deal scrutinized

Researchers also fear doctors may be ordering tests that don't need to be performed so they can receive kickbacks from insurers.

Sens. Max Baucus, D-Mont., and Chuck Grassley, R-Iowa, have asked five major health care companies — Cigna, Laboratory Corp. of America, Aetna,UnitedHealth Group and Quest Diagnostics— to send copies of lab service agreements, contract information and corporate communications, including documents provided in recent court cases relating to the practice.

Baucus is the committee chairman and Grassley its ranking Republican.

Cigna and UnitedHealth said they have received the letters and are reviewing them, and the other companies have informed Grassley's office they have also received the letters.

"We treat such requests seriously, and plan to cooperate," Quest spokeswoman Wendy Bost said.

Called "pull-through," laboratories sign contracts with insurers offering extremely low rates for a medical test in exchange for the insurers verbally agreeing that their physicians will send all of their Medicare and Medicaid cases to those laboratories.

Earlier this month, the state of California settled with Quest for $241 million and LabCorp for $49 million after a whistle-blower lawsuit accused Quest of charging California's Medicaid five times more per test than it did other customers. A similar case in New Yorkis under appeal after a judge dismissed the case because a plaintiff released confidential information.

"The inspector general has raised a flag and recent court cases raise concerns," Grassley told USA TODAY.

Andrew Baker, a whistle-blower who refused to participate in the alleged practice and eventually lost his business, said the issue needs to be raised to the national level.

"The practice is blatant manipulation of Medicare to grow your market," Baker said. "We're talking billions of dollars per year."

The senators said they had looked into the California and New York lawsuits. In the meantime, there had been several reports, including from the Department of Health and Human Services inspector general and MedPac, showing the companies had been overpaid.

"The procedures given to Medicare and Medicaid beneficiaries should not be influenced by improper relationships between labs and insurance companies," Baucus said.

Baker said both the insurance companies and the labs pressured doctors to send their lab work, and that doctors received kickbacks. The labs made more money off the Medicaid and Medicare cases because the government pays a fixed rate, and because those patients usually need more lab work than do privately insured patients because Medicare patients are older. Baker said he wrote a letter to his clients saying he would not participate, and for that, he lost his job. Quest later bought Baker's company, Unilab.

Last month, Baucus and Grassley released another committee investigation that said home health care companies were unfairly manipulating the Medicare system to increase their billings.

By Kelly Kennedy, USA TODAY

http://www.usatoday.com/money/industries/health/story/2011-11-10/medicare-fraud-probe/51159336/1

Pfizer, Humana form research pact on elderly health

(Reuters) - Pfizer Inc has formed a partnership with health insurer Humana Inc to research ways to improve healthcare for the elderly.

The five-year partnership, announced on Thursday, will focus initially on three chronic conditions: pain, cardiovascular disease and Alzheimer's disease.

Humana is one of the largest providers of plans under Medicare, the U.S. government health plan for the elderly. Pfizer is the world's largest drugmaker.

The companies cited U.S. Census projections showing that over the next 10 years the Medicare-eligible population is expected to grow to 65 million -- a 36 percent increase from 2010. The collaboration also could evolve beyond seniors in the longer term, the companies said.

The companies will seek "to develop an important body of knowledge" to advance their work, said William Fleming, vice president of Humana Pharmacy Solutions.

The companies will seek to study prescription drug use and how it affects areas such as cost and quality of care and patient outcomes, Fleming said.

One result, he said, could be that it affects how Humana designs its benefit and coverage plans or develops programs to influence how seniors take their medications.

James Harnett, Pfizer's senior director of U.S. health economics and outcomes research, said the information generated through the partnership could influence decisions about the company's development products.

MetLife's Market Survey

Costs for long-term care varies quite a bit throughout the state and even from provider to provider in the same community.  MetLife stopped selling long-term care insurance beginning in 2011 although it continues to service its existing policies.  MetLife continues to conduct a market survey.

 

For those of you interested, MetLife issued its 2011 Market Survey of Long-Term Care Costs, which is found athttp://www.metlife.com/mmi/research/2011-market-survey-long-term-care-costs.html#findings.  It indicates the following about National and Missouri's costs:

 

The national average daily rate for a private room in a nursing home rose 4.4% from $229 in 2010 to $239 in 2011 ($205 to $214 for semi private).

    Missouri average of a private room daily rate is $160 -- Kansas City area average, $157; St. Louis area average, $186; and rest of state, $186.

    Missouri average of a semi-private room daily rate is $141--Kansas City area average, $144; St. Louis area average, $194; and rest of state, $132

The national average monthly base rate in an assisted living community rose 5.6% from $3,293 in 2010 to $3,477 in 2011.

    Missouri's assisted living facilities are licensed as residential care facilities and assisted living facilities.

    Missouri's average monthly base rate is $3,490--Kansas City area average, $3,398; St. Louis area average, $4,289; and rest of state, $3,050.

The national average daily rate for adult day services rose 4.5% from $67 in 2010 to $70 in 2011.

    Missouri's average daily rate for adult day services is $70--Kansas City area average, $69; St. Louis, $72; and rest of state, $69.

     

The national average hourly rates for home health aides ($21) and homemakers ($19) were unchanged from 2010.

    Missouri's average hourly rate for home health aides is $19 and homemakers ($19)--Kansas City area average, $19 and $18; St. Louis,