Medicare

Six years ago, federal health officials were confident they could save taxpayers hundreds of millions of dollars annually by auditing private Medicare Advantage insurance plans that allegedly overcharged the government for medical services.

An initial round of audits found that Medicare had potentially overpaid five of the health plans $128 million in 2007 alone, according to confidential government documents released recently in response to a public records request and lawsuit.

The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties.

The punishments come in the third year of Medicare penalties for hospitals with patients most frequently suffering from potentially avoidable complications, including various types of infections, blood clots, bed sores and falls. This year the government also examined the prevalence of two types of bacteria resistant to drugs.

Latest Hospital Injury Penalties Include Crackdown On Antibiotic Resistant Germs

Dec 22, 2016

The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties.

Sohrab Gollogly

Five years ago, Dr. Ira Kirschenbaum, an orthopedic surgeon in the Bronx who replaces more than 200 knees each year, would have considered it crazy to send a patient home the same day as a knee replacement operation.

When Cindy Hunter received her Medicare card in the mail last spring, she said she "didn't know a lot about Medicare." She and her husband, retired teachers who live in a Philadelphia suburb, decided she didn't need it because she shared his retiree health insurance, which covered her treatment for ovarian cancer.

.S. Department of Health and Human Services

There's less than a week left in the Annual Election Period for Floridians enrolled in Medicare to change their plans.

President-elect Donald Trump unveiled two big health care decisions Tuesday.

Hospitals have long been reluctant to share with patients their assessments of which nursing homes are best because of a Medicare requirement that patients' choices can't be restricted.

For years, many hospitals simply have given patients a list of all the skilled nursing facilities near where they live and told them which ones have room for a new patient. Patients have rarely been told which homes have poor quality ratings from Medicare or a history of public health violations, according to researchers and patient advocates.

President-elect Donald Trump and House Speaker Paul Ryan agree that repealing the Affordable Care Act and replacing it with some other health insurance system is a top priority.

But they disagree on whether overhauling Medicare should be part of that plan. Medicare is the government-run health system for people age 65 and older and the disabled.

Trump said little about Medicare during his campaign, other than to promise that he wouldn't cut it.

Ryan, on the other hand, has Medicare in his sights.

The number of doctors who each prescribe millions of dollars of medications annually in Medicare's drug program has soared, driven by expensive hepatitis C treatments and rising drug prices overall, federal data obtained by ProPublica show.

The number of providers who topped the $5 million mark for prescriptions increased more than tenfold, from 41 in 2011 to 514 in 2015. The number of prescribers — mostly physicians but also nurse practitioners — exceeding $10 million in drug costs jumped from two to 70 over the same time period, according to the data.

p1 lawyer / Flickr

A fall 2017 trial date is set for a South Florida businessman accused of orchestrating a $1 billion Medicare and Medicaid fraud scheme.

Kaiser Health News

Changing the way it does business, Medicare on Friday unveiled a far-reaching overhaul of how it pays doctors and other clinicians.

Seniors who like their Medicare choice this year, shouldn't assume it will be the same next year.

A doctor in your network this year could be out of network next year. The same goes for a prescription drug that is covered this year.

Seniors who aren't comparison shopping during Medicare open enrollment, could see their costs increase.

Colleen Krepstekies with the AARP says her agency can connect seniors to organizations that can help them navigate the enrollment process.

WellCare

WellCare Health Plans, Inc., one of the largest public companies and one of the largest employers in Tampa Bay, has signed an agreement that expands its footprint in Arizona’s Medicaid and Medicare markets, according to the Tampa Bay Business Journal.

Drew Makepeace / Flickr

A majority of Americans favor government action to restrain prescription drug prices, according to a poll released Thursday.

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.

Medicare’s Readmission Penalties Hit New High

Aug 3, 2016

The federal government’s penalties on hospitals will reach a new high as Medicare withholds more than half a billion dollars in payments over the next year, records released Tuesday show.

Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans

Jul 27, 2016
Kaiser Health News

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.

Kaiser Health News

Despite objections from Congress and the hospital industry, the Obama administration said it will soon publish star ratings summing up the quality of 3,662 hospitals. Nearly half will be rated as average, and hospitals that serve the poor will not score as well overall as will other hospitals, according to government figures released Thursday.

Appeals Court Rules Against St. Pete Nursing Home In Medicare Fight

Jul 12, 2016
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A federal appeals court Monday said a bankruptcy judge did not have the authority to block health officials from cutting off Medicare and Medicaid payments to a Florida nursing home that was alleged to have violated patient-care regulations.

More Than 100 Charged In Florida In Health Care Fraud

Jun 22, 2016
U.S. Department of Justice

In what the U.S. Department of Justice described as an "unprecedented nationwide sweep," more than 100 people in Florida have been charged with crimes related to Medicare and Medicaid fraud, the federal agency announced Wednesday. 

A program that has helped seniors understand the many intricacies of Medicare, as well as save them millions of dollars, would be eliminated by a budget bill overwhelmingly approved last week by the powerful Senate Appropriations Committee.

Medicare Releases Draft Proposal For Patient Observation Notice

Jun 15, 2016

In just two months, a federal law kicks in requiring hospitals to tell their Medicare patients if they have not been formally admitted and why. But some physician, hospital and consumer representatives say a notice drafted by Medicare for hospitals to use may not do the job.

Younger people may not realize it, but seniors know well that Medicare doesn't cover all health-related needs and expenses. Many Medicare beneficiaries have some kind of supplemental insurance that partly covers the gaps. But those policies mainly provide financial protection for the patient's share of costs for regular doctor visits and hospital care covered by Medicare. Until 2006, Medicare didn't cover prescription drugs.

Some things that Medicare doesn't cover:

Demand for long-term care is expected to increase as the nation ages, but the majority of Americans 40 and older lack confidence in their ability to pay for it.

Elderly Book End-Of-Life Talks Once Labeled 'Death Panels'

May 23, 2016

The doctor got right down to business after Herbert Diamond bounded in. A single green form before her, she had some questions for the agile 88-year-old: about comas and ventilators, about feeding tubes and CPR, about intense and irreversible suffering.

Healthcare spending for some services dropped by nearly a third when people turned 65 and switched from private insurance to Medicare, according to a recent study. The decline was driven by lower prices paid by the Medicare program to doctors and other providers rather than a drop-off in the volume of services seniors receive.

A diabetes prevention program being tested by the YMCA of the USA has proved successful at reducing the risk of developing the disease, according to the Department of Health and Human Services.

So the Obama administration wants Medicare to pay for the services for beneficiaries at high risk of developing diabetes.

Long-term Care Insurance: Less Bang, More Buck

Mar 17, 2016
Heidi de Marco / Kaiser Health News

Mary Julia Klimenko thought she was prudent 20 years ago when she invested in a long-term care insurance policy, one she believed would help pay for the care she’d need as she aged.

Now she wishes she’d banked the money instead.

Doctors have long disputed the accusation that the payments they receive from pharmaceutical companies have any relationship to how they prescribe drugs.

There's been little evidence to settle the matter, until now.

A ProPublica analysis has found that doctors who receive payments from the medical industry do indeed prescribe drugs differently on average than their colleagues who don't. And the more money they receive, the more brand-name medications they tend to prescribe.

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