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D.C. Week: Lawmakers Talk Health Before Heading Out — Focus is on Medicare Advantage Plan Cuts under the ACA
WASHINGTON — Members of Congress tackled several health-related issues this week before leaving the nation’s capital and hitting the campaign trail for a final election push.
Democrats and Republicans traded jabs this week on health reform’s impact on Medicare Advantage plans, with one side praising the law’s effects and the other predicting it will hurt the program.
The Obama administration reported that the Affordable Care Act (ACA) has strengthened Medicare Advantage. Since the ACA was passed in 2010, Medicare Advantage premiums have fallen by 10% and enrollment has risen by 28%, according to a statement from the Department of Health & Human Services (HHS).
HHS also projected enrollment to increase 11% in the next year with premiums remaining steady.
But Republicans in the House of Representatives held a hearing Friday on Medicare Advantage plans and took the opportunity to bash cuts in the plan under the ACA saying it will negatively impact enrollment and benefits for seniors.
See on www.medpagetoday.com
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CMS Press Release: Medicare Advantage Program is projected to remain strong with an increase of 11% for 2013
Enrollment in the Medicare Advantage (MA) program is projected to increase by 11 percent in the next year and premiums will remain steady, Health and Human Services Secretary Kathleen Sebelius announced today. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent.
“Thanks to the Affordable Care Act, the Medicare Advantage and Prescription Drug programs have been strengthened and continue to improve for beneficiaries,” said Secretary Sebelius. “Since the law was enacted in 2010, average premiums have gone down, enrollment has gone up, and new benefits and lower drug costs continue to help millions of seniors and people with disabilities.”
For the third year in a row, the Centers for Medicare & Medicaid Services (CMS) used authority provided by the Affordable Care Act to protect beneficiaries from significant increases in costs or cuts in benefits. Access to supplemental benefits remains steady and beneficiaries’ average out-of-pocket spending remains constant.
The average MA premium in 2013 is projected to increase by only $1.47 from last year, coming to $32.59. However, if beneficiaries choose lower cost plans at the same rate in 2013, as they did in 2012, the average premium is expected to increase by only 57 cents. Access to the Medicare Advantage program will remain strong, with 99.6 percent of beneficiaries having access to a plan. Additionally, the number of plan choices will increase by 7 percent in 2013.
Last month, CMS announced that the average estimated basic Medicare prescription drug plan premium was projected to be $30 in 2013, holding steady from last year. Today’s projections show that access to a Medicare prescription drug plan will remain strong in 2013. Everyone with Medicare will have access to a wide range of plan choices.
The Annual Open Enrollment Period for health and drug plans begins on October 15 and ends December 7.
See on www.cms.gov
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For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
HCA Probe Spotlights Cardiologists’ ’Irresistible Temptation’ – HealthLeaders Media
Physicians specializing in cardiology coined the term “oculostenotic reflex” over a decade ago. But the phrase has been popping up this month in conversations about accusations that thousands of patients underwent inappropriate heart procedures at HCA hospitals in Florida and in three other states, the subject of a federal probe.
Writing in the journal Circulation in 1995, Eric Topol, MD, and Steven Nissen, MD, described this phenomenon as “an irresistible temptation among some invasive cardiologists to perform angioplasty on any significant residual stenosis after thrombolysis”—that is, after clot-busting medications have been used.
Nissen and Topol wrote that while professional organizations don’t support this practice, “the ritual of reflex angioplasty is exercised thousands of times each year.”
See on www.healthleadersmedia.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: Eight Individuals and a Corporation Convicted at Trial in South Florida in $50 Million Medicare Fraud
Eight individuals and a Miami-based corporation were convicted by a federal jury for their participation in a Medicare fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.
Antonio Macli, the owner of Biscayne Milieu Health Center Inc., a mental health care corporation, his son Jorge Macli, Biscayne Milieu’s CEO, and Antonio Macli’s daughter Sandra Huarte, an executive at the company, were each found guilty in U.S. District Court for the Southern District of Florida of one count of conspiracy to commit health care fraud, and one or more substantive counts of health care fraud, conspiracy to commit a health care kickback scheme and conspiracy to commit money laundering and substantive counts of money laundering. Antonio Macli and Jorge Macli were also convicted of substantive kickback counts. Dr. Gary Kushner, the medical director at Biscayne Milieu, was found guilty of conspiracy to commit health care fraud and a substantive count of health care fraud. Rafael Alalu, a therapist, and Jacqueline Moran, who handled Medicare billing for Biscayne Milieu, were each found guilty of conspiracy to commit health care fraud and substantive counts of health care fraud. Anthony Roberts and Derek Alexander, two patient recruiters, were each found guilty of one count of conspiracy to commit a health care kickback scheme, and each was convicted of one health care kickback count.
