Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts

Tuesday, October 23, 2018

How Our Government Helps Drug-Dealing Doctors Kill Us


madinamerica
Lawrence Kelmenson, MD October 21, 2018
 

Psychiatry and Pain Management’s soaring profits since 1990 were fed by a unique combination of favorable circumstances never before seen: First, they’re paid mostly by federal funds. These include Medicaid, Medicare, and tax subsidies for employer-paid healthcare. But unlike other federally subsidized industries, health industry goods and services are covered by insurance, so high costs don’t deter client use of them. Just imagine all the fine food and posh restaurants we would access if we had hunger insurance that paid for them.

Mental health and pain treaters have advantages over other industries that rely on insurance payments: Medicare and Medicaid, being federally funded, are able to spend endless public money with few restrictions on coverage, regardless of cost. For example, Medicare costs jumped after a 2008 law raised mental health reimbursement from 50% to 80%.1 Private health insurers tried to rein in rising mental health costs, but were blocked by 1996,2 2008, and 20103 parity laws that forbade mental healthcare limits, copays, deductibles, or certification requirements from being greater than for physical care. This is part of why private insurance is now so costly.

To tap into this endless money, the pain and ‘mental illness’ fields made use of another advantage: Unlike events covered by other types of insurance, an illness is an arbitrary concept. Doctors can thus broaden its definition in order to broaden their domain: It can be a subjective physical perception with no clear or treatable source. For example, chronic pain became an illness. Illnesses do not even need to be physical: Painful thoughts and feelings, and kids acting like kids, also became illnesses. This was endorsed by a 1992 law4 that granted funds for services for the ‘one quarter who will suffer from mental disorders’, and for biomedically-focused mental illness research to be done at the NIH.

So, unlike other insurers that can verify house fires, car wrecks, or death, health insurers can’t verify mental illness or pain. Unlike other MDs, psychiatrists and pain doctors can invent infinite chronic (and thus lucrative) illnesses. Each client can be labeled with many different ones; there’s no limit. And each illness can justify a doctor’s luring the patient into lifelong addiction to euphoria-giving pills.

These MDs can also pad profits by putting clients on disability: Clients will then return regularly/eternally to prove ongoing disability, to ensure that their SSD checks and food/housing/healthcare assistance continue. Since they won’t work, they’ll have the time (and health insurance) to do so. A 1984 law5 made adult disability approval hinge on subjective functional impairment instead of objective disease evidence; this made mental illness (or chronic pain) easier to get SSD for. In 1991,6 the Social Security administration made child disability also hinge on functionality instead of illness proof. Child SSI cases rose five-fold soon after, mostly for mental illness.7 So illness-creators opened doors to disability benefits as well as insurance cash; that’s convenient, since their addictive ‘meds’ make it hard to work.

Two 1990 laws8 9 specified depression, ADHD, etc.to be valid causes of disability (before then, schizophrenia was the only ‘mental illness’ considered disabling). This further eased access to SSD/SSI funds. These laws also rewarded these illnesses by making life-easing accommodations available to those who ‘have’ them. For example, Billy prefers to play video games rather than do homework. By getting him labeled ADHD, his busy parents and teachers won’t have to struggle to teach him good work habits, since he’ll now be given less schoolwork (he’ll also be drugged into submission, so he won’t need to be raised). And his label may qualify his family for SSI, Medicaid, and other benefits.

400 million addictive prescriptions are filled yearly.10 It’s caused so much addiction and overdosing, including among kids who steal their parents’ pills, that the lifespans of white Americans have dropped steadily (they use 2.5 times as many psych11 and opioid12 ‘meds’ as non-whites). Then a 2000 law13 authorized doctors to treat the addictions they caused with yet more opioids (suboxone, or prison heroin). It’s such blatant drug-dealing that this law had to be enacted to make it legal (it circumvented a 1914 law14 that criminalized the prescribing of opiates to maintain addicts’ addictions). Suboxone is often peddled at drug rehabs, where clients thus score rather than quit drugs. Since the 2008 parity law made insurers cover treatment for addiction the same as for physical illness, these rehabs make a killing.

