Medicare

College students studying whistleblower law heard a first-hand account from the woman who accused Halifax Health of Medicare fraud, the Daytona Beach-News Journal reports. 

For the first time, Elin Baklid-Kunz spoke publicly to Stetson University students about the whistleblower lawsuit that was settled earlier this year for $86 million, and earned $20.8 million for Baklid-Kunz and her attorneys.

HealthCare.gov

The government’s own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability — but also came away with respect for some of the health insurance site’s security features.

Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud.

Gov. Rick Scott’s leadership of the Columbia/HCA hospital chain is well known, as is the company’s record $1.7 billion fine for filing false claims for Medicare and other federal health programs.

But as he faces re-election, stories about a simultaneous investigation in the 1990s are emerging involving Scott and attempts to buy the then-publicly owned Tampa General Hospital, The Tampa Tribune reports.

Hospital Observations Favor Privately Insured

Sep 11, 2014

An increasing number of seniors who spend time in the hospital are surprised to learn that they were not "admitted" patients -- even though they may have stayed overnight in a hospital bed and received treatment, diagnostic tests and drugs.

The nation's respite from troublesome health care inflation is ending, the government said Wednesday in a report that renews a crucial budget challenge for lawmakers, taxpayers, businesses and patients.

Economic recovery, an aging society, and more people insured under the new health care law are driving the long-term trend, according to the report published online by the journal Health Affairs.

Linked In

Florida Healthcare Plus, a Medicare HMO and drug plan, is under state review for making a $600,000 error in a financial statement and has been temporarily blocked from enrolling any new members, its chief executive says.

The company, based in Coral Gables, was also recently fined $113,200 by the federal Centers for Medicare and Medicaid Services (CMS) for a different type of infraction -- "systemic failures" to provide all the benefits due to members under CMS rules.

The co-owner of a Miami home health agency was sentenced to 70 months in prison for fraudulently providing therapy to Medicare recipients.

Between 2008 and 2014, Annarella Garcia’s Professional Medical Home Health received approximately $6.25 million in fraudulent Medicare claims, the U.S. Department of Justice announced Wednesday.

Amerigroup

Two major health care groups have named new Chief Operating Officers for their Florida operations.

 Liz Miller has been promoted to the position at WellCare of Florida, the Tampa Bay Business Journal reports. She has been the vice president of product operations at the Tampa-based company since 2012. WellCare is Florida’s large Medicaid HMO contractor.

A federal report  found that 24 percent of people with questionable Medicare billing for HIV drugs live in Miami, according to the South Florida Business Journal. That’s remarkable, considering only 2 percent of the nation’s Medicare beneficiaries who get HIV drugs live in the area.

FL Prescriber Tied to Drug Maker

Aug 5, 2014

Many of Medicare's top prescribers of the expensive specialty drug H.P. Acthar Gel have financial ties to the drug's maker.

Only 18 practitioners wrote 15 or more prescriptions for the drug in 2012. At least nine — and all of the top four — were promotional speakers, researchers or consultants for Questcor Pharmaceuticals, a ProPublica analysis shows.

 The Halifax Health Board of Commissioners voted unanimously on Monday to end the final part of a five-year-long  whistle-blower lawsuit that will cost the public hospital more than $110 million, according to The Daytona Beach News-Journal

Medicare Scam Fugitive Now Most Wanted

Jul 8, 2014
HHS

 A Miami man has been added to federal health officials' list of most wanted fugitives.

Sandy De La Fe was indicted last year on charges of conspiracy to commit health care fraud and health care fraud. Investigators say De La Fe owned a Miami pharmacy and participated in a prescription drug fraud scheme that bilked Medicare out of millions of dollars.

Up to 100,000 patients remain in limbo following Humana’s announcement that it would no longer include Baptist Health South Florida hospitals in its provider network, the Miami Herald reports. Baptist Health is the largest healthcare provider in the region, boasting seven hospitals in Miami-Dade and Monroe counties and more than 30 outpatient facilities in Miami-Dade and Broward.

The federal government has joined a whistleblower lawsuit against a company that provides doctors and other health professionals to work in hospitals in Florida and many other states. IPC The Hospitalist Group operates practice groups in Jacksonville, Ocala, Southwest Florida, Tampa, Broward County, Palm Beach County, Miami-Dade County and Orlando.

