Medicare

Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing "almost impossible," he says.

Campbell, 58, spends $4,000 a month on home health care services so he can continue to live in his home just outside Los Angeles. Eight years ago, he was diagnosed with amyotrophic lateral sclerosis, or Lou Gehrig's disease, which relentlessly attacks the nerve cells in his brain and spinal cord and has no cure.

A politically prominent Florida eye doctor asked a judge for mercy Thursday as prosecutors pushed for a 30-year sentence on his conviction for Medicare fraud.

As the federal government penalizes 751 hospitals for having too many infections and patient injuries, some states are feeling the cuts in Medicare payments more than others.

HI Flickr / Flickr

Either Dr. Salomon Melgen is one of the biggest Medicare swindlers ever, stealing more than $100 million from the federal health care program, or a penny ante thief who walked off with $64,000.

Lawmakers Eye Financial 'Hit' In Disabilities Program

Dec 8, 2017

One of Gov. Rick Scott's priorities after taking office in 2011 was to resolve a longstanding deficit in the Medicaid “waiver” program that serves people with developmental disabilities.

Closing arguments are scheduled in the sentencing hearing of a politically connected Florida eye doctor convicted of stealing $100 million from Medicare, one of the largest individual thefts in the program's history.

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A federal judge heard wildly conflicting stories Tuesday about a prominent Florida eye doctor convicted in a $100 million Medicare fraud scheme. Some former patients said Dr. Salomon Melgen restored their sight for free, while others described painful and unnecessary treatments that left them blind.

Cheap Health Insurance / Flickr

Older or disabled Americans with Medicare coverage have probably noticed an uptick in mail solicitations from health insurance companies, which can mean only one thing: It’s time for the annual Medicare open enrollment.

Kaiser Health News

Medicare paid at least $1.5 billion over a decade to replace seven types of defective heart devices, a government watchdog says. The devices apparently failed for thousands of senior patients.

Orlando Sentinel

Medicare launched a website aimed at helping families choose a hospice — but experts say it doesn’t help very much.

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Agency For Health Care Administration

A Florida health care administrator accepted bribes in exchange for helping a nursing home owner accused of orchestrating a $1 billion Medicare and Medicaid fraud scheme keep his license, federal prosecutors said.

Kaiser Health News

United Healthcare Services Inc., which runs the nation’s largest private Medicare Advantage insurance plan, concealed hundreds of complaints of enrollment fraud and other misconduct from federal officials as part of a scheme to collect bonus payments it didn’t deserve, a newly unsealed whistleblower lawsuit alleges.

Court Rejects Appeal In Medicare Advantage Dispute

Jul 20, 2017
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An appeals court Wednesday rejected arguments that an arbitrator could have been biased in a dispute involving an insurance firm's attempt to receive $24 million in damages from UnitedHealthcare.

Wikimedia Commons

House Democrats are calling foul on Republican assertions that cuts to a little-known discount drug program will eventually reduce skyrocketing drug prices.

Nursing Homes Move Into The Insurance Business

Jul 13, 2017

Around the country, a handful of nursing home companies have begun selling their own private Medicare insurance policies, pledging close coordination and promising to give clinicians more authority to decide what treatments they will cover for each patient.

Double-Booked: When Surgeons Operate On Two Patients At Once

Jul 12, 2017
The University of Arkansas

The controversial practice has been standard in many teaching hospitals for decades, its safety and ethics largely unquestioned and its existence unknown to those most affected: people undergoing surgery.

But over the past two years, the issue of overlapping surgery — in which a doctor operates on two patients in different rooms during the same time period — has ignited an impassioned debate in the medical community, attracted scrutiny by the powerful Senate Finance Committee that oversees Medicare and Medicaid, and prompted some hospitals, including the University of Virginia’s, to circumscribe the practice.

When Sol Shipotow enrolled in a new Medicare Advantage health plan earlier this year, he expected to keep the doctor who treats his serious eye condition.

"That turned out not to be so," said Shipotow, 83, who lives in Bensalem, Pa.

Shipotow said he had to scramble to get back onto a health plan that he could afford and that his longtime eye specialist would accept. "You have to really understand your policy," he said. "I thought it was the same coverage."

Senate Republicans would cut Medicaid, end penalties for people not buying insurance and erase a raft of tax increases as part of their long-awaited plan to scuttle President Barack Obama's health care law, congressional aides and lobbyists say.

Each year, thousands of Americans miss their deadline to enroll in Medicare, and federal officials and consumer advocates worry that many of them mistakenly think they don't need to sign up because they have purchased insurance on the Affordable Care Act's marketplaces. That failure to enroll on time can leave them facing a lifetime of penalties.

Hospitals Appeal Ruling On Outpatient Payments

May 23, 2017
Wikimedia Commons

Dozens of hospitals across the state have appealed an administrative law judge's decision in a dispute about reimbursement rates for outpatient care of Medicaid beneficiaries.

Medicare Failed To Investigate Suspicious Infection Cases

May 11, 2017
Lottie Watts/WUSF / WUSF

Almost 100 hospitals reported suspicious data on dangerous infections to Medicare officials, but the agency did not follow up or examine any of the cases in depth, according to a report by the Health and Human Services inspector general’s office.

Almost 100 hospitals reported suspicious data on dangerous infections to Centers for Medicare & Medicaid Services officials, but the agency did not follow up or examine any of the cases in depth, according to a report by the Health and Human Services inspector general's office.

Most hospitals report how many infections strike patients during treatment, meaning the infections are likely contracted inside the facility. Each year, Medicare is supposed to review up to 200 cases in which hospitals report suspicious infection-tracking results.

Drug Coverage Denied By Medicare? How Seniors Can Fight Back

May 4, 2017
Getty

Kenneth Buss had taken Xarelto, a blood thinner, for more than a year when his mail-order pharmacy refused a request to refill his prescription several weeks ago.

mnfoundations / Flickr

Federal prosecutors argued Tuesday that a prominent Florida eye doctor tied to alleged political corruption ran a practice that was actually a well-organized scam that stole millions from Medicare.

Eye Doctor Tied To Political Corruption Portrayed As Caring

Apr 19, 2017
mnfoundations / Flickr

Attorneys for a prominent Florida eye doctor tied to corruption charges against New Jersey Sen. Bob Menendez are presenting witnesses who say he is an innovative physician who doesn't give up on his patients.

Sen. Grassley Demands Scrutiny Of Medicare Advantage Plans

Apr 19, 2017
Bill Clark/CQ Roll Call

Sen. Chuck Grassley (R-Iowa) wants federal health officials to tighten scrutiny of private Medicare Advantage health plans amid ongoing concern that insurers overbill the government by billions of dollars every year.

New Data Shows Medicaid Expansion Is Paying Off

Apr 13, 2017
www.healthcare.gov

Although the GOP-controlled Congress is pledging its continued interest — despite stalls and snags — to dismantle Obamacare, some “red state” legislatures are changing course and showing a newfound interest in embracing the health law’s Medicaid expansion.

For years, Republicans in Congress have promised to repeal and replace the Affordable Care Act, claiming that its requirement for nearly everyone to buy insurance or pay a fine is burdensome and costly, and it doesn't give people enough flexibility to get the coverage they need.

Florida is among one of the nation's top states in recovering money from health care providers suspected of Medicaid fraud.

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