Medicare

Broward Sheriff's Office

When the cops arrested Jorge Castillo at his Miami Lakes home on Monday, they found he lived well, with two Maseratis, a Range Rover and a boat. Small wonder, as the South Florida Sun-Sentinel reports.  Prosecutors say Castillo, 43, bought pharmaceutical drugs for AIDS, cancer, psychosis and other conditions from criminals.

Accountable Care Organizations, new Medicare payment arrangements aimed at improving coordination of care for the chronically ill, are really taking off in Florida, according to MedPage Today. Florida has more ACOs than any other state, even the much more populous California.

www.healthcare.gov

Enrollment in Medicare Advantage plans is booming at 14.4 million nationally, according to the Kaiser Family Foundation. In Florida, enrollment increased 10 percent last year to 1.3 million; that represents 36 percent of Florida Medicare patients. 

Continuing its pressure on the hospital system to make the pricing structure more sensible, the Obama administration on Monday released data on charges for outpatient care. They showed Floridians are charged nowhere near the same amount for similar procedures, depending on their choice of hospital outpatient site.

The data release for 30 common outpatient procedures showed, for example:

In 1979, a federal court in Tampa granted an injunction that ordered federal health officials to keep secret the  amount that Medicare pays doctors.  Now that ruling has been overturned.

That secrecy has reigned nationwide all these years -- even after the Wall Street Journal crunched data and published articles that showed certain physicians were almost certainly committing fraud and collecting unearned sums at taxpayers' expense.

Florida’s seniors may be able to breathe a little easier, knowing that the Medicare hospital trust fund will be financially sound longer than projected because health spending has moderated, the South Florida Sun-Sentinel reports. Government trustees reported that Medicare’s hospital fund should run short around 2026, two years later than projected in 2012. 

Eye Associates of Fort Myers, Naples

The number of eyelid lifts charged to Medicare tripled over a decade, even though the federal health-care program is not supposed to pay for cosmetic surgery, the Center for Public Integrity reports.

El Nuevo Herald

The Medicare Fraud Strike Force arrested 34 people in Florida as part of a nationwide sweep.  

According to an investigation by ProPublica and The Washington Post, Medicare is failing to properly monitor the drugs prescribed under Part D coverage. Analysis of the data shows doctors are overprescribing, and in some cases, giving seniors drugs that are potentially harmful or addictive. 

The health-care system was already complex enough, and it's getting more confusing as the main portions of the Affordable Care Act  are about to go into effect Jan. 1.  This is the time when con men can take advantage of the confusion, particularly targeting senior citizens.

A company started by Florida Senate President Don Gaetz, but which he later sold, is in hot water with the federal government.  In a suit filed against Chemed, the U.S. Department of Justice accused it of Medicare fraud.  Gaetz was vice chairman during part of the time in question, according to the Tampa Bay Times

Jason Redmond / AP

It isn't exactly news that hospital bills bear no relation to what products and services actually cost, or the amount that is paid. 

What IS new is the pressure on the  hospital industry to defend its pricing system. On Wednesday, the Obama administration released data showing how much each hospital charges for various types of treatment and contrasts that with how much Medicare actually pays for it.

Humana: Help Wanted, About 170 People

May 9, 2013

Humana is adding full time marketing services positions to both its Miramar and Tampa locations. It's looking to hire 170 people in Tampa Bay.

Humana's call center in East Tampa is looking to fill telesales positions just in time for the annual Medicare open enrollment period coming up in October.

Humana spokeswoman Nancy Hanewinckel said the open enrollment period, when seniors are shopping around for their plans for the next year, means lots of people calling in.

The Florida Department of Health has revoked the license of a 118-bed assisted living facility in Boynton Beach accused of numerous shortcomings, The Palm Beach Post reports.

The facility allegedly lost track of a resident who wandered away, failed to prevent a rape of one resident by another and had an office employee who committed Medicare fraud.

Ellen Weinstein / Broward Palm Beach New Times

Some of the Medicare fraud stories that come out of South Florida are pretty unbelievable, as the Broward Palm Beach New Times reports. There are plenty of people who exploit the Medicare system for quick, easy cash. Prosecutors are overwhelmed, and many guilty of Medicare fraud get little more than a slap on the wrist.  

 

At his site Our Health Policy Matters, consultant Paul Gionfriddo looks at Medicare spending on treatment for depression, and the gap in treatment between men and women even though women are more likely to be diagnosed with depression.  

