Thursday, October 19, 2017

$2.4 Million In Medicare Parts A & B Payments Made To Dead People

BY: Ali Meyer
October 19, 2017 11:30 am

Agency has not yet recouped millions in improper payments

The Centers for Medicare and Medicaid Services made $2.4 million in Medicare Parts A and B payments after beneficiaries died, according to an audit from the Department of Health and Human Services Office of Inspector General.

The agency is required to implement policies to prevent beneficiary payments from being made to deceased individuals and should ensure that improper payments are recouped if they are made.

"Our objective was to determine whether CMS's policies and procedures ensured that capitation payments were not made to MA [Medicare Advantage] organizations for Medicare Parts A and B services on behalf of deceased beneficiaries after the individuals' dates of death," the auditors said.

While auditors found that the agency generally had procedures in place to ensure payments were not made to dead people, they found that the agency did not recoup all of the improper payments. Auditors found that as of March 2017 the agency did not recoup $2,420,761 made to 978 dead beneficiaries.

The agency makes monthly capitation payments to MA organizations, which use the payments to cover Medicare Parts A and B services beneficiaries would normally need.

"At the beginning of each month, CMS makes a capitation payment to each MA organization to cover any medical services provided to each beneficiary in that month," auditors explain. "If CMS receives changes to beneficiary information that would alter previous monthly payments, it adjusts the applicable capitation payment."

"Such adjustments are processed retroactively to the effective date of the change and reported to the MA organizations on monthly payment reports," the auditors said.

The report found that the agency's data systems were generally effective in signaling when a beneficiary had died so that improper payments were not made.

"When CMS receives information about a beneficiary's death, CMS enters the date of death into its data systems and disenrolls the beneficiary," said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. "As OIG states in its report, CMS has extensive policies and procedures in place to ensure that capitation payments are not made to Medicare Advantage organizations after a beneficiary's date of death."

"CMS should implement system enhancements to identify, adjust, and recoup improper capitation payments in the future," Verma said, echoing the recommendations of the auditors. 

This entry was posted in Issues and tagged Government Waste, Medicaid, Medicare. Bookmark the permalink

Thank You Ms Meyer and Free Beacon.

Wednesday, October 18, 2017

Health Insurers In Pennsylvania Request Average Premium Rate Hikes of 31%


BY: Ali Meyer
October 18, 2017 5:00 am

Obamacare plan premiums may increase an average of 30.6 percent in Pennsylvania next year due to health care insurers rate hike requests, according to the state's acting insurance commissioner.

There are five health insurers that are participating in the marketplace in 2018, some of whom were approved for even higher rates. For example, Capital Advantage Assurance Company, which participates on the exchanges in the individual market in Pennsylvania, was approved a rate increase of 49.2 percent. UPMC Health Options was approved a rate increase of 41.15 percent, Geisinger Health Plan was approved a rate hike of 31.28 percent, QCC Insurance Company was approved a rate hike of 28.24 percent, and Highmark Inc. was approved a rate increase of 25.27 percent.

"Rates reflect estimates of future costs, including medical and prescription drug costs and administrative expenses, and are based on historical data and forecasts of trends in the upcoming year," the Pennsylvania Insurance Department explains. "The Department considers these factors, as well as factors such as the insurer's revenues, actual and projected profits, past rate changes, and the effect the change will have on Pennsylvania consumers."

According to the state's acting insurance commissioner, the rates were originally projected to increase by only 7.6 percent.

"It is with great regret that I must announce approved rates that are substantially higher than what companies initially requested," said Commissioner Jessica Altman. "Due to President Trump's refusal to make cost-sharing reduction payments for 2018 and Congress's inaction to appropriate funds, it is the reality that state regulators must face and the reason rate increases will be higher than they should be across the country."

[Ed; How about putting the blame where it belongs instead of dropping it on Trump for his even Starting to clean up Pelosi's horror?]

The commissioner also noted that those individuals who do not qualify for subsidies should shop off of the exchanges.

"The department worked with each of Pennsylvania's five marketplace health insurers to ensure they would offer an off-exchange only option that is not impacted by the disproportionate rate increases for on-exchange silver plans," the commissioner's office said.

These rate hikes come after the Obama administration announced a year ago that premiums for 2017 would rise by double-digits. According to the Kaiser Family Foundation, rate increases are a result of the increasing number of insurers experiencing losses on the exchanges.

"Nationwide, average Marketplace premiums for 2017 are increasing more than they have in the past two years," the Obama administration said. "For the median consumer, the benchmark second-lowest silver plan premium is increasing by 16 percent this year, before taking into account the effects of financial assistance." 

This entry was posted in Issues and tagged Health Care, Health Insurance, Pennsylvania. Bookmark the permalink.

Thank You Ms Meyer and Free Beacon.

