Medicare

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.

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.

mnfoundations / Flickr

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.

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