Mental health treaters capitalized on all these favors to become our most costly healthcare sector15 and a major cause of healthcare becoming our government’s top expense and top tax subsidy. Costs of other government programs also spiked, due to mental health, pain, and addiction treaters baiting and trapping millions into reliance on Social Security and other benefits. Since 2016, Congress has had to divert funds from the SS retirement to the SS disability trust fund,16 since the latter couldn’t keep up with all its mental illness and chronic pain claimants (its main recipients17). Businesses cut full-time workers in order to avoid paying their costly healthcare as is required by law. This drove yet more people to seek federal benefits. Nearly a fourth of Americans are on Medicaid now.

Psych drug and opioid prescribers are bankrupting us and exploding our debt. We spend more on healthcare and its addictive pills than all other nations, yet are still pounded by propaganda about “millions suffering needlessly from untreated mental illness.” Things will only get worse; many more mental health laws are on the way. 18 19 20 21 22 23 24 25 26
Deja Vu

Something similar actually did occur before: The British East India Company, aided by England’s parliament which invested in it, bailed it out, and made laws giving it monopolies, dominated trade in the East in the 1700s. It helped spread British colonialism there. In the 1800s, it profited greatly by growing opium in India and selling it in China. This hurt China’s economy by siphoning its silver and turning industrious Chinese people into idle, unproductive addicts. Its emperor finally halted opium imports after his son (China’s prince) died of an overdose (as did our “Prince”). The BEIC reacted by conquering, with British assistance, all Chinese ports and nearby areas, in order to ensure continued opium selling. This began what China calls its “century of humiliation” in which a great empire was brought to its knees and subjugated by England, France, and Japan.27

Are we at the start of our own lost century, with psych pill and opioid dispensers taking on the BEIC’s role? Like our drug-dealing doctors, it succeeded largely due to close alliance and support from its government every step of the way. The only difference is: Our own healers and leaders are killing us!


Show 27 footnotes

Previous articleMr. Rogers, Trauma-Informed Care, and the Limits of Information
Next articleNew Report Points to Gaps in the Evidence for Pediatric Bipolar Disorder
Lawrence Kelmenson, MD


Lawrence Kelmenson has practiced psychiatry for 32 years, working with children, adults, and families. He graduated medical school from State University of New York, and completed psychiatric residency training at Cornell. He then became staff psychiatrist, and later medical director, of Craig House Hospital in Beacon, New York until 2000, and has since conducted a psychotherapy-based private practice in Cold Spring, New York. 


Thank You Dr Kelmenson and MIA.

Monday, September 17, 2018

Trump Gets Behind Senate Bill That Would End Gag Orders Against Pharmacists Sharing Money-Saving Info

dailycaller
Evie Fordham | Politics and Health Care Reporter
 
President Donald Trump got behind a bill ending pharmacist gag clauses the Senate is set to vote on Monday afternoon.

“Americans deserve to know the lowest drug price at their pharmacy, but ‘gag clauses’ prevent your pharmacist from telling you!” Trump tweeted Monday afternoon about the Patient Right to Know Drug Prices Act. “I support legislation that will remove gag clauses and urge the Senate to act.”
He accompanied the message with the hashtag “#AmericanPatientsFirst.”

Currently, insurers and pharmacy benefit managers use the gag clauses to “forbid pharmacists from proactively telling consumers if their prescription would cost less if they paid for it out-of-pocket rather than using their insurance plan,” according to a press release from Maine Republican Sen. Susan Collins, one of the bill’s authors.
The bill would lead to “a slight decrease in federal revenues,” according to the Congressional Budget Office, but that could be offset by another provision in the bill, reported Politico. Collins’s bill also targets “pay-for-delay,” a tactic where a brand drug company pays a generic manufacturer to withhold a product that would compete with the brand drug for market share. Closing this loophole could save consumers and taxpayers money, according to the Federal Trade Commission.

