Report Says Probe Indicates Health Insures may have Fleeced Taxpayers out of $70 Billion

(NATIONAL) -- A year-long investigation by the Center for Public Integrity has revealed that health insurers may have fleeced taxpayers out of $70 billion in just five years.

The report is posted on the Center's website by reporter Wendall Potter who says taxpayers should not assume their elected lawmakers in Washington will be outraged or even launching a federal probe about this.

Potter:

"You would think members of Congress in both parties would be so outraged they'd be launching their own investigation and railing against the "fraud and abuse" they decry on the campaign trail.

But I'm not holding out much hope. That's because I know just how powerful and influential the health insurance industry is and how its lobbyists almost always get what they want out of Congress and the White House, regardless of who is sitting in the Oval Office."

The Center's investigation called the "Medicare Advantage Money Grab" found here discovered that:

- Federal officials made nearly $70 billion in "improper" payments to Medicare Advantage plans from 2008 to 2013, mostly over-billings, by manipulating or misusing a Medicare payment tool called a "risk score."

- From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for people in standard Medicare in more than 500 counties nationwide.

- Federal health officials have long kept key financial records of Medicare Advantage plans in a "black box," inaccessible to the public and press.

- Medicare Advantage health plans collect billions of dollars from controversial "house calls" that industry officials say help improve care but which critics argue inflate costs needlessly.

Reporter Potter says the findings didn't come as a shock to him because during his two decades in the industry, at both Humana and Cigna, "I came to understand just how much of a cash cow the Medicare Advantage program has become to insurers participating in the program. Wall Street financial analysts devote considerable attention to determining how much insurers' Medicare Advantage business contributes to their bottom lines and how much of the money they take in from the government is actually paid out in medical claims. The less they spend on medical care, the better, from Wall Street's perspective."

Potter adds this is a huge business and one that is growing rapidly and because the business is so profitable, insurers spend millions of dollars on lobbying, advertising, PR and "grassroots" political activities to keep the money flowing unimpeded.

If you are looking for a way to save tax for 2013, try the medical expense tax credit. This can save you tax dollars, but the calculations are often tedious. Start working on your claim well before April 30.

How much tax can you save? For example, suppose you have a net income of $50,000. What amount of medical expenses would you need to make a worthwhile claim? You'd need at least $1,500 in medical expenses to reach your three per cent threshold before any tax credits can be claimed at all.

Generally, for every $100 of medical expenses in excess of three per cent of your net income you can save $26 (using Saskatchewan rates) for 2013. Assume your medical expenses were $2,500 in total for 2013. Having $1,000 of expenses that exceed your $1,500 threshold means you'd save $260 tax.

If you only have $1,550 of medical expenses, with only $50 over the threshold, you'd save $13, which may not make the effort worthwhile, especially if you are paying an accountant by the hour.

Definitions what qualifies as a medical expense? Do an online search for "CRA medical expenses." You will find a web page listing 116 headings, ranging from attendant care to wheelchairs.

Eyeglasses count. Dental work counts, but not teeth whitening. Claim prescription drugs, but don't claim vitamins or supplements. Rehabilitative therapy is eligible. Fitness club fees are not eligible.

Did you pay for private health insurance coverage in 2013? That includes health insurance for out-of-country travel. Claim your premiums as a medical expense. Did your employer provide group health insurance such as a dental plan? When your employer provides such non-taxable benefits you cannot claim the premiums as a medical expense. Employees can only claim employee paid premiums. Check Box 85 of your T4 slip.

Similarly, retirees should check box 135 of their T4A slips for health insurance premiums deducted from employer pension payments.

Review your dental and health insurance claim forms. For each medical service listed, deduct the amount of reimbursement from the total cost. Claim only the unreimbursed portion as a medical expense on your tax return.

Medical travel costs Do you reside in a rural area, with no medical practitioners located within 40 kilometres of home? You can claim the cost of travelling to obtain treatment. Click on the "travel expenses" link on the CRA webpage. Use the simplified method to claim 45.5 cents per kilometre for trips starting in Saskatchewan.

To support your claim, list the dates of your trips and treatment locations. Describe the service (dental or physiotherapy, for example). State the medical practitioner's name. State the distance for each round trip. Claim $17 per meal and parking receipts if you had to travel at least 80 kilometres (each way) from your home.

Did you obtain treatment outside of Canada? Keep receipts for the medical service, travel and hotel costs. Convert receipt amounts to Canadian dollars.

Did you move into an assisted living retirement home because you had difficulty with daily living activities? If you are eligible for the disability tax credit, then limited amount of attendant care costs, such as food preparation, housecleaning and laundry services can be claimed as a medical expense. Your retirement home should provide a receipt breaking down rent into eligible and non-eligible services.

What if your employment income was so low in 2013 that you don't need to claim any medical expenses to eliminate tax owing? For example, suppose you had $10,000 of wages and paid $5,000 for dental work. Claim those medical expenses. You can receive a $1,142 tax refund because of the Refundable Medical Expense Supplement.

Terry McBride, a member of Advocis, works with Raymond James Ltd. (RJL). The views of the author do not necessarily reflect those of Raymond James Ltd. (RJL). Information is from sources believed reliable but cannot be guaranteed. This is provided for information only.

Securities offered through Raymond James Ltd., member of the Canadian Investor Protection Fund. Insurance services offered through Raymond James Financial Planning Ltd., not a member of the Canadian Investor Protection Fund.