Medicare

Anthem reported a 4 percent increase in third-quarter profit and beat Wall Street forecasts as the number of people the health insurer covers edged slightly higher.

Senior citizens are switching from privately run insurance plans to traditional Medicare when they face serious, long-term health conditions, a study shows.

Researchers at Brown University found that 17 percent of Medicare Advantage patients who entered nursing homes for long-term care chose to switch to traditional Medicare the following year. Only 3 percent of similar patients in Medicare made the decision to go to a private Medicare Advantage plan.

Insurers Find Out-Of-Network Bills As Much As 1,400 Percent Higher

Oct 5, 2015

It’s common knowledge that consumers have to pay more money if they choose doctors or hospitals outside of their insurance plan’s network. But a new analysis prepared by the insurance industry seeks to show just how much more in each of the 50 states.

Adventist Health System will pay $115 million to the U.S. Department of Justice to settle claims it offered doctors perks for patient referrals, the Daytona Beach News-Journal reports.

Medicare Yet To Save Money Through Heralded Medical Payment Model

Sep 14, 2015

A high-profile Medicare experiment pushing doctors and hospitals to join together to operate more efficiently has yet to save the government money, with nearly half of the groups costing more than the government estimated their patients would normally cost, federal records show.

A new model of health care run by doctors and hospitals is growing and saving money in the taxpayer-funded Medicare program, according to a new report from the federal government. However, experts say most patients still don’t understand how an Accountable Care Organization works.

White House budget director Shaun Donovan called for a "more aggressive strategy" to thwart improper government payments to doctors, hospitals and insurance companies in a previously undisclosed letter to Health and Human Services Secretary Sylvia Mathews Burwell earlier this year.

Government health care programs covering millions of Americans waste billions of tax dollars every year through these improper payments, Donovan said in the Feb. 26, 2015 letter.

When President Lyndon B. Johnson signed Medicare and Medicaid into law on July 30, 1965, Americans 65 and older were the age group least likely to have health insurance.

Here's a bit of good news for Medicare, the popular government program that's turning 50 this week. Older Americans on Medicare are spending less time in the hospital; they're living longer; and the cost of a typical hospital stay has actually come down over the past 15 years, according to a study in the Journal of the American Medical Association.

Under a plea deal with the U.S. Department of Justice, a Miami pharmacist has pleaded guilty to one count of health care fraud for his role in submitting more than $1.8 million in false claims to Medicare, according to a news release from the DOJ. Evelio Fernandez Penaranda, the owner of  Naranja Pharmacy Inc., admitted to submitting claims for Medicare beneficiaries and doctors without their consent.

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Looking at the big picture, the financial health of Social Security and Medicare doesn't appear to have worsened.

Wednesday's annual check-up found that Social Security's retirement trust fund has enough money to pay full benefits until 2035, a year later than previously projected. Medicare's giant trust fund for inpatient care won't be exhausted until 2030, the same date as last year's report.

Daylina Miller/Health News Florida

There are more than 3 million people who have health insurance through Medicare in Florida and dozens of thousands of those beneficiaries could qualify for help paying insurance premiums, deductibles, co-payments and prescriptions, according to the Florida Department of Elder Affairs SHINE program.

Six years ago, a proposal for Medicare to cover end-of-life counseling touched off a political uproar that threatened to stall President Barack Obama's health care law in Congress. Wednesday, when Medicare finally announced it will make the change, reaction was muted.

Five people have been sent to federal prison for their roles in a $25 million Medicare fraud scheme that involved people from Nicaragua and the Dominican Republic posing as U.S. patients.

The sentences imposed last week by a Miami federal judge ranged from 15 months to four years. The five defendants are among 10 who have pleaded guilty after they were charged last year in a 36-count grand jury indictment.

One person, 70-year-old Jose Eloy Sanchez, remains at large and is believed to be in Nicaragua.

Medicare Slow to Adopt Telemedicine

Jun 24, 2015
Lynn Hatter / WFSU

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.

