Medicare

Overhaul Is Proposed For Decades-Old Medicare Fraud Rules

Oct 9, 2019
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The Trump administration on Wednesday proposed overhauling decades-old Medicare rules originally meant to deter fraud and abuse but now seen as a roadblock to coordinating better care for patients. 

Vowing to protect Medicare with "every ounce of strength," President Trump spoke last week to a cheering crowd in Florida. But his executive order released shortly afterward includes provisions that could significantly alter key pillars of the program by making it easier for beneficiaries and doctors to opt out.

President Donald Trump is pledging to protect Medicare.  The president visited The Villages in central Florida – a collection of communities for residents 55 and older.  He announced and signed an executive order aimed at protecting and improving Medicare coverage.

Trump also used the event as an opportunity to tout his administration’s health care goals and achievements. He criticized the proposals set forth by his Democratic rivals, which he called socialism.

The Centers for Medicare and Medicaid Services will penalize 2,583 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data analyzed by Kaiser Health News.

President Donald Trump on Thursday accused Democrats of an all-out attempt to “totally obliterate Medicare” and portrayed himself as the program’s defender as he took steps to expand Medicare’s private insurance option.

Patricia Powers went a few years without health insurance and was unable to afford regular doctor visits. So the Missouri resident, who lives near St. Louis, had no idea that cancerous tumors were silently growing in both of her breasts.

When they started practicing medicine, most surgeons say, there was little or no information about just how many pain pills patients needed after specific procedures.

Five years after Congress passed a law to reduce unnecessary MRIs, CT scans and other expensive diagnostic imaging tests that could harm patients and waste money, federal officials have yet to implement it.

Florida Economists Grapple With Medicaid Expansions

Jul 31, 2019
Patient in discussion with doctor at a desk.
Daylina Miller/WUSF

State economists are struggling to come up with estimates of how much it would cost the state and how it would affect Florida’s economy if voters approve a far-reaching constitutional amendment that calls for expanding Medicaid. 

Retiring Abroad? Prepare To Possibly Mix And Match Health Insurance

Jul 23, 2019
Nurse escorts elderly man using walker
Wikimedia Commons

When Karen Schirack, 67, slipped on her way into her house in January and broke her left femur in multiple places, she had a decision to make. Should she get surgery to repair the fractured thigh bone and replace her hip near Ajijic, Mexico, where she has lived for 20 years, or be airlifted back to her home state of Ohio for surgery and rehab? 

Medicare Report Points To Neglect And Abuse

Jun 13, 2019
Hal Yeager / Kaiser Health News

An estimated 20 percent of Medicare beneficiaries in nursing homes who were transported to hospital emergency rooms in 2016 and treated for a variety of high-risk conditions had been potentially abused or neglected, a report released Wednesday by the federal government shows. 

Medicare, Social Security Face Shaky Fiscal Futures

Apr 23, 2019
National Institutes of Health

The financial condition of the government’s bedrock retirement programs for middle- and working-class Americans remains shaky, with Medicare pointed toward insolvency by 2026, according to a report Monday by the government’s overseers of Medicare and Social Security. 

orthopedic back brace
Wikimedia Commons

Federal authorities said Tuesday they've broken up a $1.2 billion Medicare scam that peddled unneeded orthopedic braces to hundreds of thousands of seniors via foreign call centers.

Proposed changes to some Medicare prescription drug plans are causing concern among patients with serious health conditions.

States. They're just as perplexed as the rest of us over the ever-rising cost of health care premiums.

Now some states — including Montana, North Carolina and Oregon -- are moving to control costs of state employee health plans. Their strategy: Use Medicare reimbursement rates to recalibrate how they pay hospitals. If the gamble pays off, more private-sector employers could start doing the same thing.

Big Pharma Gave Money To Patient Advocacy Groups Opposing Medicare Changes

Mar 4, 2019
Pill bottles in a warehouse
Wikimedia Commons

Dozens of patient advocacy groups, like the Bonnie J. Addario Lung Cancer Foundation and the National Coalition for Cancer Survivorship, recently appeared in national advertisements objecting to a Trump administration proposal that could limit drugs covered by Medicare providers. 

Bernie Sanders is back, but one of his signature policies never left.

In 2015, he introduced Medicare-for-all to many Democrats for the first time. Since Sanders' first run for president, that type of single-payer health care system has become a mainstream Democratic proposal.

New Fight Emerges Over HIV, AIDS Care

Feb 18, 2019
WMFE

An ongoing legal battle over which managed-care plan should be picked by the state to provide care to low-income AIDS and HIV patients in South Florida has triggered a new round of litigation that pits two competitors. 

