Medicare

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.

www.dmh.org

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.

In a column in the Miami Herald, former Miami Heat star Alonzo Mourning, who received a kidney transplant in 2003, laments a proposal to cut Medicare payments for kidney dialysis, the live-saving treatment for those who suffer kidney disease but don’t have access to a transplant. In Florida alone, Mourning writes, about 25,000 people rely on dialysis. 

Federal health officials will enact strict moratoriums on certain types of Medicare and Medicaid providers in the Miami area, Medical Daily reports. The stronger bans start Tuesday, and will affect new home health providers looking to join the programs.

Kaiser Health News

After three years and $8.5 million, a team of economists has come to the conclusion that geographic differences in health-care spending are real, both for Medicare and commercial insurers. 

In other words, the gap can't be explained by variations in income, the level of illness, or some other rational factor, the report says. For example, Medicare patients aren't sicker in super-expensive South Florida than anywhere else.  There are just more bills being sent to Medicare from South Florida than most places.

JSA Care Partners, a St. Petersburg-based multi-site physician group, was among seven Accountable Care Organizations that are leaving the high-risk “Pioneer” ACO group, federal officials announced last week).

The U.S. attorney’s office has joined a whistleblower lawsuit against a South Florida home health care company accused of padding its payroll to obtain more Medicare referrals.  The suit says that A Plus Home Health Care paid at least seven doctors’ wives and one boyfriend while expecting almost no work from the group in an attempt to lure physicians’ Medicare referrals, the South Florida Sun-Sentinel reports.

Associated Press

After weeks of bruising attacks on the Affordable Care Act by House Republicans and other opponents, Democrats Thursday retaliated with a one-two punch.

Pinellas County Sheriff's Office

Rather than run separate summaries on the various misdeeds, here’s a roundup:

While Floridians ask how health-care reform will affect them, Florida CHAIN’s Greg Mellowe is in a position to be able to answer those questions.  The nonprofit’s policy director has been following news of the health-care reform, and has some solid answers for Floridians, according to the Orlando Sentinel.

At his website Our Health Policy Matters, Paul Gionfriddo takes a look at which columns attract the fewest readers.  According to Gionfriddo, readership drops when he posts about Medicare, long term care and House Majority Leader Eric Cantor. 

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