Medicare

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
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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.

Hospitals Fret Over Caring For Newly Uninsured In GOP Plan

Mar 13, 2017
www.healthcare.gov

When Colorado expanded Medicaid coverage under former President Barack Obama's health care law, the largest provider in the Denver region hired more than 250 employees and built a $27 million primary care clinic and two new school-based clinics.

Jury selection heads into a third day in the Medicare fraud trial of a prominent Florida eye doctor, Salomon Melgen.

mnfoundations / Flickr

The Medicare fraud trial of a prominent South Florida eye doctor tied to a New Jersey senator's alleged corruption is set to begin.

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Federal prosecutors say a northeast Florida man will serve 18 months in federal prison after he pleaded guilty to stealing nearly a quarter million dollars in government benefits.

Nursing Home Exemption Sought In Medicare Managed Care

Feb 14, 2017

With the nursing-home industry lobbying for changes, a Senate Republican has proposed exempting some nursing-home residents from the statewide Medicaid managed-care system.

Back in 2014, federal officials settled on what they thought would be a straightforward fix to curb abusive pill pushing: Require doctors and other health providers to register with Medicare in order to prescribe medications for beneficiaries.

Drug companies could be forgiven if they're confused about whether President Trump thinks the government should get involved in negotiating the price of prescription drugs for Medicare patients.

Just a few days before Trump was sworn in, he said the pharmaceutical industry was "getting away with murder" in the way it prices medicine, and he promised to take the industry on. It was a promise he'd made repeatedly on the campaign trail.

WellCare

Tampa-based WellCare Health Plans, which covers nearly 4 million people through Medicare and Medicaid programs, reported an increase in income last year, according to an earnings report released Tuesday.

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.

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