Medicare

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.

Daylina Miller/Health News Florida

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.

Daylina Miller/Health News Florida

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.

Gage Skidmore (Flickr)

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.

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

SCOTT SIMON, HOST:

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.

mnfoundations / Flickr

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.

Copyright 2017 Fresh Air. To see more, visit Fresh Air.

TERRY GROSS, HOST:

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
p1 lawyer / Flickr

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."

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