HHS and the Department of Justice have announced that 89 medical industry professionals have been charged with allegedly defrauding Medicare of about $233 million. In Los Angeles, 13 individuals were charged with various scams totaling $23 million. AP/Washington Post et al.
Physician advocates expressed optimism that a U.S. Senate hearing on replacing the sustainable growth rate formula held Tuesday will pave the way toward permanently resolving the issue. The SGR sets Medicare physician reimbursement rates. Senate Finance Committee Chair Max Baucus and Sen. Orrin Hatch -- the committee's ranking member -- recently have escalated the debate on a replacement formula. Modern Healthcare.
In a letter sent to health care providers last week, U.S. Sens. Max Baucus and Orrin Hatch asked for input on the best ways to permanently replace the sustainable growth rate formula, which sets Medicare physician reimbursement rates. The lawmakers asked what changes could be implemented to ensure that the values of services reflect the resources involved in treatment delivery, among other questions. The Hill's "Healthwatch."
A new analysis from ProPublica finds that CMS has done little to monitor unsafe prescribing patterns or investigate unsafe practitioners in Medicare Part D. According to CMS officials, oversight of the Part D program falls to private health plans. ProPublica/Washington Post.
Experts say that hospitals in low-income areas could be hardest hit by a program that aims to curb Medicare readmissions. Most of the California hospitals that have received the program's maximum penalty serve low-income patients. KPCC's "KPCC News."
On Monday, Department of Health Care Services Director Toby Douglas announced that Cal MediConnect -- a demonstration project intended to better manage care for residents enrolled in both Medi-Cal and Medicare -- will not begin until January 2014 at the earliest. Few details were given as to the cause of the delay. Payers & Providers.
Although the White House did not address Sen. Tom Harkin's concerns about Affordable Care Act funding, the senator plans to lift his hold on Marilyn Tavenner's nomination as CMS administrator. The Senate is expected to confirm Tavenner. Kaiser Health News' "Capsules" et al.
Contrary to the popular health insurance "cost-shifting" theory, reducing Medicare payment rates for hospital inpatient care does not accelerate growth in private insurers' costs, according to a study published in the journal Health Affairs. Researchers found that when Medicare payment rates were reduced by 10% from 1995 to 2009, private insurance payment rates dropped by 3% to 8% during that time. Politico.
According to a new study, providing Medicare beneficiaries with a single plan that blends drug, physician, hospital and supplemental coverage could generate up to $180 billion in savings over 10 years and reduce beneficiaries' out-of-pocket costs. The Hill's "Healthwatch" et al.
CMS and HHS are partnering with analytics firm Archimedes to expand access to de-identified Medicare claims data. The project aims to speed the development of software that could leverage analytics to improve care and reduce costs. Clinical Innovation & Technology et al.
Advocates are challenging a CMS rule that denies coverage for certain services when Medicare beneficiaries are placed in observation care. A lawsuit seeks to remove the observation care designation. USA Today/Kaiser Health News, Washington Post/Kaiser Health News.
Last week, a federal jury in Los Angeles found an Anaheim physician and two others guilty in a $1.5 million Medicare fraud case. From 2007 to 2012, the physician and another health care professional received kickbacks from a medical supply official for fraudulent prescriptions for durable medical equipment. CMS paid nearly $1 million for the false and fraudulent claims. Los Angeles Times' "Money & Co."
A new proposed rule from CMS would increase by 0.8% reimbursements for acute care hospitals that successfully participate in the Inpatient Quality Reporting System. The proposal also would cut disproportionate share hospital payments to 25% of the amount Medicare currently pays. MedPage Today et al.
To encourage whistleblowers to come forward, CMS has proposed raising the maximum reward for reporting Medicare fraud to $9.9 million. In related news, the Senate Finance Committee has released a series of reports on combating health care fraud. Modern Healthcare et al.
The Bipartisan Policy Center has released a plan to reduce the federal deficit by about $560 billion over 10 years by curbing health care costs. The plan would eliminate the sustainable growth rate formula and make other changes to Medicare. Kaiser Health News' "Capsules" et al.