Centers for Medicare & Medicaid Services

Hospitals nationwide overbilled the Medicare program as much as $25.8 million for providing patients an advanced type of radiation procedure used to treat difficult-to-reach tumors on an outpatient basis.

medicaid.gov

A national group has asked the federal government to extend the deadline for public comment on Florida’s proposed Medicaid changes after a glitch on medicaid.gov prevented submissions.

The Trump administration says many of the organizations that help people enroll in health plans on the federal insurance marketplaces don't provide enough bang for the buck, sometimes costing thousands of dollars to sign up each customer. So it is cutting their funding, some by as much as 90 percent, the government told the groups last week.

Secret Data On Hospital Inspections May Soon Become Public

Apr 18, 2017

The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation's hospitals that put patients' health and safety at risk, under a groundbreaking proposal from federal health officials.

The Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government.

CMS Identifies Hospitals Paid Nearly $1.5B In 2015 Medicare Billing Settlement

Aug 23, 2016

A year after paying nearly $1.5 billion to more than a third of U.S. hospitals to resolve longstanding Medicare billing disputes, the Obama administration has disclosed who got paid.

Study Suggests Federal Standard May Be Thwarting Some Transplant Patients

Jun 7, 2016

For the roughly 15,000 people who need a liver transplant, it’s a waiting game. With demand for donated livers far outstripping supply, patients may spend months or years on a transplant waitlist, their position in the line gradually improving as they get sicker. A recent study suggests that this system may be changing but not necessarily for the better.

Administration Says New Rules For Medicaid Plans Will Improve Service For Enrollees

Apr 26, 2016

The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors.

Bowing to pressure from the hospital industry and Congress, the Obama administration on Wednesday delayed releasing its new hospital quality rating measure just a day before its planned launch.

Feds Say New Abortion Law Can’t Block Clinic Funding

Apr 20, 2016

A key federal health agency on Tuesday notified Florida and other states that they may not ban Medicaid funding for family-planning services at clinics that also offer elective abortions.

Feds Could Block State Ban On Planned Parenthood Money

Apr 4, 2016

A new Florida abortion law seeks to ban Medicaid funding for family-planning services at clinics that also offer elective abortions --- such as clinics run by Planned Parenthood --- but the federal government appears unlikely to allow that part of the law to take effect.

Cigna Profits As Medicare Softens Penalty Policy

Mar 14, 2016
Associated Press

Cigna will get to keep hundreds of millions of dollars in bonus payments for some of its Medicare Advantage plans, despite recently-imposed sanctions for mismanaging those plans in ways that federal officials said threatened seniors’ health and safety.

HealthCare.gov

Consumers shopping on the government's health insurance website should find it easier this year to get basic questions answered about their doctors, medications and costs, according to an internal government document.

GAO: More Oversight Needed Over Medicare Advantage

Oct 1, 2015
General Accountability Office

The federal government needs to increase its oversight over private Medicare health plans to make sure seniors have adequate access to doctors and hospitals, according to a report released this week by congressional auditors.

Medicare Yet To Save Money Through Heralded Medical Payment Model

Sep 14, 2015

A high-profile Medicare experiment pushing doctors and hospitals to join together to operate more efficiently has yet to save the government money, with nearly half of the groups costing more than the government estimated their patients would normally cost, federal records show.

Feds Wary Of State's LIP Plan

Jun 1, 2015

The federal Centers for Medicare & Medicaid Services is wary of approving a state proposal for helping fund hospitals without knowing more about Florida's plan for the future, an official said Friday.

The statement came as the two sides try to work out an agreement on how to fund hospitals under a program known as the Low Income Pool, or LIP. Funding for the program will decline to $1 billion in the 2015-16 budget year, which begins July 1.

Daylina Miller/Health News Florida

Hospital administrators and Democratic lawmakers are still trying to persuade Gov. Rick Scott and the Florida House on an alternative to Medicaid expansion.

A coalition called "A Healthy Florida Works" is urging the lawmakers to accept a revamped proposal from the Florida Senate. They met today at the St. Petersburg Chamber of Commerce.

Senate LIP Plan Added to Federal Proposal

Apr 21, 2015
Agency for Health Care Administration

The state agency responsible for Medicaid submitted a new proposal Monday to the federal government for up to $2.2 billion in health-care funding, but the move might be too late to break a budget impasse.

