Medicare

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).

 

In a coincidence of timing that has confused many Medicare beneficiaries, the open-enrollment period for Medicare Advantage and drug plans begins Oct. 15 -- two weeks after the sign-up for the uninsured at the Affordable Care Act Marketplace

It's official, if anyone was in doubt: A federal grand jury is investigating three former top executives of Universal Health Care, a now-defunct Medicare-plan company in St. Petersburg.

(See other business news below)

In the race to inform the public about the Affordable Care Act, now that people are paying attention, Kaiser Health News offers two new groups of questions and answers.

A federal judge in Hartford, Conn., has thrown out a lawsuit filed by the Center for Medicare Advocacy on behalf of 14 beneficiaries who were socked with thousands of dollars in unexpected charges for nursing-home admission after a hospital stay, Kaiser Health News reports. 

Even though the Affordable Care Act was signed into law three years ago, confusion over what it does and doesn’t do has reached a fever pitch, with both deliberate and accidental misunderstandings careening around the Internet.   Fact-checking organizations are trying to keep up.

Law May Rescue Patients from Paperwork

Sep 18, 2013
Bruce R. Bennett/The Palm Beach Post

The disease Greg Eisenstein endures is described as more painful than childbirth or even amputation in the medical literature. The state of Florida, Eisenstein says, is making him worse. (Editor's note: This story has been reprinted with permission from the Palm Beach Post.)

A Pembroke Pines chiropractor who was allowed to keep practicing after pleading guilty in the 1980s to defrauding insurance companies is in trouble again, the South Florida Sun-Sentinel reports. This time, David Hirschenson is accused of illegally chasing down accident victims to offer them medical services.

As Chan Lowe with the South Florida Sun-Sentinel writes, it’s just a matter of time before the fight against the Affordable Care Act will die. As Lowe writes, it happened with Social Security and Medicare, once folks started to benefit from those programs. Lowe predicts that same thing will happen with the federal health law better known as Obamacare.

So many misleading claims and outright lies have been told about the Affordable Care Act that the public awaits the implementation of its meatiest parts with confusion and -- for some -- fear. 

The former CEO of Hollywood Pavilion psychiatric facility who was found guilty of $67-million Medicare fraud in June had asked that she be sentenced to house arrest in her waterfront mansion. Instead,  Karen Kallen-Zury, 60, was sentenced to 25 years in prison and ordered to repay the $40 million she stole, according to the Miami Herald (paywall alert)

Responding to changes in the Medicare auditing system, which gave a bonus payment to audit teams that found questionable admissions, hospitals started holding patients in "observation" status even though the patients thought they had been admitted.

It leaves patients owing a lot more for their hospital stay, and -- worst case -- the entire nursing home bill if they are transferred to one. A number of Medicare patients and consumer groups are suing to get the problem solved, but so far it hasn't been.

Florida has the second-highest rate of uninsured adults under 65 in the nation, second only to Texas, the Naples Daily News reports. U.S. Census figures from 2011 show nearly 25 percent of Floridians under 65 don’t have health insurance -- a total of about 3.8 million residents, the Miami Herald reports.

A blog by St. Petersburg cardiologist and author David Mokotoff published in Kevin MD talks about how the length of a hospital stay has changed over the years depending on how Medicare pays.  The stays used to be too long, then they were too short. Now Medicare is penalizing hospitals if they don't get patients on the road to recovery before sending them home.

At his blog Our Health Policy Matters, consultant Paul Gionfriddo has his own measuring stick to compare states on how healthy they are.  He gives extra weight to prevention and public health, since those are disproportionately important in affecting community health.

Even though he lives in Florida, Gionfriddo doesn't place the state in the top 10.

Florida’s Agency for Health Care Administration has reported to federal officials -- who control the purse strings for Medicare -- that Halifax Hospital poses an “immediate and serious threat to the health and safety of patients,” the Orlando Sentinel reports. The hospital has to demonstrate it has cleaned up its act in order to ward off financial penalties.

Scott Keeler / Tampa Bay Times

With Congress on a five-week recess, members are rallying the troops around the state. And the troops are responding. As the South Florida Sun-Sentinel reports, U.S. Rep. Debbie Wasserman Schultz introduced Leslie Sheffield of Fort Lauderdale, a cancer survivor who cares for her 92-year-old mother. Sheffield told a crowd that she and her husband both got sizeable rebate checks on their health insurance this year because of the health law. Wasserman Schultz is a Democrat from Weston. 

In response to a billion-dollar whistleblower suit that alleges Halifax Health violated federal laws prohibiting kickbacks to doctors, hospital officials say they were merely serving the public by making sure they paid enough to keep good doctors. The bonuses they paid to certain physicians were needed to ensure they would stay at the safety-net hospital, the Daytona Beach News-Journal reports.

The newest wave in health care may be as close as your computer.  More hospitals and doctors are using technology, such as Skype, to treat patients, the South Florida Sun-Sentinel reports.  This can benefit patients who live too far from needed specialists, as well as allowing doctors to consult colleagues when dealing with complex cases.

Tampa-based WellCare Health Plans exceeded expectations on Wall Street for the second quarter, the Associated Press reports.

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Medicare has stepped up the top rate of pay cuts for hospitals that have high readmission rates, Kaiser Health News reports. In Florida, about four out of five hospitals will have a penalty in their Medicare reimbursement rate. The average penalty across the state was 0.35 percent, which means about one-third of one percent of their Medicare payments will be withheld in the coming year. 

Data Dive Finds Doctors For Rent

Aug 5, 2013

Silly me. I thought "rent-seeking" was something only landlords did.

But economists have their own way of looking at the world. To them, rent-seeking is a term for describing how someone snags a bigger share of a pie rather than making a pie bigger, as the venerable Economist explains it.

So, a drugmaker can be seen as a rent-seeker if it cajoles doctors to prescribe more of a particular brand of medicine at the expense of a rival pharmaceutical company's wares.

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