Medicare Advantage Congress

Final Announcement: MAC is now part of Health Care – From Policy to Practice

noreply@blogger.com (Unknown) — Fri, 06 Feb 2009 18:26:00 +0000

The MAC blog is now part of Health Care – From Policy to Practice blog. We have more content, news and networking available to share with you on this new blog. Thanks for your continued readership and make sure to subscribe to the new feed.

http://healthcareinsights.blogspot.com/

Happy Holidays from Medicare Advantage Congress

noreply@blogger.com (Unknown) — Wed, 24 Dec 2008 08:00:00 +0000

We're going to be taking some much needed time away from the world of Medicare/Medicaid to enjoy the holiday season with our loved ones.

Our sincerest thanks for your continued readership of the blog and we look forward to your participation, thoughts and ideas moving forward in 2009.

Stay tuned we're getting ready to launch a new blog that looks at the broader issues of Healthcare, update your RSS feed now as we get it ready for our official launch:
http://healthcareinsights.blogspot.com/

We wish to you a joyous holiday season.

Healthcare Insights To Launch in 2009!

noreply@blogger.com (Unknown) — Tue, 23 Dec 2008 08:00:00 +0000

We're getting ready to launch a new blog that looks at the broader issues of Healthcare, providing breaking news, insights and strategies into Health Plan business and operations., update your RSS feed now as we get it ready for our official launch:

http://healthcareinsights.blogspot.com/

Medicare to Docs: Go Electronic in 2012

noreply@blogger.com (Unknown) — Mon, 22 Dec 2008 08:00:00 +0000

Medicare, the federal health insurance program for the elderly and disabled, will offer financial bonuses to doctors who prescribe drugs electronically rather than on paper. Doctors who do not will face penalties from Medicare starting in 2012. From Reuters.

Medicare states that this is to improve efficiency between doctors and pharmacies and to avoid problems with handwriting, patients who lost prescription notes, etc. However, how much is this going to cost doctors--especially those who are serving low income areas or who are in private practice? I understand that Medicare is now offering monetary incentives to doctors who welcome this program but why bribe doctors into doing something that they will already ahave to do in a few years.

Medicare should, if they are mandating that doctors adhere to this new policy, spend money to educate docs and their staff on the new inititative.

Just the Essentials: Deciding on Medicare Coverage Plans

noreply@blogger.com (Unknown) — Fri, 19 Dec 2008 14:14:00 +0000

We stumbed across this very informative piece this morning by Allsup on MarketWatch that details the 10 most important things that indivudals/caretakers must ask themselves when figuring out appropriate Medicare coverage.

The article stresses that knowing one's healthcare needs is the key to understanding what plans are solid for their needs.

We highly recommend that you print out this list, available here.

U.S. Nursing Homes Get "Zagat" Rated by Feds

noreply@blogger.com (Unknown) — Thu, 18 Dec 2008 17:19:00 +0000

For a listing of the ratings by state, please click here.

By offering ratings to each nursing home, it gives a clear rating of the quality of the home. Though a visit is always encouraged, soon people would be able to choose a nursing home much like choosing a place for vacation.

What is particularly interesting about this report is that non-profit oranizations take better care of their clients than for profit organzations. This is probably because non-profits are so tied into keeping their non-profit status that a system of checks and balances in high order.

An analysis of nearly 16,000 nursing homes reveals for-profit homes are more likely to provide inferior care than their non-profit rivals, according to a USA TODAY examination of the federal government's first ratings of the homes' performance.

The new Zagat-like rating system, released today by the Centers for Medicare & Medicaid Services, assigns homes one to five stars for quality, staffing and health inspections, plus an overall score.

What do you think of the rating system? How will it affect U.S. nursing homes?

Texas Medicaid Fraud

noreply@blogger.com (Unknown) — Wed, 17 Dec 2008 16:51:00 +0000

Oops! More kickbacks for health officials have landed Texan health officials in some serious hot water. What is important about this case, as with all fraud cases, is that it affects the individuals who trusted in others to do their job and to do it well. People don't want to be seen as dollar signs, it grows contempt in the consumer which is just bad business.

This case, with phony advocacy groups and false marketing materials is predatorial and wrong and these individuals deserve to be prosecuted by the full extent of the law.

J&J’s Janssen Pharmaceutica funneled kickbacks to Texas health officials, distributed false marketing materials and deployed phony advocacy groups to get its Risperdal antipsychotic prescribed to low-income Texans, the state alleges in a new filing in an ongoing fraud lawsuit filed in 2006, according to The Dallas Morning News

Medicare assures patients about access to oxygen

noreply@blogger.com (Unknown) — Tue, 16 Dec 2008 14:24:00 +0000

From AP:

Medicare officials tried on Monday to quell growing worry by the elderly that they could lose access to lifesaving oxygen supplies with the start of the new year.