Seniors Aging In Place Turn To Devices And Helpers, But Unmet Needs Are Common

Feb 14, 2019
Older hand holding another hand
NPR

About 25 million Americans who are aging in place rely on help from other people and devices such as canes, raised toilets or shower seats to perform essential daily activities, according to a new study documenting how older adults adapt to their changing physical abilities. 

Doctor, Nursing Facility Under Fire For Kickback Scheme

Feb 7, 2019
Stethoscope and gavel against a white backdrop.
Wikimedia Commons

An orthopedic surgeon, a nursing facility and several health care executives will pay $1.5 million to settle federal allegations of a kickback scheme involving Medicare and TRICARE patients.

The Orlando Sentinel reports Dr. Kenneth Krumins agreed to pay $500,000, while Conway Lakes Health & Rehabilitation Center, its Atlanta-based management company Clear Choice Health, and three executives -- Matthew File, Jeffrey Cleveland and Geoffrey Fraser -- will collectively pay $1 million.

The federal government took a new step this week to reduce avoidable hospital readmissions of nursing home patients. The move targets the homes' bottom lines by lowering a year's worth of payments to nearly 11,000 nursing homes, and giving bonuses to nearly 4,000 others.

These financial incentives, determined by each home's readmission rates, significantly expand Medicare's effort to pay medical providers based on the quality of care instead of just the number or condition of their patients.

For some older adults, private Medicare Advantage plans next year will include a host of new benefits, such as transportation to medical appointments, home-delivered meals, wheelchair ramps, bathroom grab bars, or air conditioners for asthma sufferers.

But the new benefits will not be widely available, and they won't be easy to find, during this fall's enrollment period.

Of the 3,700 plans across the country next year, only 273 in 21 states will offer at least one. About 7 percent of Advantage members — 1.5 million people — will have access, Medicare officials estimate.

Once again, Medicare is moving front and center in this fall's campaigns.

Throughout the election season, Democrats have been criticizing Republicans over votes and lawsuits that would eliminate insurance protections for pre-existing conditions for consumers.

But now Republicans are working to change the health care conversation with a tried-and-true technique used by both parties over the years: telling seniors their Medicare coverage may be in danger.

Flickr Creative Commons

The federal agency that administers health insurance to low-income and senior patients is making its hospital evaluations available online. Patients will be able to see which hospitals aren’t meeting quality of care standards-and why.

Medicare For All? CMS Chief Warns Program Has Enough Problems Already

Oct 17, 2018
iStock

The Trump administration’s top Medicare official Tuesday slammed the federal health program as riddled with problems that hinder care to beneficiaries, increase costs for taxpayers and escalate fraud and abuse.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS), said those troubles underscore why she opposes calls by many Democrats for dramatically widening eligibility for Medicare, now serving 60 million seniors and people with disabilities, to tens of millions other people.

Open Enrollment For Medicare Has Begun

Oct 16, 2018
Hands signing a form
Flickr Creative Commons

People ages 65 and older and those with qualifying disabilities have until December 7 to choose between Original Medicare and Medicare Advantage which is sold by private insurers.

Medicare Advantage Plans Shift Their Financial Risk To Doctors

Oct 9, 2018
iStock

STUART, Fla. — Dr. Christopher Rao jumped out of his office chair. He’d just learned an elderly patient at high risk of falling was resisting his advice to go to an inpatient rehabilitation facility following a hip fracture.

He strode into the exam room where Priscilla Finamore was crying about having to leave her home and husband, Freddy.

“Look, I would feel the same way if I was you and did not want to go to a nursing home, to a strange place,” Rao told her in September, holding her hand. “But the reality is, if you slip at home even a little, it could end up in a bad, bad way.”

After a few minutes of coaxing, Finamore, 89, relented and agreed to go into rehab.

Keeping patients healthy and out of the hospital is a goal for any physician. For Rao, a family doctor in this retiree-rich city 100 miles north of Miami, it’s also a wise financial strategy.

Pharmacy Technician amongst two shelves of prescription pills.
Daylina Miller/Health News Florida

The federal government is changing rules about how it helps with treatment for substance-abuse disorders, including requiring screening new Medicare beneficiaries for opioid abuse.

iStock

The federal Centers for Medicare & Medicaid Services has given SOLIS Health Plans approval to begin offering Medicare Advantage plans in Florida beginning in 2019 in Miami-Dade, Broward, Palm Beach, Orange and Hillsborough counties. 

medicare.gov

Open enrollment for Medicare begins October 15 and this year there are lots of changes that will create more health care options for seniors.

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