 

A Fort Lauderdale CPA has been named bankruptcy trustee for St. Petersburg-based Universal Health Care Group Inc., the parent corporation of two health plans that were placed in liquidation by the state of Florida last month.

The Chapter 11 Trustee is Soneet R. Kapila, founding partner of Kapila & Company, CPAs, according to a spokeswoman for the company, Jeanne Becker.

U.S. Bankruptcy Judge K. Rodney May of the Middle District of Tampa signed the order approving Kapila's appointment on Monday.

A 47-year-old Daytona-area woman who worked at Halifax Medical Center for 15 years says she saw illegal kickbacks to doctors and billing fraud that went on for more than a decade, and kept hoping someone else would report it.

Seniors in Florida and six other states are having to wait an extra month to get power wheelchairs and other heavily marketed, high-profit machines that Medicare has identified as widely over-used and subject to fraud, the Palm Beach Post reports.

The demonstration program requires that patients get approval from the federal agency before one of the identified devices can be delivered.

iStockphoto.com

Instead of cutting payments to Medicare Advantage plans, which have high enrollments in Florida, the Centers for Medicare & Medicaid Services has decided to increase the rate by 3 percent after heavy lobbying, the Associated Press reports.

Tampa Bay Times

Health-fraud investigators spent most of Thursday night copying data from the computers at Universal Health Care after federal agents raided the company early Thursday and ordered hundreds of workers out of their offices in the downtown St. Petersburg building.

Meanwhile, Dr. Akshay "A.K." Desai, who founded and ran the Medicare and Medicaid  HMO company, was nowhere in evidence. The gates were closed at his ultra-modern mansion on Tampa Bay.

Downtown Photo

Broward Health has agreed to pay Ryan Tannehill, quarterback for the Miami Dolphins, $100,000 or more a year to let the hospital system use his name and photo, the Broward Bulldog reports. The hospital system said it’s a good marketing deal, but some question the use of taxpayer dollars. 

Should Medicare Pay Be Tied to Geography?

Mar 25, 2013

Doctors and hospital administrators in parts of the country that are heavy Medicare spenders can relax their grips on their prescription pads and billing computers.

An influential panel on Friday panned the idea raised in Congress to pay them less for Medicare services if their regions are heavy users of medical services.

The idea is an outgrowth of decades of research into why Medicare spends more per beneficiary in some places such as New York City, Florida and McAllen, Texas, and significantly less in parts of Minnesota and Wisconsin.

Patients who have insurance through Universal Health Care won’t have it after April 1, the Tampa Bay Times reports. As part of the state’s takeover of the troubled St. Petersburg-based insurer, thousands of Medicare and Medicaid members will have to switch to a different plan.   

A bankrupt Medicare plan based in St. Petersburg will be turned over to the State of Florida's Division of Financial Services  by April 1 under an order issued Thursday by a circuit court judge in Tallahassee. As the Tampa Bay Times reports, this puts hundreds of Universal Health Care employees at risk of losing their jobs. 

As the Affordable Care Act nears its third birthday this Saturday, a poll finds the public actually knows less about the law now than when it passed in 2010. Oh, and a lot of what people think they know just isn't so.

Those are the central findings of this month's tracking poll just released by the Kaiser Family Foundation.

A federal judge has sentenced Gary Kushner, a 72-year-old Plantation physician, to 12 years in prison for Medicare fraud, according to a press release from the U.S. Department of Justice. 

A jury last August found Kushner guilty after a two-month trial based on evidence that he and co-conspirators submitted $50 million in fraudulent billings through Biscayne Milieu, a Miami-based mental-health clinic. Kushner had been medical director of the clinic.

The first time federal health officials corrected their work on hospital penalties, it turns out, they goofed. So now they’re correcting it again. For some Florida hospitals, the latest correction is a good thing.

State regulators are in an emergency court hearing Wednesday morning in Tallahassee, asking a judge to liquidate Universal Health Care and turn it over to them by April 1. 

They say the financial turmoil at the St. Petersburg-based plan has led many health-care providers to stop treating Universal's patients because the company owes them money, the Tampa Bay Times reports.

Florida Hospital repaid almost $3 million to Medicare following an audit, which the attorney for a whistleblower says is evidence their lawsuit has legs, the Orlando Sentinel reports.  The hospital says the audit was routine and that the amount repaid is far less than 1 percent of revenue, a minor matter.  

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