With a rise in phony marketing scams, which this blog has covered, many less than reputable companies are preying on the elderly for more money to offset their own losses during this economic climate. We must assure people that Medicare, though wacky and seemingly mismanaged will not keep individuals from life saving access to medical supplies. Any individual representing a company that claims to do so is wrong. Always do background checks on any company or individual who contacts you our someone you know about your personal Medicare status.

For the rest of this article, please click here.

DaVita gets Department of Health subpoena for documents related to Medicare practices

noreply@blogger.com (Unknown) — Mon, 15 Dec 2008 15:48:00 +0000

From CNN/AP

Dialysis services company DaVita Inc. said Monday it is responding to a Department of Health and Human Services subpoena for documents related to Medicare claims for several drugs.

What do you think will come out of this government audit of DaVita? DaVita has willingly given up all of their documentation and files regarding Medicare claims, so perhaps they have nothing to hide. We'll keep you posted on any new developments.

For the rest of this article, please click here.

First Spanish Medicare Educational Video for Seniors Released

noreply@blogger.com (Unknown) — Fri, 12 Dec 2008 14:41:00 +0000

From MarketWatch:

Award-winning journalist Maria Antonieta Collins has partnered with UnitedHealthcare to create the first-ever Spanish-language Medicare educational DVD for seniors and their caregivers.

What do you think of this outreach to the elderly Latin community?

For more information and for the video, please click here.

AP: Medicare insurers' profits exceed expectations

noreply@blogger.com (Unknown) — Thu, 11 Dec 2008 15:15:00 +0000

Health insurance companies that serve the elderly and disabled in Medicare are realizing significantly higher profits than they anticipated, resulting in the companies getting $1.3 billion more than projected, congressional auditors say.

This is likely due to an increase in payments to companies by the elderly, without an increase in services by the organizations. This money is now being seen as a profit that the companies in question must diligently work with the government to make sure that the clients served via Medicare are getting the best care that they deserve. We'll keep you posted on any new developments.

For the rest of this article, please click here.

AP: Retired players to get new Medicare benefit

noreply@blogger.com (Unknown) — Wed, 10 Dec 2008 17:16:00 +0000

The NFL and its union will pay a combined $100 a month toward the Medicare costs of retired players under a new plan announced Tuesday.

Good for them! I love it when organizations take care of their retirees. Let's hope that more visable organzations follow suit!

For a direct link to this article, please click here.

Indiana: Beware of Medicare scams

noreply@blogger.com (Unknown) — Tue, 09 Dec 2008 15:28:00 +0000

Everyone should be on the look out for Medicare fraudsters out to get money from unsuspecting seniors. Medicare does not contact seniors to go over their health care benefits and medicare does not schedule time to visit with seniors in their homes. If you or someone you know has been contact by a source claiming to help out with Medicare, let the authorities know immediately.

For an example, please click here.

New gun for seniors could be subsidized by Medicare

noreply@blogger.com (Unknown) — Mon, 08 Dec 2008 16:17:00 +0000

From The Raw Story:

A New Jersey company says they have gotten federal approval to market a gun to the elderly and hopes to have it subsized by Medicare.Constitution Arms says its Palm Pistol will aid seniors with arthritis who would otherwise have trouble pulling the trigger. The device allows individuals to shoot by squeezing with their thumb.The company's president Matthew Carmel says its "something that they need to assist them in daily living," and has applied to have the gun approved as a Class 1 medical device, the same designation given by Medicare to walkers and wheelchairs.

For the rest of this article, please click here.

Medicare, Social Security Owe Up to $52 Trillion to Current Retirees and Workers

noreply@blogger.com (Unknown) — Fri, 05 Dec 2008 17:28:00 +0000

Press Release:

DALLAS, Dec 03, 2008 /PRNewswire-USNewswire via COMTEX/ --

Debts Up To Three and Half Times Greater Than Entire U.S. Economy
If the federal government stopped the Medicare and Social Security programs tomorrow -- collecting no more payroll taxes and allowing no more accrual of benefits -- it would still owe up to $52 trillion to those who have already earned these benefits, according to a new study by the National Center for Policy Analysis (NCPA).
"The numbers are staggering," said Andrew Rettenmaier, an NCPA senior fellow and coauthor of the study. "No one thinks we are going to end these programs," he said, "but if we account for federal obligations the way private pensions and state and local governments are required to, the federal government owes up to $52 trillion (in current dollars) as of today."

To put the numbers in perspective, the size of the entire U.S. economy is $14 trillion. The newly released study determined that: --

An estimated $9.5 trillion is owed to current retirees -- an amount
equal to almost $250,000 per person 65 years of age and older in 2008.

-- Adding the liability owed to those nearing retirement (55 and older)
more than doubles the accrued debt to $20.6 trillion.