The bill’s other authors are Republicans Sens. John Barrasso of Wyoming and Bill Cassidy of Louisiana, as well as Democratic Sens. Claire McCaskill of Missouri and Debbie Stabenow of Michigan. (RELATED: StudySeniors Should Think Twice Before Reaching For The Aspirin Bottle)

The Senate has already approved a similar measure that applies to gag clauses as they apply to drugs needed by in Medicare Part D and Medicare Advantage participants, reported the Washington Examiner.

Follow Evie on Twitter @eviefordham.
Send tips to evie@dailycallernewsfoundation.org.

Content created by The Daily Caller News Foundation is available without charge to any eligible news publisher that can provide a large audience. For licensing opportunities of our original content, please contact licensing@dailycallernewsfoundation.org.

Tags : donald trump medicare part d susan collins 


Thank You Ms Fordham and the DC.

Saturday, August 18, 2018

Democratic Socialist Ocasio-Cortez Bans Media From Town Hall Events


Natalia Mittelstadt | August 17, 2018 | 5:02 PM EDT

Alexandria Ocasio-Cortez, the 28-year-old Democrat congressional candidate for New York’s 14th district, banned the media from her “listening tour” events at Corona on Sunday and the Bronx last Wednesday, according to Queens Chronicle.

The press ban came after a Bronx community meeting Ocasio-Cortez had last Tuesday with healthcare activist Ady Barkan. Ocasio-Cortez’s campaign manager, Virginia Ramos Rios, said that they were “mobbed” by reporters, “even though we said no Q&A and no one-on-one [interviews].”

“We wanted to help create a space where community members felt comfortable and open to express themselves without the distraction of cameras and press. These were the first set of events where the press has been excluded,” said Ocasio-Cortez’s campaign spokesman, Corbin Trent. “This is an outlier and will not be the norm. We’re still adjusting our logistics to fit Alexandria’s national profile.”

According to Ocasio-Cortez’s Twitter, the “listening tour” events are “intended for lively, compassionate discourse with a diversity of viewpoints.” 



 

She tweeted that, at the Corona event, she and the attendees “talked about race, immigration, healthcare, disability rights and housing.”

Ocasio-Cortez, who says she is a Democratic Socialist, supports, among other things, Medicare for All, a Federal Jobs Guarantee, Abolish ICE, Support LGBTQIA+, Gun Control, a Peace Economy, End Private Prisons, and Mobilizing Against Climate Change.


Thank You Ms Middlestadt and CNS. 







Friday, December 15, 2017

Medicare Fails To Recover Hundreds of Millions of Dollars In Lab Overcharges

Kaiser Health News
Fred Schulte December 15, 2017

Five years ago, Companion DX Reference Lab hoped to cash in on cutting-edge genetic tests paid for by Medicare.

The Houston lab marketed a test to assess how a person’s genes affect tolerance for drugs such as opiates used to treat chronic pain. It also ran DNA tests to help treat cancer and urine screens to monitor drug abuse.

But the lab went bust last year after Medicare ordered it to repay more than $16 million for genetic tests health officials said were not needed.

Companion Dx is one of at least six clinical labs mired in bankruptcy court after Medicare alleged they improperly billed the government for unnecessary urine, genetic or heart disease tests expected to cause hundreds of millions dollars in losses to taxpayers, an investigation by Kaiser Health News found.

KHN INVESTIGATION

Liquid Gold: Pain Doctors Soak Up Profits By Screening Urine For Drugs

As the nation’s bill for drug and genetic tests has climbed to an estimated $8.5 billion a year, there’s mounting suspicion among health insurers that some testing may do more to boost profit margins than help treat patients.

Medicare has slashed fees for urine tests and tightened coverage of some genetic screens, which can cost Medicare $1,000 or more per person. Private insurers, who mostly have paid these bills without question, also are taking a more penetrating look at spending on the controversial lab work.