For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor.

The House voted Tuesday to kill a federal panel that is supposed to find ways to curb Medicare spending, as Republicans ignored a veto threat and leveled their latest blow at President Barack Obama's health care overhaul.

Members of the Independent Payment Advisory Board have never been appointed, and the panel has never recommended savings from Medicare, the $600-billion-a-year health care program for the elderly.

Study: 19 Million Uninsured If Law Repealed

Jun 22, 2015
U.S. Supreme Court

Repealing the federal health law would add an additional 19 million to the ranks of the uninsured in 2016 and increase the federal deficit over the next decade, the Congressional Budget Office said Friday.

Eastlakeoncology.com

 A Florida oncologist was charged Thursday with giving cancer patients medications, including chemotherapy drugs, from other countries that were not approved by the federal Food and Drug Administration.

Justices Decline Baker County Hospital Case

May 19, 2015
Baker County Medical Services

The U.S. Supreme Court on Monday turned down an appeal by a small North Florida hospital in a case that centered on payments for treating federal detainees. Justices declined to hear the appeal from Ed Fraser Memorial Hospital, a 25-bed facility in Baker County.

Gov. Rick Scott on Monday announced his nine appointments to a commission tasked with examining hospital finances, naming only one health care professional to the commission and a chair that has been a frequent donor to the governor and other Republican causes.

The governor has gone on the attack against hospitals over a fight to expand Medicaid and extend federal funds that help hospitals who care for Medicaid and uninsured patients. The issue is creating a potential $1 billion hole in the state budget.

Florida Hospital

 The Inspector General at the Department of Health and Human Services claims that Florida Hospital owes the federal government $11.5 million in Medicare overpayments made between January of 2011 and June of 2012, according to the Orlando Sentinel

New momentum for a lasting fix to Medicare's doctor-payment problem shows that lawmakers may finally be recognizing what has long bothered their constituents.

Year after year, the threat of 20 percent payment cuts averted at the last minute has seemed a curious way to run a program that lives depend on.

Associated Press

 An extraordinary bipartisan accord between House Speaker John Boehner and Minority Leader Nancy Pelosi is letting both parties exhale as they move toward ending the nagging annual threat of Medicare cuts to physicians. Yet each side is bragging about far more than that.

U.S. House of Representatives

A budding bipartisan deal to shelter physicians from Medicare cuts, championed by the House's two top leaders, is drawing powerful allies including the American Medical Association and a rainbow of conservative and liberal groups.

Daylina Miller/WUSF News

The need to reduce patient readmission rates is leading hospitals across Florida to share ideas with one another.  

Federal authorities haven’t publicly accused taxpayer supported Broward Health of submitting bogus claims to Medicare and Medicaid, but the health system still has racked up a $10.2 million tab for legal advice, the Florida Bulldog reports.

The younger brother of a man accused of laundering $238 million in Medicare dollars from Florida to Cuba's banking system was sentenced to 3 1/2 years in federal prison on Wednesday, the Miami Herald reports.

Eduardo Perez de Morales was barely an adult when his brother recruited him into the scheme, but he admitted he continued with the partnership even after realizing it was illegal, the Herald reports. 

  The White House is holding the first in a series of forums to hear about the most important issues facing older Americans. 

The event Thursday in Tampa comes amid a historic demographic shift in the U.S. as the massive baby boom generation moves closer to old age.

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 A Pembroke Pines resident was sentenced Thursday to 17 years in prison stealing the identities of physicians and filing false claims to Medicare, the South Florida Business Journal reports.

The. U.S. Attorney’s Office in Miami said Alejandra Collazo forged prescriptions for services not ordered by physicians and accepted payments through her clinic, Vortex Medical Center & Management Services of Hialeah.

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Some physicians are starting to warn their patients who winter in Florida that physicians may be ordering tests they don’t need, the New York Times reports. 

Medicare data show that some doctors in Florida have been ordering tests at twice the rate of doctors in Massachusetts, according to analysis by the Times

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