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Category Archives: Medicare

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CMS to Update Nursing Home Compare

Posted in Advocacy, Medicare, Regulatory enforcement, Staffing
On Oct. 6, President Obama signed the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which aims to improve quality through increased transparency and standardized assessments in several areas surrounding critical care issues across skilled nursing facilities, home health agencies, long-term care hospitals, inpatient rehabilitation facilities, and other post-acute care (PAC) providers.  IMPACT will allow both payments … Continue Reading

Extendicare Settlement with DOJ

Posted in Advocacy, Medicare, Trial themes
Extendicare Health Services Inc. (Extendicare) and its subsidiary Progressive Step Corporation (ProStep) have agreed to pay $38 million to the United States and eight states to resolve accusations that Extendicare billed Medicare and Medicaid for materially substandard nursing services that were so deficient that they were effectively worthless and billed Medicare for medically unreasonable and unnecessary … Continue Reading

DOJ Settlement with Johnson & Johnson

Posted in Medicare, Medications
Global health care giant Johnson & Johnson (J&J) and its subsidiaries will pay more than $2.2 billion to resolve criminal and civil liability arising from allegations relating to the prescription drugs Risperdal, Invega and Natrecor, including promotion for uses not approved as safe and effective by the Food and Drug Administration (FDA) and payment of … Continue Reading

False Claims Act

Posted in Medicare, Trial themes
In another story of Medicare fraud, a Seattle doctor admitted filing approximately 900 false claims.  John C. Chen could face up to 45 years in prison because he defrauded the government.  Many of the 900 claims were submitted for patients who were deceased.  Other claims were submitted when he wasn’t even in the country.  See … Continue Reading

Ensign and Medicare Fraud

Posted in Medicare, Trial themes
The Ensign Group Inc. reached a $48 million settlement with the government over allegations that they committed Medicare fraud. The Ensign Group Inc. is a California nursing home management company which runs homes in 10 states. Two former employees filed whistle-blower lawsuits against the home under the False Claims Act, which allocates a portion of … Continue Reading

ObamaCare Slows Health Care Spending

Posted in Medicare
The NY Times reported he growth of federal spending on health care will continue to decline as a proportion of the overall economy in the coming decades, in part because of cost controls mandated by President Obama’s health care law, according to the nonpartisan Congressional Budget Office. The budget office said in its annual 25-year forecast … Continue Reading

ObamaCare in North Carolina

Posted in Medicare
North Carolinians came out in droves for Obamacare enrollment, signing up at a rate that beat nearly every other red state.  More than any other state, North Carolina may represent the huge disconnect between Obamacare’s success in getting people health insurance and its failure to help the Democratic politicians who voted for the law. The … Continue Reading

Medicare Spending Declines

Posted in Medicare
Sarah Kliff is impressed by the above chart: This simple, four-line chart is amazing news for the federal budget. It shows that the government is expected to spend about $50 billion less paying for the Medicare program this year than it had expected to just four years ago. What this chart shows is how much the Congressional … Continue Reading

Medicare Fraud in Lab Billing

Posted in Medicare, Trial themes
The Wall Street Journal had an article about Medicare Lab Billing.  Medicare allowed $1.7 billion in 2010 payments to clinical laboratories for claims that raised red flags, according to a report to be released, the latest example of how the federal insurance program for the elderly and disabled is susceptible to fraud and abuse.  The report, by … Continue Reading

Another Omnicare Settlement with DOJ

Posted in Medicare, Medications, Trial themes
WKYC reported that repeat offender Omnicare Inc., the nation’s largest provider of pharmaceuticals and pharmacy services to nursing homes, has agreed to pay $124.24 million for allegedly offering improper financial incentives to skilled nursing facilities in return for their continued selection of Omnicare to supply drugs to elderly Medicare and Medicaid beneficiaries.  The Anti-Kickback Statute … Continue Reading

ObamaCare Slows Growth of Medicare Spending

Posted in Medicare
Here’s some encouraging news: Adjusted for timing shifts, Medicare growth is even lower through eight months at just 0.3 percent. And even after removing the effects of temporary policies, year-to-date Medicare growth remains extremely low at 2.5 percent, even lower than through April. This is more than a full percentage point below economic and beneficiary growth, … Continue Reading