Classical Music: Rimsky-Korsakov, Scheherazade: Gergiev Conducting the Vienna Philharmonic

An outstanding performance

20th Century Classical Music: Howard Hanson Symphony #6

Tuesday, October 17, 2017

Eugenics/Govt Healthcare Watch: In The U.K. NHS Provokes Fury With Indefinite Surgery Ban For Smokers and Obese

The Telegraph
Laura Donnelly, Health Editor 17 October 2017 • 9:00pm

The NHS will ban patients from surgery indefinitely unless they lose weight or quit smoking, under controversial plans drawn up in Hertfordshire.

The restrictions - thought to be the most extreme yet to be introduced by health services - immediately came under attack from the Royal College of Surgeons.

Its vice president called for an “urgent rethink” of policies which he said were “discriminatory” and went against the fundamental principles of the NHS.

In recent years, a number of areas have introduced delays for such patients - with some told operations will be put back for months, during which time they are expected to try to lose weight or stop smoking.

But the new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight” at all, unless the circumstances are exceptional.

The criteria also mean smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalysed before referral.

East and North Hertfordshire CCG and Herts Valleys said the plans aimed to encourage people “to take more responsibility for their own health and wellbeing, wherever possible, freeing up limited NHS resources for priority treatment”.

Both are in financial difficulty, and between them seeking to save £68m during this financial year. 

Continue Reading

Thank You Ms Donnelly and The Telegraph. 

Read more of Ms Donnelly's Healthcare reports here.

This is the road Obamacare's headed down.

Full repeal, and nothing less.

Presumption On Parade: Shrinks Take To Streets To Demand 'Narcissistic' Trump's Ouster

Seriously, where do you start with these quacks?

They of all people are accusing someone else of being a narcissist?

"Yes, in my over educated opinion, this person is broken, and it's my job to churn out billing paperwork saying so. Can I fix them? Of course not." 

Their profession itself is a Warner Brothers cartoon defining 'Narcissism'. The only things missing are Elmer Fudd, Daffy Duck, and Marvin the Martian.

New York Post
Amy Russo and Mary Kay Linge October 14, 2017

They’re not nuts about Trump.

Some 125 psychologists and other mental health professionals marched along lower Broadway Saturday to demand that President Trump be thrown out of office, based on a constitutional clause allowing presidents to be ousted when their cabinets decide they are ” unable to discharge the powers and duties” of their job.

“We can sense the power of Trump’s underlying fear that he is worthless and weak by how intensely he resists and retaliated against any criticism,” said Harry Segal, a Cornell University psychologist.

“No matter how minor, he can’t let anything go.”

Michelle Golland, also a clinical psychologist, agreed.

“We’re actually suffering from his narcissistic personality,” she said. “He has no empathy. You can feel it, the way he spoke about the San Juan mayor… She has PTSD and our president mistreats her. She is re-victimized. That is a narcissist.”

The marchers, dressed in black and wearing red plastic strips around their necks reading “Danger,’’ were led by psychologist Peter Fraenkel of City College, who carried a drum and beat out a funereal rhythm.

The psychologists and their political action committee, “Duty to Warn,’’ cites the 25th amendment which lays out the rules for removing a president from office.

Thank You Ms Russo, Ms Linge, and NY Post.

Saturday, October 14, 2017

Here's How Trump Has Silenty Gutted Obama's (Obamacare) Legacy

Hang on rate payers. Despite that Union of foot dragging K Street Pimps called Congress, it's being dealt with.

Daily Caller
Robert Donachie, Capitol Hill and Health Care Reporter
11:30 AM 10/13/2017 

President Donald Trump has surgically dismantled Obamacare over the course of his first year in office, largely under the noses of the American public, Democrats and members of his party that have spent the last nine months trying to upend the American health care system.

Over the course of his first nine months in office, he rolled back funding for a program intended to help individuals navigate the insurance marketplace, signed an executive order to allow for groups to purchase insurance across state lines and stopped federal funding for Obamacare subsidies.

Taken in tandem, it appears the administration is working to overhaul the American health care system without the help of Congress, a body that has failed a handful of times to repeal and replace Obamacare during the first months of Trump’s presidency.

Each of these actions has a significant impact on the viability of the current health care system.

Obamacare Subsidies

The Trump administration announced late Thursday evening that it will no longer fund a crucial feature of Obamacare that helps low-income Americans purchase health insurance on the Affordable Care Act state exchanges, known as cost-sharing reductions.

“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” the White House said in a statement. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”

Under the leadership of former Speaker John Boehner, the House filed suit against the Obama administration in 2014, claiming it was illegally reimbursing marketplace insurers for CSRs.