-- Adding the benefits accrued by younger workers brings the total to as
much as $52 trillion. The beneficiaries include all retirees, as well as
anyone in the workforce above 22 years of age.

For the rest of this release, please click here.

Compliance 360 Enhances Solution for Managing Claims Audits and Appeals

noreply@blogger.com (Unknown) — Thu, 04 Dec 2008 14:44:00 +0000

Compliance 360 Claims Auditor(TM) Reduces Audit Cost Liability for a Wide Variety of Claims Audits including those in the CMS Medicare Recovery Audit Contractor (RAC) program

Compliance 360, a leading provider of Software-as-a-Service (SaaS) solutions for enterprise governance, risk and compliance (eGRC) and the most widely used solution in the healthcare industry, today announced the general availability of its claims audit solution that helps organizations manage a wide variety of claims audits and appeals, including those conducted under the CMS Medicare Recovery Audit Contractor (RAC) program.

The Compliance 360 Claims Auditor is designed specifically for industries such as healthcare, insurance, financial services and student lending where the government is taking an increasingly active role in regulatory scrutiny and enforcement. Regulated organizations in these industries are being asked with increasing frequency to open their records and demonstrate that they are in compliance with the regulatory agency's rules and reimbursement policies. The Compliance 360 Claims Auditor allows organizations to maintain one central system of record for all types of claims audits and provides management with a system of alerts, dashboards, and workflow.

For the rest of this article, please click here.

Baltimore Sun Editorial: Medicare Waste

noreply@blogger.com (Unknown) — Wed, 03 Dec 2008 14:50:00 +0000

Baltimore Sun:

Private health insurance plans that serve nearly a fourth of all Medicare beneficiaries, including more than 40,000 in Maryland, were set up under the assumption that the private companies could provide the same services as Medicare at a lower cost. Instead, many have significantly increased costs without improving care, a new analysis of the Medicare Advantage program shows.It's time for the multibillion-dollar waste to end. Congress should act early next year to reduce these payments to private insurance companies to the level of traditional Medicare. That could save $160 billion over the next 10 years, money that would be better spent offsetting the soaring costs of Medicare as a flood of baby boomers join the program. Enrollment in private Medicare fee-for-service plans has exploded to 2.3 million recently from just 26,000 at the end of 2003. That growth has driven up costs because the government pays the private insurers 13 percent on average more than it would spend for the same number of beneficiaries receiving traditional Medicare. In Maryland, the extra money raked in by the insurance companies added an estimated $28.7 million to the cost of Medicare last year - $16 million to private insurers and $12.7 million in increased premiums paid by seniors participating in Medicare Part B, according to the analysis by the USAction Education Fund for Progressive Maryland, a liberal advocacy group here.
In a campaign debate this fall, President-elect Barack Obama described the extra costs as a "giveaway" to private insurers. And former Sen. Tom Daschle of South Dakota, who has been picked by Mr. Obama to become secretary of health and human services, recently warned that such overpayments to insurance companies are threatening Medicare's solvency.

For the rest of this editorial, please click here.

Economy likely to move up Medicare's insolvency

noreply@blogger.com (Unknown) — Tue, 02 Dec 2008 14:35:00 +0000

From WashingtonPost.com:

Federal health officials estimate that the struggling economy will speed up by one to three years the exhaustion of the Medicare trust fund covering hospital and nursing home care.
Trustees for the Social Security and Medicare programs warned last March that the trust fund for Medicare Part A would become insolvent in 2019. But the chief actuary for Medicare said Monday the economy will likely generate less revenue through payroll taxes than the trustees had projected.

Once the trust fund is exhausted, the federal government will continue to pay for hospital care and other services, but it initially would only have enough money coming in to cover 78 percent of estimated costs.

Trustees issue a once-a-year report on the financial conditions for Social Security and Medicare. In the fall, the trustees get an update that tells them what's happening versus what their latest projection indicated. In the latest update, Medicare's top actuary braced the trustees for a deterioration in Medicare's finances.

For the rest of this article, please click here.

NYT: Medicare’s Too Costly Private Plans

noreply@blogger.com (Unknown) — Mon, 01 Dec 2008 14:59:00 +0000

From NYTimes.com:

Private health insurance plans were supposed to bring better care and lower costs to elderly patients covered by Medicare. Instead they have increased the cost and complexity of the program without improving care, according to new analyses published by the respected journal Health Affairs. Congress clearly has more work to do to remove unjustified subsidies that prop up many of the most inefficient private plans.

Back in the 1980s, private plans — known as health maintenance organizations — were seen as a savior for Medicare. They could provide the same or better services as traditional fee-for-service Medicare, but because of managed care they could do it at a lower cost. Over the years Congress brought other, less managed private plans into Medicare, and in 2003 the Republican-dominated Congress substantially increased government payments to private plans.

