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Medicare plan fraud may hit seniors harder than expected

Prospective Medicare recipients in the Urban and Dental Health Plan (UH/DPD) program may face greater and more difficult time keeping up with health insurance costs before dementia coverage eventually kicks in.

The potential fraud is only among Medicare recipients admitted to the Demographic and Health Data Exchange, a program that counts who enrolls in the federally-funded plan. This potential diagnosis might not be detected until later years of life because the rate of prescriptive symptoms is one of the indicators Medicare uses to provide benefit information to Medicare beneficiaries aged 66 or older. Medicare does not study whether any dementia symptoms might precede dementia. The study only enrolled patients with hospital-acquired and non-hospital-acquired acute conditions.

In the latest issue of JAMA Otolaryngology-Head & Neck Surgery, researchers compared the rates of diagnosed and denied geriatric conditions among Medicare beneficiaries undergoing major surgeries at a participating medical center versus 51,978 Medicare beneficiaries of similar political persuasion.

The researchers found:

“Although our study findings diversify the demographic and behavioral characteristics targeted in programs that use Medicare data, the prevalence of dental erythroplasia and of a lack of oral capacity among Medicare beneficiaries is similar among hospital-acquired and non-hospital-acquired aged individuals,” said M. Loretta Best, M.D., an associate professor of otolaryngology at UCLA and the study’s senior author.

The research is the first to assess dental erythroplasia and dental dysfunction in the U.S. Medicare population, and it suggests that preventive measures that date past about 5 years, might not be sufficient.

Best said that although its data are low, she and her colleagues will continue the study over the next several years. “I think it’s critical to conduct a large longitudinal study that for patients,” she said.

She noted further that dental erythroplasia and dysfunctions in various patient populations and in different geographic locations, possibly across different time lines of the entire lifetime of disease progression, are also areas where studies could look into, through examining other groups of individuals.

“We need further research to further understand why they exist in the first place, what could be done to address them, and the impact they might have on the individual and the system,” Best said.

She said she hopes the findings will help dentistry, cardiology, and other health benefits at large who might not be able to afford and process dental examinations.

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