The defendants were charged in a superseding indictment returned June 5, 2012. Twenty other individuals who worked at Biscayne Milieu have all previously pleaded guilty.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
JAMA Forum: A Tale of 2 Health Plans
Consider 2 plans for health coverage.
In plan No. 1 (the ACA), the approach is to help everyone under the age of 65 years who doesn’t have insurance coverage. Everyone who is really poor is offered Medicaid. Everyone else will be put into a regulated market.
In plan No. 2 (the Romney plan for Medicare), the approach is to change the way everyone over the age of 65 years gets health insurance. Everyone who is really poor is offered Medicaid. They—along with everyone else—will also be put into a regulated market.
The differences between the end points of the ACA and the Romney plan for Medicare are shockingly similar. With enough tweaks and some serious efforts at compromise, one could be accepted in exchange for the other. The powers of both competitive bidding and regulatory reform could be used.
We could stop demonizing the other side for trying to “end America” by seeking results that aren’t much different from our own.
I’m not optimistic. It’s an election year. And despite protestations that good policy is the goal, it seems far too often that politicians care more about winning elections than about Americans winning a better health care system.
See on newsatjama.jama.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
US Attorney’s Office – W. Dist. MO: Psychologist Pleads Guilty To $1 Million Health Care Fraud
David M. Ketchmark, Acting United States Attorney for the Western District of Missouri, announced today that a psychologist practicing in the Lebanon, Mo., area pleaded guilty in federal court today to engaging in a $1 million scheme to defraud Medicare and Medicaid.
Rhett E. McCarty, 67, of Lake Ozark, Mo., pleaded guilty before U.S. District Judge Howard F. Sachs to health care fraud and to forgery.
McCarty is a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area.
Between Sept. 17, 2008, and April 5, 2012, McCarty submitted Medicare and Medicaid claims for daily or near daily psychotherapy services to 19 beneficiaries for which he was paid $1,276,334. Although McCarty did provide some services for most of these beneficiaries, he admitted that he did not see those beneficiaries more than once a week. McCarty also admitted that, based on an estimate of the services he did provide, the amount he was paid by Medicare and Medicaid for services he did not provide to these 19 beneficiaries was $1 million.
McCarty also admitted that he forged (or caused another person to forge) the signatures of five of the beneficiaries on patient sign-in sheets in order to obtain $418,507 in Medicare and Medicaid payments.
By pleading guilty today, McCarty must forfeit to the government $1 million, which represents the proceeds of the fraud scheme.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
US Attorney’s Office – Idaho: Caldwell Optometrist Pleads Guilty To Defrauding Health Care Benefit Progtams
BOISE – Christopher Card, 59, of Caldwell, Idaho, pled guilty in United States District Court today to a superseding information charging him with one count of executing a scheme to defraud health care benefit programs, U.S. Attorney Wendy J. Olson announced. Card is a licensed optometrist in Idaho and the former owner, manager and care provider at Total Vision, P.A., in Caldwell.
According to the plea agreement, on various dates between 1993 and August 31, 2010, Card executed a scheme to defraud Idaho Medicaid, Medicare, Blue Cross of Idaho, Regence Blue Shield of Idaho, and the Rail Road Retirement Board (RRB), by making false statements, and by submitting false, fraudulent, and fictitious claims for reimbursement to these health care benefit programs. The total loss to the health care benefit programs and the restitution agreed to by the parties is $1 million.
According to the plea agreement, Card fraudulently billed health care benefit programs, especially Medicaid and Medicare, for false diagnoses, including glaucoma, acquired color deficiency (color blindness), tension headaches, macular degeneration, treatment of eye injuries and removal of foreign objects from the eye. Card billed for testing that did not actually occur and for testing results that were falsified or altered. He admitted that in late October 2008, he altered his fraudulent diagnoses and billing practices when he learned that federal and state health care fraud investigators interviewed a former employee.
According to the plea agreement, 18 patients identified in the original indictment were diagnosed by Card with glaucoma or glaucoma-related conditions. All were subsequently examined by other doctors; only one was determined to actually have the glaucoma or glaucoma related diseases that Card had diagnosed. Card falsely diagnosed the 18th patient, and others, with acquired color deficiency. According to the plea agreement, the patients named in the original indictment were not the only patients for whom Card falsely billed health insurance companies.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
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