Medicare

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.

What's Best Value in Medicare Plan?

Dec 3, 2013

Even when a Medicare Advantage plan wins the federal top-quality 5-star rating, it isn’t necessarily the right choice for every beneficiary, according to a cost-sharing analysis from HealthMetrix Research.

Per-person Medicare spending, much higher in Florida than all but one other state, has seen a dramatic increase in "post-acute" services -- nursing homes, home-health services, rehabilitation, and so on. And there is no rhyme or reason to the spending; patients who are much alike may be sent to nursing homes in one region, sent home in another. 

A judge has ruled that a Daytona Beach hospital violated the federal Stark Law, which bars physicians from getting extra cash from patient referrals through kickbacks, split fees and other under-the-table arrangements, the Orlando Sentinel reports.

The case, scheduled to go to trial in March, stems from a 2009 lawsuit filed by whistleblower Elin Baklid-Kunz, a former compliance officer for Halifax Hospital.  Hospital officials have denied wrongdoing.

Tampa-based WellCare Health Plans Inc. is planning to borrow $600 million, the Tampa Bay Business Journal reports. The company, which provides managed care services for Medicaid and Medicare health plans, will issue senior notes in a public offering.

A 40-something patient I'll call Ted has a list of conditions that would have tongue-tied Carl Sagan. Even though I see Ted in my clinic every month, he still winds up visiting the emergency room 20 times per year.

Yes, 20.

Before he became my patient, he went even more frequently. So, the current situation, bad as it may be, represents halting progress.

Lottie Watts/WUSF / WUSF

More than half of the Medicare Advantage plans available for enrollment now in Florida for 2014 coverage earned a rating of at least four stars out of five, according to data organized by Avalere Health

Four Florida plans -- all sponsored by Cigna -- earned the coveted five-star rating: three plans in Bay County and one in Miami-Dade. There were no five-star Advantage plans available in 2013 anywhere in Florida.

Lottie Watts / WUSF

It's open enrollment season for Medicare, the time when beneficiaries can switch plans if they want. Plenty of private insurance companies are competing to enroll them in Medicare Advantage plans.

If you have Medicare, or you're getting close to age 65, your mailbox is likely overflowing with offers. The ads are coming at you on TV, too. 

George Washington University

Many have grumbled about it before, but now it's been officially noted in the nation's top health-policy journal, Health Affairs: Florida gets shortchanged when it comes to graduate medical education funding from Medicare. And it's not the only one.

John Pendygraft / Tampa Bay Times

UnitedHealthcare’s AARP Medicare Advantage plan is dropping thousands of physicians from its network, as well as extras like fitness classes through Silver Sneakers, the Tampa Bay Times reports (paywall alert). In the words of one beneficiary whose plan will soon stop paying for aqua aerobics classes at the YMCA, the change in benefits is “pretty dumb.” 

Carmen Gonzalez, who had escaped to Cuba five years ago after stealing $8.2 million from Medicare, made the mistake of coming back.

WellCare

Tampa-based WellCare Health Plans, Inc. has replaced chief executive officer Alec Cunningham with chairman David Gallitano. 

Monday was yet another troubled day for the Affordable Care Act.

Sunday night, the outside vendor that operates two key parts of the website that lets people browse and sign up for health insurance experienced a failure.

The failure took place at a vendor called Verizon Terremark and presumably affected other clients as well as HealthCare.gov, the federal website that people use to sign up for insurance under the Affordable Care Act.

Florida has plenty of choices when it comes to Medicare Advantage plans and prescription drug coverage from private companies -- in fact, more than most places in the nation and more than some beneficiaries can cope with, as the Orlando Sentinel reports, citing Kaiser Family Foundation research.

Federal agents raided West Palm Beach eye doctor Salomon Melgen’s office for the second time this year, the Palm Beach Post reports. For four years, Melgen has been in a dispute with the federal government over allegations he was overpaid millions of dollars by Medicare. His attorney says Tuesday’s raid is payback for a lawsuit the doctor filed against U.S. Department of Health and Human Services. 

UnitedHealthcare, which sells AARP Medicare products including HMO-style Medicare Advantage plans, took out a full-page newspaper ad that blamed the decision to shrink provider networks in 2014 on reductions in federal funding. But as the Tampa Bay Times reports, payments from the federal government to Medicare Advantage plans will actually increase 3.3 percent next year. (Paywall after 15th click) 

Pages