Archive for the ‘Medicare & Medicaid’ Category
Wednesday, June 15th, 2011
Just a few days following his announcement that he is pursuing candidacy for the Republican presidential nomination in 2012, Newt Gingrich, harshly condemned the House Republican’s plan to renovate Medicare radically, which is the federally funded program that provides health care to retirees.
Gingrich, who is the former Speaker of the House, led a conservative resurrection back in the ’90s. He said that the Republican’s plan for Medicare is “too big a jump” for the citizens of this country, comparing it to the overhaul in health care already put in motion by Democratic President Barack Obama.
Appearing on the NBC television show Meet the Press, Newt Gingrich said,” I’m against Obamacare, which is imposing radical change, and I would be against a conservative imposing radical change.”
Why G.O.P.’s Plan may be to Radical?
Gingrich said, “I don’t think right-wing social engineering is any more desirable than left-wing social engineering.” He also said, “I don’t think imposing radical change from the right or the left is a very good way for a free society to operate.”
The Republican’s plan to refurbish the Medicare program is the most extensive since the creation of the program. Instead of direct payment for health care, health care coverage for older citizens would be subsidized.
Republicans in the House have portrayed this plan as a way to address the long-term financial issues in the nation. On the other hand, Democrats, along with their many allies, have sought after seizing the public’s concern over the plan, stating that such changes could actually hurt elderly citizens, who are somewhat of an influential group when it comes to voting.
Faced with public meeting filled with protest following the introduction of the Medicare proposal back in early April 2011, House Republicans have begun to indicate that they are ready to put the plan on the back burner for the time being.
photo credit: ProgressOhio
Wednesday, January 5th, 2011
In the last year of working on cases of false claims and fraud against the United States government, the Justice Department has been successful in the collection of a record three billion dollars.
According to Assistant Attorney General Tony West health care fraud accounted for $2.5 billion (USD) in civil judgments and settlements for the past fiscal year ending in September, 2010.
In cases that alleged fraud against Medicare, as well as other federal health programs, the government was successful in collecting more than a billion and a half dollars in settlements with medical device companies and pharmaceutical companies.
Pfizer Included in $2.5 billion Total for Health Care Fraud
Keep in mind that this total does include the more than $650 million in the record settlement with Pfizer. As you may recall, Pfizer Inc. was accused of marketing drugs for uses other than those that are approved by the Food and Drug Administration.
The $3 billion in judgments and settlements for this past fiscal year, which ended on September 30, represented a 25% increase over the previous year. In the last fiscal year, the government only recovered just under two and a half billion dollars.
Assistant Attorney General Tony West told reporters in a recent briefing, “We will hold you accountable whether you are a corporation or an individual.” He also said, “The numbers from this last fiscal year and for the last two years show that that accountability comes at a high price.”
According to the Justice Department, the majority of the cases that resulted in the recovery of the funds were brought out to the government by whistle-blowers. According to federal law, whistle-blowers can press fraud claims on the behalf of the government, and then they can share in any of the money that is recovered.
Thursday, October 7th, 2010
After years of undercover surveillance and Medicare claim investigations, officials in five major U.S. cities resulted in the indictment of 94 individuals and a total of $251 million in fraudulent Medicare payments. The cities involved in the largest Medicare fraud takedown in U.S. history included New York City, Houston, Detroit, Miami, and Baton Rouge. Miami alone caught a whopping 33 of the 94 scammers.
What Is America Doing to Fight Medicare Fraud?
Once the government realized that between $60 and $90 billion dollars are stolen through the Medicare system each year, several measures were put into place.
The most powerful of these measures is part of the Affordable Care Act. Through this act, Medicare can stop payments with even the mere suspicion of fraudulent claims by a provider.
In Miami, forcing medical care providers recertify their practices resulted in a drop of $1.6 billion in claims, more than half of the annual $3 billion taken through fraud.
With more government money to fight fraud, Medicare can deal with fraudulent claims in a more realistic time frame. Previously, bills were paid and then investigate. Now, claims can be investigated quickly and then paid. This results in a drop in unnecessary billing, patient bribery, and the viral nature of Medicare fraud.
Is the Fraud Crackdown Working?
New health care reform and stronger support from city law enforcement allows the areas most affected by Medicare fraud to track, arrest, and indict those responsible for fraudulent behavior. Those guilty of fraud include teens, the elderly, immigrants, nurses, doctors, and medical billing specialists. Hundreds were arrested in the past two years and new indictments are made almost daily.
While the recent crackdown on Medicare fraud is just the beginning, major progress has been made in the effort to reduce and eventually eliminate the high rates of Medicare fraud in the United States.
Wednesday, July 28th, 2010
Struggling to make it through in the midst of an ever-worsening budget impasse over Medicare reimbursement, the Center for Medicare & Medicaid Services (CMS) couldn’t wait any longer. CMS is now implementing a 21% cut in physician payments, which will affect an estimated 50 million claims. Claims that were held back since June 1 will be the first to feel the effects of the cuts.
