guam medicare

Guam’s participation in the federal Consumer Assistance Program grant was completed in October 2012, but Guam continues to provide assistance to consumers with health insurance questions or problems. See below for a state-specific list of approved Medicaid and CHIP SPAs.

TTY: 1(877) 486-2048. Two owners of Guam Medical Transport (GMT) were sentenced to prison terms today for their roles in a health care fraud and money laundering scheme that resulted in a loss to the United States of approximately $10.8 million, one of the largest single Medicare ambulance fraud cases ever prosecuted by the Justice Department. Top Cities in GU: Dededo (1) Tamuning (1) All Cities in GU. The new consumer protections and benefits of the Affordable Care Act still apply to you.

Guam Medicare Advantage Prescription Drug Plans The plans below offer Medicare Advantage Prescription Drug plan coverage to Guam residents.

If you have questions about your health insurance that are not covered by the above resources, call the Health Insurance Assistance Team of the U.S. Center for Consumer Information and Insurance Oversight at (888) 393-2789. 1055 East Colorado Blvd, Suite 200 If you have questions about insurance you bought for yourself and/or your family or you have insurance provided by an employer who does business only in Guam, contact: Guam Department of Insurance

Guam has elected to operate a title XXI funded Medicaid Expansion program.

Pasadena, CA 91106

From January 1, 2014 to December 31, 2015 there is a temporary 2.2% FMAP increase for all Medicaid enrollees, bringing Guam’s FMAP to 57.2%. The Fraud Section leads the Medicare Fraud Strike Force.

Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for approximately $19 billion.

The statutory FMAP local matching rate increased from 50%/ 50% to 55% federal /45% local, effective July 1, 2011.

An official website of the United States government.

The Medicaid program in Guam differs from Medicaid programs operating in each of the 50 states and the District of Columbia. It is a 100% fee-for-service delivery system with one hospital currently servicing the territory.

Judge Tydingco-Gatewood also ordered the defendants to pay $10,884,964.49 in restitution and to forfeit the same amount.

A federal government website managed and paid for by the U.S. Centers for Medicare & More information about waivers is available on the Waivers page. There are no deductibles or co-payments under the Guam Medicaid program. If you have a hard time affording health coverage and you have questions about eligibility for Medicaid or current Medicaid benefits, go to: Guam Department of Public Health and Social Services Phone: (671) 735-7224/7302 Fax: (671) 734-6860 According to their admissions at the plea hearing, from approximately March 11, 2010, to approximately March 21, 2014, the defendants engaged in a conspiracy to defraud Medicare and TRICARE by submitting claims for reimbursement for medically unnecessary ambulance services that GMT provided to patients with ESRD.

Unlike the 50 states and the District of Columbia, where the federal government will match all Medicaid expenditures at the appropriate federal matching assistance percentage (FMAP) rate for that state, in Guam, the FMAP is applied until the Medicaid ceiling funds and the Affordable Care Act available funds are exhausted. As part of the scheme, the defendants directed GMT employees to remove from internal documents references to GMT patients’ ability to walk because they knew that Medicare and TRICARE would not provide reimbursement for the patients.

The year 2020 marks the 150th anniversary of the Department of Justice. If you have a hard time affording health coverage and you have questions about eligibility for Medicaid or current Medicaid benefits, go to: Guam Department of Public Health and Social Services They then caused these expenses to be falsely categorized as business expenses of GMT, thereby improperly reducing GMT’s taxable income and GMT’s corresponding tax liability, they admitted. The state Medicaid and CHIP plans spell out how each state has chosen to design its program within the broad requirements for federal funding. Like Medicaid, CHIP is administered by the states, but is jointly funded by the federal government and states.

Through Section 1108 of the Social Security Act (SSA), each territory is provided base funding to serve their Medicaid populations. Room 238 Specifically, the defendants admitted they were aware that many of GMT’s patients were not bed-confined, and did not have acute medical conditions that would otherwise qualify them for ambulance transportation. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

States have choices in their approach to delivery system design under the Medicaid and CHIP programs. It is a 100% fee-for-service delivery system with one hospital currently servicing the territory. Secure .gov websites use HTTPS

Phone: (671) 635-1817

Currently, Guam has no demonstrations or waivers. Guam Memorial Hospital Authority Acute Care Hospital (Medicare Certified) Location: 85o Gov Carlos G Camacho Road, Tamuning, Guam 96913 Ratings:NA Phone: (671) 647-2552 . If you are a veteran and have a question or concern about veterans’ health care benefits, go to: US Department of Veterans Affairshttp://www1.va.gov/health/(877) 222-VETS (8387).

