Medicare

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).

Associated Press

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.

Patients who receive treatment at physician practices and outpatient clinics owned by large healthcare companies are being hit by bills for “hospital services,” even though they didn’t set foot in the hospital, the Miami Herald reports. And it’s legal.

Linda Drake, 57, of Miami received a $210 bill after seeing a doctor at an outpatient clinic owned by UHealth, part of the University of Miami. Her private insurer wouldn’t pay it.

A new study shows that critically injured patients with health insurance are more likely to stay put at non-trauma hospitals than be transferred to more skilled facilities, according to Kaiser Health News and NPR.

A federal judge says Florida lost $11 million in 2006 when WellCare executives committed Medicaid fraud, the Tampa Bay Times reports. That amount will influence the sentencing of three WellCare executives who were found guilty in June of Medicaid fraud.  Prosecutors had tried to convince U.S. District Judge James S. Moody Jr.

Federal officials are lengthening a temporary moratorium on new home health care agencies in Miami-Dade and Monroe counties, and have also included Broward County in the ban. As the Miami Herald reports, the six-month ban that starts today is an attempt to deter Medicare and Medicaid fraud. Federal health officials say Miami-Dade has the highest ratio of home health agencies to Medicare beneficiaries and has the biggest payments.

Denial of benefits and confusion over out-of-pocket costs top the list of complaints to a Medicare consumer help line, according to a report cited in the Tampa Bay Times.

The report was based on more than 14,000 calls in 2012 to the Medicare Rights Center, a non-profit advocacy group. The center said denial of benefits -- in which the federal agency declines to pay a claim -- accounted for 33 percent of the calls.

The Office of Medicare Hearings  and Appeals, which is overwhelmed, has decided to bring the cases filed by beneficiaries to the front of the line. That means appeals by hospitals, nursing homes, doctors and other health-care providers could be on hold for two years.

Following the example of private companies, Medicare is moving to limit the number of drug brands it will cover. The Centers for Medicare and Medicaid Services have proposed to allow private prescription-drug plans under Medicare Part D to cover only some of the antidepressants on the market, not all, according to the South Florida Sun Sentinel.

The owner of a South Florida clinic has pleaded guilty to defrauding Medicare to the tune of almost $20 million, the Associated Press reports. Isabel Medina could face 10 years in prison for her role in several health schemes.

 

MIAMI - A South Florida woman has pleaded guilty to involvement in several health care fraud schemes that cost the Medicare program an estimated $20 million.

Former Merfi Corp. clinic owner Isabel Medina pleaded guilty Tuesday in Miami federal court to health care fraud conspiracy, which carries a maximum 10-year prison sentence. The 49-year-old Medina will be sentenced in March.

PolitiFact

The claim from the former director of the Office of Management and Budget that Medicare spending fell between 2012 and 2013 is true, according to PolitiFact.

Twelve Florida hospitals had outcomes significantly better than average on results for hip and knee replacement operations in the past three years, according to Medicare data published on the Hospital Compare website.

Three of them scored significantly better than average on both the rates of complications and re-admissions, the two categories analyzed. They are Heart of Florida Regional Medical Center in Davenport, Holy Cross Hospital in Fort Lauderdale and Ocala Regional Medical Center.

A West Palm Beach eye doctor’s patients call him a  "miracle worker" for using cutting edge medicine to preserve their vision.  But the FBI and Department of Health and Human Services have a different view of Dr. Salomon Melgen, according to the Miami Herald.  Melgen, a close friend of U.S. Sen. Bob Menendez, D-N.J., has seen his offices raided twice this year, as part of a Medicare fraud investigation.

Carol Gentry

On Jan. 1, hundreds of Florida doctors who now treat UnitedHealthcare's Medicare patients will be dropped. A host of patients have been affected nationwide. (See update: FMA Protests Doctor-Dropping)

Yoselis Ramos / WUSF

If you weren't looking for it, you might miss it, sitting between a nail salon and a discount grocery store in a shopping plaza that seems to have an endless parking lot. Tucked in the plaza is a multi-million dollar medical clinic. 

"The model is all inclusive, where you can come and get everything taken care of in one place," said Mark Kent, CEO of CAC-Florida Medical Centers, a subsidiary of health insurance giant Humana.

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