In the late 1990’s the funding formula for Medicare reimbursements was first enacted in conjunction with the Balanced Budget Act. However, even at that time it was thought by some to be flawed. Today the formula is thought to be seriously flawed, and is growing more and more out of sync with its original intended purposes with each passing year.
Medicare Cuts Could Affect Quality of Care
Even though Medicare has instituted this drastic cut it too may stand to be on the losing side of the board as well, considering there are already a huge number of medical practices that currently do not take on Medicare’s elderly patient population.
Participating physicians will see a direct impact of the 21% cut with the average office visit now being reimbursed at about $8.00 less than what they were in 2007. Medicare may also feel the brunt of this unresolved state of affairs.
If a resolution is indeed reached, and the cuts reversed, they are looking at having to swallow about .30 cents per claim that is reprocessed. This translates out to a staggering potential of $15 million dollars for the first 50 million claims alone.
Only time will tell how it will all play out in the end, if there ever will be an end. In the meantime, there is no way for anyone, including physicians, patients and even Medicare to avoid the huge impact of this monumental move.
Thursday, July 8th, 2010
California has one of the highest rates of uninsured citizens in the country with more than 6.4 million people currently without health insurance coverage. That said, it stands to reason that any additional coverage at the federal level is a huge plus for not only the California government but for the residents as well.
Positive effects of health care reform in California
When it comes to California, the federal overhaul would help those who can afford health insurance but are currently unable to get it. It will assist those who aren’t able to obtain coverage by providing them with a means to acquire health care benefits. Additionally, the bill will also go a long way in tackling the desire to provide Californians with the preventative means to uncover unhealthy conditions in the early stages, where they can be addressed promptly, and thus help everyone get more affordable California health insurance. There is a downside of this bill, however; read below to learn what it is.
Wednesday, April 7th, 2010
Advocates of measures to improve the efficiency of health care have been advocating electronic prescribing for many years, and if recent efforts in this area are anything to go by, as many as 75% of doctors might be using e-prescriptions in just five years. E-prescriptions are paperless prescriptions, written electronically by your doctor and sent electronically to your pharmacy. No print-outs are involved at all – your doctor doesn’t print you a copy, and a copy isn’t faxed to your pharmacy. All the work is done electronically.
What Are the Benefits of Electronic Prescriptions?
Adopting an e-prescribing system has a number of benefits for both doctors and patients. The system is more efficient, potentially saving millions of dollars in health care expenditure, and meaning shorter waits for people getting prescriptions filled. More importantly, it could completely eliminate the harmful errors that can result when a doctor’s handwriting is misread by a pharmacist. (more…)
Wednesday, September 16th, 2009
President-elect Barack Obama should take note – health reform is about the little things just as much as it is sweeping changes to the system.
Information gathered from a batch of more than 8,500 meetings held around the country in December will be compiled and used to help design the healthcare proposal that has been in the news as of late. Obama’s transition team plans to post some of the material at change.gov.
One particular meeting took place late December 2008, between newly appointed secretary of health and human services, the former Senate Majority Leader Tom Daschle, and more than two dozen seniors During this meeting, seniors told Daschle that they placed more importance on certain things such as waiting times to see their doctor, the increasing cost of prescription drugs, and the narrow range of Medicare coverage for certain medical procedures, equipment, and treatments.
Friday, August 21st, 2009
It’s not just the unemployed facing healthcare insurance problems, according to a new Robert Wood Johnson Foundation report compiling research carried out by the State Health Access Data Assistance Center at the University of Minnesota. Nearly 20% of American workers have no health insurance, up from around 14% in the mid-1990s.
During the mid-1990s, one in seven American workers had no insurance. Just ten years later, that figure has increased to one in five workers uninsured, or around six-million more people over the mid-1990s total.
Thursday, March 5th, 2009
Fibromyalgia is a devastating disease that causes chronic pain and other symptoms for those who are affected – but it’s a disease with no known cause and no standard treatment. Many people haven’t even heard of the condition, but if that’s the case it’s not because the drug industry isn’t trying hard enough.
Drug Companies’ Hundreds of Millions Help Raise Awareness of Fibromyalgia
Last year, drug industry giants Pfizer and Eli Lilly spent hundreds of millions of dollars in advertising to “raise awareness” of fibromyalgia. The companies donated more than six million dollars to non-profit organizations for educational campaigns and medical conferences, too.
That’s more than the companies donated for Alzheimer’s, and diabetes. And only donations made for cancer, depression, and AIDS were higher than the donations made to further the cause of fibromyalgia.
Wednesday, October 29th, 2008
Many of us rarely ponder what our health and life are worth. It’s often assumed that life is priceless, but that doesn’t do justice to the stratospherically rising health care and insurance costs; in fact health bills are now the leading cause of bankruptcy.
One common way to calculate the value of our life is to use the same equation used by many health care providers. That cost was once $50,000 per year of quality life, according to the international standard for government-run health insurance plans across the globe. This number has been disputed by economists at Stanford and they were able to calculate that a year of quality life is actually $129,000! That is a lot of money for a year of life, but of course: life is priceless!