Medicare currently pays the private plans — now called the Medicare Advantage program — 13 percent more on average than the same services would cost in the traditional fee-for-service program. Some of the added payments are used to provide extra benefits for enrollees, like reduced cost-sharing or reduced premiums for such extra benefits as vision and dental care.
The added value averages more than $1,100 a year per patient. Not surprisingly, that makes them attractive to individuals and employers seeking coverage for retirees. It has fueled an explosive growth in enrollments. Almost a quarter of all Medicare beneficiaries, more than 10 million people, are enrolled in private plans.

For the rest of this post, please click here.

Bayer to Pay $97.5 Million to Settle Kickback Claim

noreply@blogger.com (Unknown) — Wed, 26 Nov 2008 15:08:00 +0000

From Bloomberg.com:

A unit of Bayer AG agreed to pay $97.5 million to settle accusations that it paid kickbacks to diabetic-equipment suppliers, the U.S. Justice Department said.
Bayer Healthcare LLC was accused of giving $2.5 million to Liberty Medical Supply Inc. to persuade Liberty to provide its patients with Bayer diabetic-testing equipment such as testing strips and glucose monitors, the Justice Department said in a statement.
Bayer also was accused of paying $375,000 in kickbacks to 10 other diabetic suppliers and causing them to submit false claims to Medicare, the government said. From 1998 through 2007 the suppliers filed false claims on the sales to get Medicare reimbursements, the statement said.
“Paying health care suppliers to place a particular brand of device with Medicare beneficiaries violates the law and will not be tolerated,” said Gregory G. Katsas, assistant attorney general for the Civil Division.
Bayer spokeswoman Susan Yarin said the payment puts the matter behind the unit, based in Tarrytown, New York.

For more information, please click here.

Update: Medicare Advantage Payments

noreply@blogger.com (Unknown) — Tue, 25 Nov 2008 20:10:00 +0000

This post on GOOZNEWS.com discusses how several reports have recently taken aim at Medicare Advantage. The NY Times states that payments to health insurance organizations on average are 12 percent higher than what the government would spend on beneficiaries in traditional Medicare, and payments to Medicare Advantage plans are 17 percent higher.

How will the new administration deal with Medicare Advantage, since payments are ridiculously higher than traditional Medicare?

Medicare Advantage Paid Too Much

noreply@blogger.com (Unknown) — Mon, 24 Nov 2008 21:29:00 +0000

Fierce Healthcare reports that studies form the Medicare Payment Advisory Commission suggest that private health care plans for Medicare beneficiaries may be a good place to start cutting. The studies also show that private insurance plans are driving up costs because they are paid on average 13 percent more than allocated for traditional Medicare. Do you think private health care plans should be cut?

Miami physicians sentenced for Medicare fraud

noreply@blogger.com (Unknown) — Fri, 21 Nov 2008 15:27:00 +0000

From BizJournals.com:

Two Miami physicians were sentenced to prison on Thursday for their roles in an HIV infusion scheme that defrauded the Medicare program out of $6.8 million.
A Miami federal court judge sentenced Carlos Contreras, 61, to three years and Ramon Pichardo, 58, to four years in prison. They also were ordered to repay $4.2 million in restitution to the Medicare trust fund.
Contreras and Pichardo each pleaded guilty to one count of conspiracy to commit health care fraud. Contreras was owner and a doctor at CNC Medical Corp. in Miami. Pichardo was a doctor there.
Contreras and Pichardo admitted that, between November 2002 and April 2004, they conspired with others to file $6.8 million in false claims to the Medicare program for HIV infusion services that were not provided or medically necessary.

Medicare Part D Drug plans

noreply@blogger.com (Anonymous) — Thu, 20 Nov 2008 20:08:00 +0000

At US News, they have the new prices for most popular Medicare Part D stand alone drug plans. Most have increased a significant amount. See the prices here.

Medicare Troubles with Part D

noreply@blogger.com (Unknown) — Wed, 19 Nov 2008 19:40:00 +0000

From USNews.com:

Phillip Moeller writes,

Besides premium increases, many Part D plans have added other fee hikes, reduced covered drugs, and backed off on other protections as well. These changes are extensive and are layered onto a program with mind-numbing variables. The nation is broken up into 34 coverage regions, for example, and most states offer roughly 50 different private insurance plans with huge ranges of coverages and costs.
Whew! Paul Krugman may have won a Nobel Prize for economics, but I bet even he would have a hard time figuring out the best Part D plans for his elderly relatives. This year, more than ever, though, it will pay to look carefully at Part D choices. So, grab another cup of coffee, and bear with me.
The Part D program began with much fanfare and confusion in 2006. Since then, more than 16 million people ages 65 and over have signed up for the stand-alone Part D plans, and they've tended to stick with their original choices despite many plan changes in 2007 and 2008.

For the rest of this article, please click here.