The new model for the Low Income Pool, or LIP, program closely follows legislation approved by the state Senate earlier this month. LIP, which is largely used to cover the expenses of uninsured, low-income Floridians who show up at hospitals needing treatment, is set to expire June 30.

Georgetown University Health Policy Institute

A plan to provide health care coverage to 800,000 Floridians faces an uphill battle after unanimous approval by the Senate Health Policy Committee.

Nearly 2.5M In FL, 36 Other States Pick Plans on HealthCare.gov

Dec 17, 2014

More than 1 million people selected a health plan during the fourth week of the health law’s open enrollment and nearly 2.5 million have done so since it began Nov. 15, federal officials said Tuesday.

“And this was before an extremely busy weekend,” said Andy Slavitt, principal deputy administrator of the Centers for Medicare & Medicaid Services, which oversees the federal online marketplace used by 37 states.

Tuesday’s report did not include enrollment for the final three days before the Dec. 15 deadline for people to enroll if they want coverage to begin Jan. 1.

Streamlined Marketplace Site Unveiled

Oct 9, 2014
Healthcare.gov

Consumers using the federal healthcare.gov website when open enrollment begins next month should expect a faster website with a shorter application form and features making it easier to use on mobile devices, Obama administration officials said Wednesday.

In a briefing with reporters, they showed off a live version of the updated site and said it has already been used to enroll about 20,000 people.

Still, they did not promise that the website will be glitch-free when it opens for purchases on Nov. 15.

For Autistic Adults, Options Scarce

Sep 23, 2014

It’s getting easier for parents of young children with autism to get insurers to cover a pricey treatment called applied behavioral analysis. Once kids turn 21, however, it’s a different ballgame entirely.

Many states have mandates that require insurers to cover this therapy, but they typically have age caps ranging from 17 to 21, says Katie Keith, research director at the Trimpa Group, a consulting firm that works with autism advocacy groups.

Attempts to have more than 50,000 medically-needy Floridians enroll in the state’s Medicaid managed care program have been scrapped, the News Service of Florida reports.

The state had asked the Centers for Medicare & Medicaid Services to include these individuals in the statewide transition to private insurer oversight of Medicaid’s medical coverage. But the federal government balked at the size of monthly premiums, according to the News Service.

Raising hopes that Medicaid expansion isn't as dead as it seems, U.S. Sen. Bill Nelson told Florida House Democrats on Wednesday that he is working on a solution with federal health officials -- but he wouldn't say what it was.

As The Florida Current reports, Nelson also said the state budget for 2014-15, which is being written right now, could lose $600 million in federal funds if the state doesn't compromise. He said it will be "a real shocker," but didn't elaborate.

Federal agencies are teaming up to improve oversight of nursing homes, a practice that now misses a third of the cases of substandard care, according to Kaiser Health News.

Is FL a Risk to Healthcare.gov?

Feb 26, 2014
The Associated Press

Security experts working for the federal government last fall said two-thirds of state computer systems that were supposed to tap into federal computers to verify personal information for coverage were rated as "high risk" for security problems, the Associated Press reports.

According to a map from the House Committee on Oversight and Government Reform, Florida was one of the states the security experts identified as having a risky connection point.

Federal officials are lengthening a temporary moratorium on new home health care agencies in Miami-Dade and Monroe counties, and have also included Broward County in the ban. As the Miami Herald reports, the six-month ban that starts today is an attempt to deter Medicare and Medicaid fraud. Federal health officials say Miami-Dade has the highest ratio of home health agencies to Medicare beneficiaries and has the biggest payments.

Jason Redmond / AP

It isn't exactly news that hospital bills bear no relation to what products and services actually cost, or the amount that is paid. 

What IS new is the pressure on the  hospital industry to defend its pricing system. On Wednesday, the Obama administration released data showing how much each hospital charges for various types of treatment and contrasts that with how much Medicare actually pays for it.

Data being released by Medicare for the first time allow the public to see just how absurdly inflated most hospital bills have become -- bearing little relationship to what Medicare, Medicaid and private insurers actually pay.

Two medical supply companies, including one based in Boca Raton, may be subpoenaed to testify before Congress to explain why a review of their claims showed that two-thirds or more were improper, McClatchy Newspapers reports.

iStockphoto.com

Instead of cutting payments to Medicare Advantage plans, which have high enrollments in Florida, the Centers for Medicare & Medicaid Services has decided to increase the rate by 3 percent after heavy lobbying, the Associated Press reports.

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