Yet, getting these firms to repay Medicare and private insurers remains a formidable challenge. While some doctor-owned labs have dodged collection efforts for years, several testing firms deeply in debt to Medicare appear to have few assets to repay overcharges dating back years, court records show.

“Medicare shouldn’t be paying for dubious tests, but the time to catch that is in the very beginning when [labs] are asking for payment,” said Steve Ellis, vice-president of Taxpayers for Common Sense, a budget watchdog group. “They need to increase oversight so the dollars don’t go out the door in the first place.”

Continue Reading.

Thank You Mr Schulte and KHN.

Wednesday, December 6, 2017

Opiod Deaths At Hospitals Quadruple, Fueled By Medicare Patients

dailycaller
Steve Birr Vice Reporter
3:36 PM 12/05/2017

The death rate for people hospitalized for an opioid-related condition soared over the past 15 years, fueled in large part by an increase in Medicare patients.

A report from Health Affairs released Monday revealed the opioid death rate in hospitals more than quadrupled between 2000 and 2014, despite the number of overall hospitalizations related to opioids remaining relatively flat. The death rate of patients from other drugs also remained largely unchanged over this period. The death rate increase is due to a shift in the nature of opioid hospitalizations, reports CNBC.

Hospitalizations for opioid poisoning rose over the researched period, while ones for opioid dependence or abuse fell. Patients increasingly came in with more serious addictions and exposure to substances like heroin and synthetic opioids like fentanyl. The researchers found in 2014 there were roughly 20.2 deaths per 1,000 hospitalizations related to opioids, up from only 4.3 per 1,000 hospitalizations in 2000.

Dr. Zirui Song, an assistant professor from Harvard Medical School who authored the report, found whites and low income individuals were the most likely to be hospitalized for opioid related conditions. Song noted that “people enrolled in Medicare, not those in Medicaid, accounted for the fastest-growing share” of hospitalizations from opioids.

“Medicare beneficiaries went from the smallest proportion of [opioid-related] hospitalizations in the 1990s to the largest share by the mid-2000s,” Song said in the report, according to CNBC.

Song says the troubling increase of opioid-related hospital deaths is driven by the national epidemic, which killed 64,070 Americans in 2016, according to the Centers for Disease Control and Prevention.

President Donald Trump declared the opioid epidemic a “public health emergency” Oct. 26, giving states hit hard by opioid addiction flexibility on how they direct federal resources to combat rising drug deaths.

Drug overdoses are now the leading cause of accidental death for Americans under 50.

Data from the National Institute on Drug Abuse released Sept. 7 predicts the addiction epidemic in America will continue to deteriorate, pushing drug deaths to an estimated 71,600 in 2017. If the estimates prove accurate, 2017 will be the second year in a row that drug deaths surpass U.S. casualties from the Vietnam War.



Thank You Mr Birr and the DC.

Monday, January 9, 2017

Price's Appointment (HHS) Boosts GOP Plans To Overhaul Medicare and Medicaid

Kaiser Health News





President-elect Donald Trump’s selection of Rep. Tom Price to head the Department of Health and Human Services signals that the new administration is all-in on both efforts to repeal the Affordable Care Act and restructure Medicare and Medicaid.

Price, a Georgia Republican who currently chairs the House Budget Committee, was among the first to suggest that not just the ACA but also Medicare are on the near-term agenda for newly empowered Republicans.

Privatizing the Medicare program for seniors and disabled people and turning the Medicaid program for the poor back to the states are long-time goals for Republicans in Congress and the White House. They say the moves could help put the brakes on health spending. Opponents argue, however, that both changes are aimed instead at shifting the financial burden of health care from the federal budget to states and individuals.

That question — should the federal government continue to provide open-ended health benefits? — could prove to be a key battle line.

