Medicare

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. 

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.

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