The defendants further admitted to conspiring to engage in money transactions involving the proceeds of their health care fraud scheme.


GMF, Guam 96921 1240 Route 16 Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Shawn N. Anderson of the Districts of Guam and the Northern Mariana Islands, Special Agent in Charge Eli S. Miranda of the FBI’s Honolulu Field Office, Special Agent in Charge Justin Campbell of IRS Criminal Investigation (IRS-CI) Seattle Field Office and Special Agent in Charge Timothy DeFrancesca of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) Los Angeles Regional Office made the announcement.

Phone: (671) 735-7224/7302 A lock (LockA locked padlock) or https:// means you’ve safely connected to the .gov website.

There are no deductibles or co-payments under the Guam Medicaid program. Fax: (626) 229-1098http://www.dol.gov/ebsa/consumer_info_health.html.

Guam must exhaust its Affordable Care Act (Section 2005) allotment prior to using these funds.

The agencies listed below can help you take advantage of some of these new protections and benefits and they can answer your questions about different types of coverage. This case was investigated by the FBI, IRS and HHS-OIG.

Currently, Guam has no online Medicaid/CHIP application. The defendants admitted they were aware that GMT was transporting patients who did not qualify for ambulance transportation under applicable Medicare and TRICARE regulations and guidelines, with which they had failed to familiarize themselves.

The conspiracy resulted in improper payments to GMT of approximately $10.8 million, the defendants admitted.

The Affordable Care Act included many new opportunities for states to augment and improve their Medicaid and CHIP programs.

According to court documents, GMT submitted claims to Medicare totalling approximately $32 million during the course of the scheme. Learn more about the history of our agency at www.Justice.gov/Celebrating150Years. At this time, Guam is 100% fee-for-service (FFS) and does not offer managed care services to its beneficiaries. The Children’s Health Insurance Program was established in 1997 to provide new coverage opportunities for children in families with incomes too high to qualify for Medicaid, but who cannot afford private coverage. Los Angeles Regional Office Bureau of Health Care Financing Administration

If you need health insurance, be sure to check out HealthCare.gov’s Plan Finder. P.O. States are increasingly moving to the use of managed care and other integrated care models in serving their Medicaid beneficiaries. Medicaid Services. Fax: (671) 633-2643. Senior Litigation Counsel John A. Michelich and Trial Attorney Michael McCarthy of the Criminal Division’s Fraud Section and First Assistant U.S. Attorney Marivic David of the District of Guam and the Northern Mariana Islands prosecuted the case. Guam Regional Medical City Acute Care Hospital (Medicare Certified) Location: 133 Route 3, Dededo, Guam 96929 Ratings:NA Phone: (671) 645-5500 .

123 Chalan Kareta, Mangilao GU 96913

Guam became a territory in 1950 and its Medicaid program was established in 1975. Demonstration and waivers are vehicles states can use to test new or existing ways to deliver and pay for health care services in Medicaid and CHIP. U.S. District Judge Frances Tydingco-Gatewood of the District of Guam sentenced Clifford P. Shoemake, 63, of Guam, and Kimberly Clyde “Casey” Conner, 60, of Saipan, to serve 71 and 63 months, respectively, in federal prison in connection with their Oct. 29, 2019, guilty pleas to one count of conspiracy to commit health care fraud and one count of conspiracy to engage in monetary transactions with the proceeds of specified unlawful activity.

An official website of the United States government.

If you are not eligible for Medicaid, your child may still be eligible for the Children’s Health Insurance Program. Barrigada, Guam 96913 Mailing Address: P.O. Official websites use .gov
If you have a question, complaint, or dispute regarding insurance you get through a “self-insured” employer (typically a large company or one with locations in multiple states or countries), go to: U.S. Department of LaborEmployee Benefits Security Administration A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, Medicaid Beneficiaries with Complex Care Needs and High Costs, Community Integration Through Long-Term Services and Supports, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Lawfully Residing Immigrant Children & Pregnant Women, Home & Community Based Services Authorities, June 2020 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Expenditure Reporting for Medicaid & CHIP, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, Medicaid Enterprise Certification Toolkit, Medicaid Eligibility & Enrollment Toolkit, SUPPORT Act Provider Capacity Demonstration, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Medicaid MAGI & CHIP Application Processing Time. Guam became a territory in 1950 and its Medicaid program was established in 1975.

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