Democrats and consumer advocates say the changes would break a promise to guarantee health services made when Medicare and Medicaid were enacted in 1965.

“That is the explicit intent of these proposals, to cap liability and shift costs,” said Edwin Park of the left-leaning think tank the Center on Budget and Policy Priorities.

Len Nichols of George Mason University agreed: “It’s about fixing the growth rate so they can be certain of a lower federal commitment to health care.”

Republicans, however, say in the face of rising federal deficits, it would be irresponsible not to rein in the programs’ spending.

“We have a moral obligation to the country to do this,” House Speaker Paul Ryan told the New York Times in 2011, when he first proposed the plans as chairman of the House Budget Committee.

Medicare, which covers roughly 57 million elderly and disabled Americans, and Medicaid, which covers more than 77 million people with low incomes, are among the biggest items in the federal budget, together costing an estimated $1 trillion in 2016, according to the Congressional Budget Office.

And, more importantly, both programs are expected to keep growing, consuming ever more of the budget. According to the CBO, over the next 30 years, the percentage of federal spending claimed by the major federal health programs (primarily Medicare and Medicaid) is expected to rise from just over 6 percent to more than 10 percent.

“By reforming these programs in the future, we can preserve them for the present,” said Ryan in another 2011 interview.

Both GOP proposals for the major medical entitlement programs date back decades.

Proposals to replace the open-ended Medicaid program, in which the federal government matches whatever states spend, with a block grant that would limit the federal government’s financial responsibility first surfaced in the early 1980s, during the Reagan administration. When Republicans took over Congress in 1994, the idea reemerged, was passed and sent to President Bill Clinton, who vetoed it. President George W. Bush revived the idea again in 2003, but he could not get Congress to act on it.

The latest version of the proposal offered by House Republicans would give states the option of modifying the plan so that the federal payments to states would be based on a per capita funding formula.

A number of Republican governors have supported the idea, because the program would generally relieve states from rules governing who and what to cover in Medicaid in exchange for accepting limited funding.

But advocates for the poor say it would lead to fewer people getting fewer services. Because the federal contribution proposed by Ryan is specifically set to increase more slowly than predicted inflation in health care, “states could either contribute much more to their Medicaid programs, or, more likely, use that flexibility to make deep cuts to the program,” said Park.

A 2012 estimate from the Urban Institute said that year’s proposal could result in 17 million people losing coverage, and payments to health care providers could be cut by nearly a third.

Thomas Miller of the conservative American Enterprise Institute says more recent proposals have gotten less draconian. “It’s gotten a little better because as opposed to a big block grant, it’s gone to the per capita allotments” that would be based on the number of people enrolled in the program.

Park of the CBPP said that would be better than simply giving states a single pot of money. With a per-capita cap, the federal contribution would rise as more people are added to the program. But the cuts would still be deep, he said, because “you’re achieving similar savings by slashing spending per beneficiary.”

In Medicare, the concept of “premium support,” which would give enrollees a set amount of money to spend on the health plan of their choice, emerged in the mid-1990s. The original proposal was geared to using competition to slow the growth of Medicare spending.

But later iterations of the Medicare proposal would increase contributions intended to pay for insurance more slowly than the expected rate of health inflation. That means that instead of covering the government’s share of a set package of benefits, what is currently referred to as Medicare’s defined benefit, the program would instead pay a specific amount, often referred to as a defined contribution, that might not be able to pay for those benefits.

“Right now, the federal government says you pay [a set share] of those costs” through Medicare premiums, deductibles and co-pays and beneficiaries get government funding to cover guaranteed benefits in return, said Park. “Under premium support there would no longer be that guarantee and there would no longer be a defined set of benefits.”

Miller of AEI said any effort to push these GOP plans for Medicare and Medicaid will run into stiff headwinds — even in a Republican-controlled Congress — because it’s difficult to take something away from people.

Congress can’t simply cut the programs, he said. “You have to tell people why you’re doing this. You have to say this is actually going to improve the health care system.”

