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Category Archives: Medicare

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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

Tenet Accussed of Kickback Scheme

Posted in Medicare
Tenet Healthcare, the parent company of Hilton Head Hospital, is denying allegations that the hospital was involved in a kickback scheme involving the Medicaid program.  The lawsuit says the hospitals fraudulently billed Medicaid for tens of thousands of ineligible claims, and asks that the hospitals pay damages and penalties. A federal whistle-blower accuses the Hilton Head Hospital and … Continue Reading

Avoidable Hospitalizations

Posted in Medicare
A new study finds that three-fifths of hospitalizations from nursing home patients could be avoided. Nursing home patients have a number of risk factors against them including diabetes, renal disease, and multiple medications. However, the study found that staffing, quality and reimbursement were risk factors as well. The most avoidable hospitalizations are infection, injury and … Continue Reading

Settlement in False Claims Act

Posted in Medicare, Medications
A few weeks ago, we posted a blog about the connection between doctors and prescription sales. In that article, financial data was used to show that doctors who worked with a pharmaceutical company, giving presentations and speeches, were more likely to prescribe a drug that the company had marketed. In a similar tale of big pharma … Continue Reading

Another Kickback Scheme

Posted in Medicare
Philip and Morris Esformes have been accused of taking over a million dollars in kickbacks from Omnicare Inc. during its purchase of Total Pharmacy. The whistleblower, Maureen Nehls, filed the suit under the False Claims Act. The Esformes, as operators of nursing homes, are accused of switching their facilities to Total Pharmacy, which Philip had … Continue Reading

Survey Guidelines for Antipsychotics

Posted in Medicare, Medications
The Centers for Medicare & Medicaid Services has updated survey guidelines regarding nursing homes’ use of antipsychotic medications for dementia care. The interim guidance revises Appendix P and Appendix PP of the State Operations Manual. The Appendix P update includes new surveyor tasks to ensure that survey samples include enough residents who have dementia and … Continue Reading

Medicare Eligibility Tips

Posted in Medicare
If you thought planning for retirement was bad, you might want to check out this article from Matt Wallace, an attorney and CPA in Port Huron, MI. His article provides tips and details about Medicare eligibility, and how to plan Medicare costs so that nursing home fees don’t break your bank. He quashes rumors about … Continue Reading

Medicare Fraud

Posted in Medicare, Verdicts/Settlements
Last month a federal jury found that Tuomey Healthcare System, a SC hospital, was engaging in Medicare fraud. The hospital was receiving kickbacks on referral fees, using its influence to create partnerships with doctors, solidified by contracts, and engaging in a kickback system. Tuomey received $39 million of Medicare money, all through fraudulent claims. They claim … Continue Reading

Medicare Transparency

Posted in Medicare
The Wall Street Journal (WSJ) reported that after 33 years, Judge Marcia Morales Howard vacated the injunction that kept Medicare information private. Information on individual doctors has for the past 33 years been considered an issue of the doctor’s privacy. But Judge Howard said that since the Privacy Act had been narrowed in its scope, … Continue Reading

Medicare Solvency Extended

Posted in Medicare
The Medicare Trustees reported encouraging news for seniors: the program is projected to retain its solvency for two years longer than was predicted in 2012.  Medicare is expected to be fully solvent until the year 2026, a decade longer than what predicted in 2009.  For seniors this means that the program has more funds than … Continue Reading