Hospitals to Pay for Patient Harm

Jun 24, 2014

Beginning in October, hospitals that have higher-than-acceptable rates of patient complications will see their Medicare payments cut by 1 percent.  In Florida, 31 are in the danger zone, according to a preliminary analysis. 

Of those, two from the lower Gulf Coast were considered at extreme risk of penalty because their scores were so bad, according to the study by the Centers for Medicare and Medicaid Services.

Cigna has joined a growing number of private insurers that limit approvals for spinal-fusion surgery because it is frequently done on patients who will not benefit and could even be harmed.

Shands Health Care System will pay $3.25 million to settle part of a whistle-blower lawsuit claiming six Shands hospitals billed and received overpayments from the government’s Medicare, Medicaid and Tricare programs, the Orlando Sentinel reports.

FL Doctors Win Medicare Bonuses

Jun 12, 2014
Kaiser Health News

Hundreds of Florida doctors are recipients of the first round of bonuses from the federal government – a thank-you for saving taxpayers $33 million on Medicare last year.

Those who receive the performance bonuses are part of primary-care networks called “accountable care organizations,” or ACOs, created by the Affordable Care Act.  ACOs take financial responsibility for the care of their Medicare patients.  

A new investigation alleges the federal government improperly paid nearly $70 billion in Medicare Advantage charges between 2008 and 2013.

Medicare Won't Pursue Overpayments

Jun 2, 2014

Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a new report from the inspector general of the U.S. Department of Health and Human Services.

But in its reply to the findings, the Centers for Medicare and Medicaid Services (CMS), which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most expensive visits because it isn't cost effective to do so.

WellCare Health Plans

The interim CEO of WellCare Health Plans says he’s trying to move past the company’s troubles and focus on expanding its Medicare, Medicaid and prescription drug business, the Tampa Bay Times reports.

Dave Gallitano, the WellCare board chairman who led the ouster of the Tampa-based firm's most recent CEO last November, has made significant changes the past six months.

Instead of helping to plan his elegant July wedding at the Biltmore Hotel in Coral Gables,  Eduardo Perez de Morales is being held in the Broward County jail on charges of Medicare fraud, the Miami Herald reports.

A physician who ran the American Cancer Treatment Centers in Rockledge and Titusville for almost 20 years failed to put up a defense in a whistleblower Medicare fraud case because he thought it was moot when his medical practice filed for bankruptcy.

FL Docs Make Pricey Medicare Claims

May 16, 2014

When Medicare patients come in for an office visit, the doctor bills for that interaction on a scale of one to five.

A one is a relatively quick, simple office visit. A five is more complex and lengthy.

Oh, and that level five visit also pays more.

For Some Doctors, Almost All Medicare Patients Are Above Average

May 15, 2014

Office visits are the bread and butter of many physicians' practices. Medicare pays for more than 200 million of them a year, often to deal with routine problems like colds or high blood pressure. Most require relatively modest amounts of a doctor's time or medical know-how.

Walter Bianco has had hepatitis C for decades. He's known about it for 20 years. And now he's reaching the end of the road.

"The liver is at the stage next to becoming cirrhotic," the 65-year-old Arizona man says.

Taxpayers have been good to Tampa-based WellCare Health Plans Inc., and they're about to get even more generous. 

In WellCare's case, the benefactor is Medicaid. But Humana, another company that is big in Florida and is releasing earnings, apparently is benefiting from enrollment through the Affordable Care Act, as Forbes reports.

A Bradenton nursing home has been suspended from Florida’s Medicaid program on charges of fraud, forcing the home's Medicaid patients to be moved on Friday.  
About 25 to 28 Medicaid recipients residing at the Riverfront Nursing and Rehabilitation Center were in the process of moving, according to the Bradenton Herald.  On April 15, Florida’s Agency for Health Care Administration issued an order suspending Medicaid privileges for the nursing facility.   

The second phase of a whistle-blower case brought against Halifax Health will focus on patient admissions and whether the hospital improperly charged Medicare for their stays, according to the Daytona Beach News-Journal.

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