Categories: Medicaid, Medicare, Syndicate, The Health Law

Tags: U.S. Congress


Thank You Ms Rovner and KHN. 

Thursday, August 13, 2015

Half Of U.S. Hospitals Face Readmission Penalty

Only Half? Oh, wait. The majority of the 2,232 who escaped penalties had automatic Exemptions

fiercehealthcare
Kaiser Health News analysis shows hospitals will lose a combined $420 million beginning in October

Most hospitals will face some sort of Medicare penalty for excessive 30-day readmissions, losing a combined $420 million in the fourth year of the federal readmission reduction program, according to a Kaiser Health News analysis.
Beginning in October, 2,592 hospitals will receive lower payments for Medicare patients that stay in the hospital, whether or not they are readmitted, according to KHN. The fines are based on readmissions between July 2011 and June 2014 for Medicare patients who were hospitalized due to a heart attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacements.
The KHN analysis found that Medicare fined a hospital if it had a higher number of readmissions than the agency deemed appropriate based on the hospital's mix of patients and how the hospital industry performed overall.
The report also reveals that: 
  • The average Medicare payment reduction is 0.61 percent per patient stay
  • Thirty-eight hospitals will receive the maximum cut of 3 percent
  • A total of 506 hospitals will lose 1 percent or more of their Medicare payments
  • All but 209 of the hospitals penalized in this round were also punished last year
The lower payments will impact three-quarters of hospitals in Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York and Rhode Island, according to the analysis.
The majority of the 2,232 hospitals that escaped Medicare penalties were automatically exempt because they specialize in certain types of patients, were designated as critical access hospitals or didn't have enough cases for an accurate assessment, the article said.
Although hospitals have been lobbying for changes in the Hospital Readmissions Reduction Program to penalties for readmission factors beyond their control, the Centers for Medicare & Medicaid services said in a final rule released last week that it would not make unilateral changes in the program because some safety-net hospitals are able to keep readmissions rates low.
The agency said in the rule that it doesn't want to hold hospitals to different standards for the outcomes of their patients of low sociodemographic status because it does't want to "mask potential disparities or minimize incentives to improve the outcomes of disadvantaged populations."
To learn more:
- read the KHN analysis
- here's the final rule

Thank You Ms McDonald and fiercehealthcare.

Saturday, May 31, 2014

Obama Quietly Issues Rule Paving Way For Sex-Change Operations Through Medicare

Build a Base - Buy a Vote. No matter How small a percentage of the populace this will buy, when it's Other People's Money, . . Just Waste It.
weaselzippers;
Obama Quietly Issues Rule Paving Way For Sex-Change Operations Through Medicare


And they don’t think anyone will have a problem with this?
WASHINGTON — In a relatively quiet announcement Friday, the Obama administration struck a major blow for transgender rights by ending a decades-long blanket ban that prevented Medicare from covering sex reassignment surgery.
The Department of Health and Human Services’ Departmental Appeals Board, an internal review structure within the byzantine federal agency, issued a ruling that ended a ban on Medicare even considering covering sex reassignment surgery and related care because a fear of “serious complications” resulting from the “experimental” surgery. That language was issued in 1981, and most medical professional organizations now consider sex reassignment surgery a safe and accepted procedure. The DAB ruling noted the change in how sex reassignment surgery is understood 33 years after the Medicare ban was issued.
“Even assuming the [National Coverage Determination]’s exclusion of coverage at the time the NCO was adopted was reasonable, that coverage exclusion is no longer reasonable,” reads the ruling. “This record includes expert medical testimony and studies published in the years after publication of the NCO.”
Experts say the change to Medicare could have far-reaching implications for American medicine, helping to drive more private insurers to offer coverage for sex reassignment surgery and related care. Though it fits within President Obama’s promise to make the government fairer to LGBT Americans, the DAB announcement was a relatively quiet one. The White House did not trumpet the move, and advocates for the change issued a joint statement hailing it but downplaying it as a revolutionary change for transgender people, instead casting it as bringing Medicare up to speed with the rest of the medical profession.
“This decision removes a threshold barrier to coverage for medical care for transgender people under Medicare,” leaders of the ACLU, Gay & Lesbian Advocates & Defenders and the National Center for Lesbian Rights — the groups that fought for the change — said. “It is consistent with the consensus of the medical and scientific community that access to gender transition-related care is medically necessary for many people with gender dysphoria.”