Therapy Utilization Trends

Posted in Medicare
CMS released “Observations on Therapy Utilization Trends”, a memo detailing the breakdown of rehabilitation categories and their corresponding numbers in nursing homes. Rehabilitation categories are broken down into Ultra-High, Very-High, High, Medium, and Low. Over the past two years the numbers for the Very-High, High, Medium, and Low categories has stayed relatively stable, but there … Continue Reading

How Much Medicare Paid a Specifc Doctor

Posted in Medicare
The NY Times has a form to find a doctor or other medical professional among the more than 800,000 health care providers that received payments in 2012 from Medicare Part B, which covers doctor visits, tests and other treatments. Payments may also cover overhead, such as staff salaries and drug costs. In some cases, when … Continue Reading

Arrests for False Medicare Billing

Posted in Medicare
 A federal task force charged 90 people, including 16 doctors, with generating $260 million of false Medicare billings following raids in cities across the country. The arrests mark the seventh notable crackdown by the Medicare Fraud Strike Force, a joint effort of the Justice Department and the Department of Health and Human Services launched in … Continue Reading

Fraud for Unfilled Prescriptions

Posted in Medicare
Raheel Pervez , a pharmacy owner, has been sentenced for his part in a scheme that drained $16 million from the NY Medicaid program.  Pervez will only serve one to three years for his part in a scheme that billed Medicaid for unfilled prescriptions. The pharmacies were ordered to pay $16.7 million in restitution to Medicaid and … Continue Reading

Medicare Pays for Dementia Screening

Posted in Medicare
Kaiser Health News had an article about the new requirement in ObamaCare that requires Medicare to cover a screening for cognitive impairment during an annual wellness visit.  Dementia screening tests are typically short questionnaires that assess such things as memory, attention and language and/or visuospatial skills. One of the most common, the mini-mental state examination, consists … Continue Reading

Medicare Fraud Efforts

Posted in Medicare
 Improper Medicare payments cost about $50 billion last year, a Health and Human Services official told a House panel, testimony that prompted a rare display of bipartisanship in a usually divided House.  In 2013, the government recovered $4.3 billion from people trying to defraud the government, and has recovered $19.2 billion over the past five … Continue Reading

Fixing Medicare Waste and Fraud

Posted in Medicare
 The Pittsburg Post Gazette had an interesting article from Kaiser on how the federal government is trying to lower Medicare spending at hospitals and nursing homes. "Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to … Continue Reading

Medicare To Publish Data On Doctors

Posted in Medicare
The Wall Street Journal: Federal officials plan to release reimbursement information on April 9 or soon after that would show billing data for 880,000 health-care providers treating patients in the government-run insurance program for elderly and disabled people. It will include how many times the providers carried out a particular service or procedure, whether they … Continue Reading

Hospice Medicare Fraud

Posted in Medicare
The Medicare News Group warned about a new medicare fraud strategy involving hospice.  Hospice is a palliative care program that gives patients with life-ending illnesses a choice to forgo intensive treatment at the end and focus instead on dying more comfortably.  Up until a decade ago, hospice was primarily used by patients diagnosed with cancer … Continue Reading

Medicare and Maintenance Therapy

Posted in Medicare
A settlement of a federal lawsuit in Jimmo v Sebelius will increase the amount of days of care for which an older person could expect to receive Medicare payment for therapy provided in a skilled nursing facility. Maintenance therapy is allowed as a service Medicare will pay for in nursing homes. This means that many older persons … Continue Reading

Medicare Payments in SC

Posted in Medicare
Kaiser Health News had an interesting article about Medicare spending.  One out of every five dollars Medicare spends goes to nursing homes, home health services or other post-acute facilities and services. The spending varies greatly between states. The article contains a chart that breaks down Medicare’s 2011 spending into five broad categories.   Spending has been adjusted … Continue Reading

MedPAC’s Recommendations on Profit Margins

Posted in Medicare
Senior Housing News reported that Medicare Payment Advisory Commission (MedPAC) is recommending Congress to cut Medicare reimbursements to the nursing home industry in the coming years. The total profit margin for the nursing home industry was 1.8% last year, according to MedPAC.  But looking at freestanding skilled nursing facility Medicare margins, nursing homes had a 13.8% margin in … Continue Reading

Medicare’s Sustainable Growth Rate

Posted in Medicare
The Congressional Budget Office (CBO) projected earlier this year that replacing Medicare’s sustainable growth rate (SGR) payment formula would cost $138 billion. This projection was $100 billion less than prior estimations, but Congress’s first bill to repeal and replace the SGR is estimated to add much more to that baseline. The SGR is already controversial … Continue Reading