Medicare

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.

Breaking Down ACOs

Apr 16, 2014

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

This carrot-and-stick approach encourages the formation of Accountable Care Organizations in the Medicare program.  ACOs have become one of the most talked about new ideas in Obamacare, because providers make more if they keep their patients healthy.

Linked In

Florida Healthcare Plus, a financially struggling Medicare Advantage plan, has brought in a new CEO who's an experienced senior-products executive and turnaround artist.

Susan Rawlings Molina, who arrived at the Coral Gables-based company in January, says she was recruited for the task by her predecessor, Ray Quirantes. Although the company has been losing money, she told Health News Florida Tuesday afternoon, its investors have provided adequate capital and want to make it a success.

Haider Ali Khan, patriarch of the now-defunct Quality Health Plans Inc., has been arrested and charged with more than a dozen felonies involving health-insurance fraud, state officials said.

Khan, who was president of the Tampa-based Medicare plan before it closed, turned himself in to Leon County Jail officials on April 3 and was released on $150,000 bond, according to the state Office of Insurance Regulation (OIR). His arrest came 20 months after that of his son and daughter, both of whom were also executives in the company.

PolitiFact

Gov. Rick Scott has done a very good job of confusing the public, particularly Medicare beneficiaries, about what is happening in the government program for the elderly and disabled and about and how it relates to the Affordable Care Act, PolitiFact says.

Associated Press

Dr. Salomon Melgen, the Palm Beach County ophthalmologist who received more than any other doctor in the country from Medicare in 2012, tried to use political pull in the Democratic Party to get the FBI off his case.

Three of the top five Medicare payments in 2012 went to doctors who practice in Florida, according to data from the Centers for Medicare and Medicaid Services. The Florida doctors topping the list are Salomon E. Melgen of West Palm Beach (#1), Asad U. Qamar of Ocala (#2) and Alexander M. Eaton of Fort Myers (#5).

While only a small fraction of doctors receive more than $3 million a year from Medicare, Florida accounts for way more than its share -- one in four. And guess which state is home to the doctor who made nearly $21 million?

Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.

No Cut in Medicare Plan Rates, After All

Apr 8, 2014

Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members.

After estimating in February that the cuts required by the Affordable Care Act as well as other adjustments would reduce would reduce what it pays insurers next year by 1.9 percent per beneficiary, the Department of Health and Human Services said Monday it would instead give Medicare Advantage plans a raise of 0.4 percent.

"Vacuum erection systems," also known as penis pumps, are among the medical devices that Medicare Part B pays for, and according to a ruling by PunditFact, Medicare has paid millions of dollars for them. The fact-checkers set out to check the claim that Medicare has spent on $172 million on the devices, and ruled it “mostly true.” Ilyse Hogue, president of NARAL Pro-Choice America, was slightly incorrect on the timeframe she gave during an appeara

 A crackdown on Medicare fraud in South Florida is pushing illegal prescription drug trafficking north, federal investigators told a U.S. Senate Committee.

The Senate Committee on Aging learned that groups are moving north of Miami, the epicenter of prescription drug trafficking, and into the Treasure Coast and Central Florida, the South Florida Sun Sentinel reports..

A new drug hailed as a breakthrough against hepatitis C comes at a price that  puts treatment out of reach for most who need the medication -- $84,000 for a standard 12-week course of Sovaldi, manufactured by Gilead Sciences.

Florida’s Medicare contractor, First Coast Service Options in Jacksonville, recently announced plans to limit coverage for follow-up drug tests, and is accepting public comment.

Federal agencies are teaming up to improve oversight of nursing homes, a practice that now misses a third of the cases of substandard care, according to Kaiser Health News.

The federal government intends to fine Florida for what it describes as a violation of the Social Security Act -- limiting Medicaid patients' emergency room visits to six a year -- the Tampa Bay Times reports.  

In December 2012, the Centers for Medicare and Medicaid Services  rejected the plan from the Florida Agency for Health Care Administration to cap the visits.

The latest delays in implementing the Affordable Care Act are prompting critics to challenge the Obama administration’s legal authority to tweak the law, the Miami Herald reports.

The latest deadline extension, delaying the date for certain employers to offer health benefits to full-time workers, led some Republicans and conservative groups to say it’s a political ploy related to the critical mid-term elections.

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