Thank You Mr McMorris Santoro and Zip. 

Tuesday, April 15, 2014

CA Hospitals Overbilled Medicare By $367 Million

FierceHealthFinance;
CA Hospitals Overbilled Medicare By $367 Million

Auditors miffed about claims hiatus in SGR patch bill



California's hospitals received nearly $367 million in Medicare overpayments in 2012, primarily for inpatient services, the San Francisco Business Times reported.

The overpayments in California were part of $2.4 billion in alleged mispayments involving hospitals from two years ago, according to data supplied by the Centers for Medicare & Medicaid Services (CMS).

Overall, CMS believes the hospitals received $2.3 billion in overpayments and about $109 million in underpayments. California, which had the nation's highest total of excess payments, represents about 10 percent of the U.S. population but about 15 percent of the overpayments. Its total was more than double that of New York and nearly triple that of Florida.


Although the numbers reported by recovery audit contractors are large, theBusiness Times noted that the 18-month hiatus on claims audits that was included in the recent patch to the sustainable growth rate (SGR) formula complicates ongoing follow-up. Congress lumped in the auditing hiatus, along with a delay in the implementation of ICD-10, in its annual SGR patch bill when a permanent fix to SGR collapsed over objections to the insertion in legislation of a delay for the individual mandate to purchase health insurance. However, CMS did expand the overall authority of auditors to deny claims.

Nevertheless, the hiatus also has the auditor community riled up--and conflicted.
"Our members vehemently oppose this oversight holiday," said Becky Reeves, a spokeswoman for the American Coalition for Healthcare Claims Integrity (ACHCI), which represents recovery audit contractors, Medicare audit contracts and zone program integrity contractors. However, individual auditing organizations can't comment on the hiatus due to contracts they signed with CMS to provide services, according to the Business Times.

The hiatus could potentially keep ongoing waste in the Medicare program from going unchecked, the ACHCI suggested in a statement.

However, David Sayen, California's regional CMS administrator, told the Business Times that the hiatus is a sign that the agency's auditing program actually works.

To learn more:
- read the 
San Francisco Business Times article
- here's the CMS 
report (.pdf)
- check out the ACHCI 
statement

Related Articles:
House approves temporary SGR fix
CMS expands contractors' claims denial authority
Medicare RACs recoup $2.4B in overpayments in nine months
Congress demands RAC reform
OIG blasts Medicare, RACs for weak oversight
CMS to suspend RAC requests


Thank You FierceHealthFinance and Mr Shrinkman.

$367 Million seems a bit low to us, . . . but, . . . . oh well, . . . those numbers Must be right if they came from CMS.

also from Mr Shrinkman back in 2012:

Medicare Fraud Detection System Disappoints

"A computer initiative to stop fraudulent Medicare billing at the point of claims submission has so far been a disappointment, reported the Associated Press.
To date, the $77 million computer system, which went online in mid-2011, had prevented exactly one bad claim by late last year. That totaled $7,591."



Wednesday, September 18, 2013

OIG Blasts Medicare, RACs For Weak Oversight

fierce health finance has;
OIG Blasts Medicare, RACs For Weak Oversight
September 6, 2013 | By 


The Office of Inspector General has been critical of Medicare oversight in previous reviews, and Tuesday's report is no different. This week, the OIG claimed the Centers for Medicare & Medicaid Services may not be catching all overpaid claims and therefore allowing high amounts of improper payments to persist, MedPage Today reported.

