Medicare

Medicare Advantage Plans Shift Their Financial Risk To Doctors

Oct 9, 2018
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STUART, Fla. — Dr. Christopher Rao jumped out of his office chair. He’d just learned an elderly patient at high risk of falling was resisting his advice to go to an inpatient rehabilitation facility following a hip fracture.

He strode into the exam room where Priscilla Finamore was crying about having to leave her home and husband, Freddy.

“Look, I would feel the same way if I was you and did not want to go to a nursing home, to a strange place,” Rao told her in September, holding her hand. “But the reality is, if you slip at home even a little, it could end up in a bad, bad way.”

After a few minutes of coaxing, Finamore, 89, relented and agreed to go into rehab.

Keeping patients healthy and out of the hospital is a goal for any physician. For Rao, a family doctor in this retiree-rich city 100 miles north of Miami, it’s also a wise financial strategy.

Daylina Miller/Health News Florida

The federal government is changing rules about how it helps with treatment for substance-abuse disorders, including requiring screening new Medicare beneficiaries for opioid abuse.

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The federal Centers for Medicare & Medicaid Services has given SOLIS Health Plans approval to begin offering Medicare Advantage plans in Florida beginning in 2019 in Miami-Dade, Broward, Palm Beach, Orange and Hillsborough counties. 

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Open enrollment for Medicare begins October 15 and this year there are lots of changes that will create more health care options for seniors.

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.

Medicare.gov

Check your mailboxes Florida residents because your new Medicare card is coming soon.

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The Obama administration improperly paid insurance companies and HMOs nearly $434 million in 2014 when Affordable Care Act policies first became available, according to a new federal inspector general’s report. 

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Prime Healthcare Services, one of the nation's largest hospital systems, agreed Friday to pay $65 million to settle allegations of Medicare overbilling in California.

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Sen. Bernie Sanders' "Medicare for all" plan would increase government health care spending by $32.6 trillion over 10 years, according to a study by a university-based libertarian policy center.

That's trillion with a "T."

The Trump administration announced a plan Friday that would affect about 40 percent of the payments physicians receive from Medicare. Not everybody's pleased.

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The Trump administration's Medicare chief on Wednesday slammed Sen. Bernie Sanders' call for a national health plan, saying "Medicare for All" would undermine care for seniors and become "Medicare for None."

Hyperbaric oxygen therapy provider Healogics Inc. agreed to pay up to $22.51 million to settle allegations that it violated the federal False Claims Act by knowingly causing wound care centers to bill Medicare for unnecessary and unreasonable treatments.

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Medicare will run out of money sooner than expected, and Social Security's financial problems can't be ignored either, the government said Tuesday in a sobering checkup on programs vital to the middle class.

Looking For Lower Medicare Drug Costs? Ask Your Pharmacist For The Cash Price

May 30, 2018
Kaiser Health News

As part of President Donald Trump’s blueprint to bring down prescription costs, Medicare officials have warned insurers that “gag orders” keeping pharmacists from alerting seniors that they could save money by paying cash — rather than using their insurance — are “unacceptable and contrary” to the government’s effort to promote price transparency.

But the agency stopped short of requiring insurers to lift such restrictions on pharmacists.

Tampa General Hospital

Tampa General Hospital is throwing its support behind a bipartisan proposal that, if passed by Congress, would allow it and other large health-care systems to challenge how the government estimates additional Medicare payments.

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It came down to the wire, but a federal agency that helps thousands of Florida seniors sign up for Medicare will be funded for another year.

NPR

For years, confusion has surrounded the conditions under which older adults can receive physical, occupational and speech therapy covered by Medicare.

When Anne Soloviev went to Braun Dermatology and Skin Cancer Center in Washington, D.C., for her semiannual dermatology checkup in early January, the physician assistant diagnosed fungus in two of her toenails.

Soloviev hadn't complained about her toenails or even noticed a problem.

But the physician assistant offered a solution anyway. She called in a prescription for an antifungal medicine to a specialty pharmacy with mail-order services that would send it to Soloviev's Capitol Hill home.

Medicare.gov

In April, the government will start sending out new Medicare cards, launching a massive, yearlong effort to alter how 59 million people enrolled in the federal health insurance program are identified.

Physical therapy helps Leon Beers get out of bed in the morning and maneuver around his home using his walker. Other treatment strengthens the 73-year-old man's throat muscles so that he can swallow food more easily, says Beers' sister, Karen Morse. But in mid-January, his home health care agency told Morse it could no longer provide these services because he had used all his therapy benefits allowed under Medicare for the year.

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A program that helps thousands of Florida seniors sign up for Medicare could lose all of its funding by the end of the month if Congress doesn't act.

Hospital Agreement Ends Budget Standoff

Mar 7, 2018
WGCU

Helping end a budget impasse, lawmakers have agreed to keep a current Medicaid payment formula for hospitals and to increase funding for nursing homes by $40 million, the Senate’s top health-care budget writer confirmed Wednesday afternoon.

HMO Rate Cuts Dropped In Budget Talks

Mar 2, 2018

Medicaid managed care plans are no longer on the chopping block. 

At 87, Maxine Stanich cared more about improving the quality of her life than prolonging it.

She suffered from a long list of health problems, including heart failure and chronic lung disease that could leave her gasping for breath.

When her time came she wanted to die a natural death, Stanich told her daughter, and she signed a "do not resuscitate" directive, or DNR, ordering doctors not to revive her should her heart stop.

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President Donald Trump’s new budget proposal flirts with combating high prescription drug prices, but industry watchers say the tweaks to Medicare and Medicaid do little more than dance around the edges of lowering the actual prices of drugs.

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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.

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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.

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