Obamacare subsidies were instituted to help low and moderate income individuals who participate in the exchanges. To make consumers put more “skin in the game,” Obamacare effectively raised deductibles to levels that are tough for many Americans to meet without some financial support. CSRs were put in place to help compensate insurance companies for coinsurance, co-pays and deductibles that low-income consumers could not otherwise pay out on their own.

Boehner, along with House leadership, felt that CSRs required an annual appropriation approved by Congress. The House argued that because Congress had never explicitly appropriated the funds for those payments, the administration’s actions were unconstitutional. After nearly two years of deliberation, Senior Judge of the U.S. District Court for the District of Columbia Rosemary M. Collyer concluded the House’s claim had legal standing and allowed the case move forward on May 12, 2016.

Over the course of the past 16 months, the Obama and Trump administrations have kicked the court hearing back. For those that side with Republicans, a troubling result of the appeal and numerous delays is that CSRs are still funded as they were when the Obama administration first appealed. Trump’s move Thursday essentially ends the debate, unless Congress chooses to act.

One of the glaring problems with abruptly stopping CSR payments is that it will likely lead to skyrocketing premiums for Obamacare enrollees. Roughly half of the consumers who purchase health insurance through Obamacare qualify for cost-sharing reductions

Consumers are already facing double-digit premiums under Obamacare, but stopping the subsidies for insurance companies means the costs that insurers are not getting covered from the government will get transferred to the consumer.

When insurance providers signaled they would drop out of the Obamacare market altogether in 2017, one of their primary concerns was whether or not Trump would continue paying out these subsidies.

The federal government was slated to pay out around $7 billion in CSRs in 2017. Obamacare consumers saw their out-of-pocket costs lower by over $1,000 through these subsidies.

Congress could still act on the 2014 lawsuit and stymie Trump’s move. If they do not, Obamacare customers are likely to see their premiums and out-of-pocket costs soar in the future.

Obamacare Navigator Funding

The Trump administration has argued that many of the Obamacare programs are merely a superluous use of time and resources, including the navigator program. As such, the administration announced in September that it would cut some of the navigator program’s funding by as much as 90 percent.

Obamacare navigators are individuals that help consumers and businesses seek and obtain health insurance plans that meet their specific needs. They also provide outreach and educational assistance surrounding the health care marketplace.

Over 70 percent of regional programs and 55 percent of statewide navigators anticipate rolling back programs in rural areas because of the administration’s funding cuts, Kaiser Family Foundation reports. The overwhelming majority, or 89 percent, of navigators expect having to fire staff because of the cuts.

Cuts to navigators are important in that the Obamacare marketplace can be difficult to navigate, even for an experienced consumer.

The majority of navigators, despite the cuts, plan on participating in the market in 2018.

Executive Order

Trump signed an executive order Thursday that charged a number of federal agencies with finding ways to expand access to health insurance plans that are outside of Obamacare regulations. The order relaxes the rules and regulations surrounding association health plans — groups of small businesses (and possibly individuals) that join together to purchase insurance. The order would also allow these groups to purchase insurance across state lines.

“With these actions … We are moving toward lower costs and more options in the health care market, and taking crucial steps toward saving the American people from the nightmare of Obamacare,” the president said Thursday.

“This will direct [agencies] to take action to increase competition, increase choice, and increase access to lower-cost, high-quality health-care options,” Trump added. “This will cost the United States virtually nothing, and people will have great, great health care.” 

One of the main criticisms this order will face is that it will create a bifurcated insurance marketplace, where healthy people and small business purchase health insurance through association plans and older, sicker individuals purchase from the Obamacare state exchanges. One group is comprised of healthy, low-risk people and they have low premiums, while the Obamacare marketplace is left with a lot of sick folks and thus charge higher premiums.

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Thank You Mr. Donachie, the DC, and above all, President Trump.

Here We Go Again: People DIAGNOSED As Bipolar or Schizophrenic Have Higher Mortality Rates Than Those Not Yet Diagnosed

Here's the summary at

Here's the paper it's drawn from.

Social Justice.

The more of it you create the more 'Mental Illness' you create. The two go hand in hand. When you grant special people special rights you deprive other, non-special people of their rights, and Bingo, the unhappiness/depression index skyrockets.

Or, as the old German maxim would have it:

The more laws, the less justice.

This is the State empowering Godless Narcissists (which makes them as Diagnosably NUTZ as any of the people they work over) who've bought a State Approved Work License to peddle made up Labels for Diseases which aren't Diseases, Drugs, Real Diseases, Violence and Death.

And scads of billable hours of collectivist bait and switch bullshit from 'roid warming 'Therapists' who sit scribbling down ideations into folders to make sure their billing paperwork doesn't bounce.
Most of America, when it pays attention at all, focuses on the criminal drug cartels in Mexico, instead of the global Drug Cartels underwriting the above.