The report found problems with CMS' action--or inaction--regarding improper payment vulnerabilities and referrals for potential fraud, as well as with RAC performance evaluations.

Medicare recovery auditors (RACs) reviewed 2.6 million claims in fiscal years 2010 and 2011 and identified roughly half of the claims with improper payments totaling nearly $1.3 billion.

While CMS identified 46 vulnerabilities that resulted in improper payments, it only took corrective action to address 28 of them and failed to evaluate the effectiveness of these actions. The OIG pointed out that by not evaluating corrective actions CMS can't determine if they effectively reduce improper payments.

Moreover, by June 2012, CMS still had not taken corrective action on the remaining 18 vulnerabilities that totaled $31 million in improper payments.

The report also showed CMS received six referrals of potential fraud from RACs but had not addressed them as of last November.

CMS also failed to evaluate RACs' performance on all contract requirements. For example, the performance evaluations did not assess RACs' timeliness or documentation requirements for referring potential fraud to CMS.
The OIG called on CMS to evaluate the effectiveness of corrective actions, review and take appropriate action on fraud referrals, and develop additional evaluation metrics to improve RAC performance--recommendations to which CMS mostly agreed, accoding to the report summary.

Last month, an OIG audit found the ability of CMS to recover billions of dollars in Medicare overpayments is hampered by poor record-keeping, as well as turnover among the contractors responsible for collecting overpayments. What's more, the agency is stuck with $543 million in "not collectible" overpayments, FierceHealthcare previously reported.

For more:
- here's the OIG 
summary and report (.pdf)
- read the 
MedPage Today article

Related Articles:
RAC medical record requests up 47%
OIG: CMS stuck with $543M in 'not collectible' overpayments
Providers ask Senate committee to rein in RACs
Health leaders to Congress: RACs inappropriately denying payments
RACs reclaim $1.37B in overpayments as criticism mounts


Thank You Ms Caramenico and Fierce Health Finance.

Tuesday, August 6, 2013

Medicare Slaps Two-Thirds of US Hospitals With Readmission Penalties

fiercehealthcare has;
Medicare Slaps Two-Thirds of US Hospitals With Readmission Penalties
August 5, 2013 | By 


Two-thirds of the nation's hospitals will get hit with fines in the second round of Medicare's readmission penalties, according to data released Friday by the Centers for Medicare & Medicaid Services.

For the upcoming year, 2,225 of the nation's 5,700 hospitals will receive payment reductions totaling $227 million starting on Oct. 1. Of those hospitals, 18 hospitals will lose 2 percent of Medicare reimbursements, the top penalty, while 154 will lose 1 percent or more.

In the first round of penalties, almost 300 hospitals received the maximum fine--a 1 percent loss of their base Medicare paymentsFierceHealthFinance previously reported.
This time around, 1,074 hospitals will receive higher penalties, including 283 hospitals not penalized in round one that will see Medicare payment reductions in the upcoming year, Kaiser Health News noted.

However, 1,371 hospitals will see a lower fine. And nationwide, total readmission penalties will fall $53 million to $227 million, down from the $280 million in total fines recouped during round one.

KHN highlighted Alegent Creighton Health Midlands Hospital in Papillion, Neb., as the hospital that will see the largest drop in fines as it goes from the maximum 1 percent fine in round one to no fine in round two.

The CMS data showed hospitals that treat large numbers of poor people took a major hit from fines for high readmissions in both rounds of penalties, KHN noted.

Such figures validate concerns from the Medicare Payment Advisory Commission. In a June report, MedPAC concluded readmission penalties levied against safety-net hospitals are too onerous and should be reversed, pointing out that low-income patients are harder to keep tabs on post-admission, because they often cannot afford medications or have easy access to physicians

For more:
- here's the CMS 
data (see FY 2014 IPPS Final Rule readmissions reduction data file)
- read the 
KHN article



Thank You Ms Caramenico and Fierce Healthcare.