Medicare

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.

Associated Press

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) 

In a column in the Orlando Sentinel, Scott Maxwell shares his outrage over questionable profits in hospice care, especially since he has helped promote it over the years.

UnitedHealthcare is triggering a furor in southwest Florida by dropping 300 physicians from its AARP/Medicare Complete HMO network, according to the Fort Myers News-Press.

Lottie Watts / WUSF

Open enrollment for people who have Medicare plans started this week. It's the time when all people with Medicare, the federal health insurance program for people 65 and older and the disabled, can change their private Medicare Advantage plan or prescription-drug coverage.

Health News Florida's Lottie Watts talked with Kathy Winans, the regional vice president for United Health Care Medicare plans, about this year's open enrollment, which runs from Oct. 15 through Dec. 7. 

An auto-insurance company owned by the founder of the “1-800-Ask-Gary” referral service has been barred from writing new policies, the Sarasota Herald-Tribune reports. Dr. Gary Kompothecras’ Sarasota-based AGIC Inc. is fighting with the state Office of Insurance Regulation over allegations that it doesn't have enough funds to pay future claims.

In other business news:

Wikipedia.org

Nearly half of Medicare beneficiaries in South Florida took a pricey brand-name pill -- Prevacid, Prilosec or Nexium -- to control stomach acid in 2010, according to a new study. At 45 percent, the popularity of these proton pump inhibitors is three times its rate in Grand Junction, Colo.

In this week's column at  at Our Health Policy Matters,  health policy consultant Paul Gionfriddo of Lake Worth says that a modest reduction in Medicare benefits of  about $10 a month and a tiny tax increase of one half of 1 percent on employers and workers could make Medicare fully solvent for generations.

But what are the chances that this Congress would be willing to discuss such a thing? The current members can't even stand up to the medical-device lobby.

Today, Oct. 15, is the first day of open enrollment for Medicare beneficiaries to choose their drug plan and HMO-style Medicare Advantage plan for 2014.  They can save money if they do some research, but if they don't, most will pay more this year. 

Researchers on Medicare enrollment predict that millions of beneficiaries will remain in their current plan rather than hassle with doing the research to see what has changed. And that would be a mistake, since so many plans are switching the drugs they cover or the premiums and co-pays they charge.

A Miami Beach doctor will stay in a federal detention center while he awaits trial for Medicare fraud, the Miami Herald reports. Dr. Christopher Gregory Wayne, known for his punk rock style and nicknamed the “Rock Doc” by patients, is charged with a dozen counts of Medicare fraud totaling $230. But the indictment alleges systematic abuse: he’s accused of billing for, on average, 500 physical therapy sessions a day in 2008. 

Dr. Christopher Gregory Wayne, called the “Rock Doc" and known by a signature punk-rock hairstyle, has been charged with 12 counts of Medicare fraud, The Miami Herald reports (paywall alert).

 

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