Monday, May 25, 2009

Medicare Waste Could Total $2.8 Billion

posted: 27 MINUTES AGO
filed under: Financial Crisis
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WASHINGTON (May 18) - A federal program with a history of making billions of dollars in erroneous payments for wheelchairs, oxygen machines and other medical equipment continues to grossly underestimate its own mistakes, according to federal investigators.
The Medicare program spends about $10 billion annually in payments to suppliers of medical equipment for the elderly and disabled. For years, federal inspectors have documented payment errors that expose the program to fraud and abuse. Last year the inspector general who oversees Medicare estimated the waste could be as high as $2.8 billion annually.
A sampling of payments for fiscal year 2008 conducted by an outside contractor found that roughly 70 percent should not have been approved, according to a new report by the inspector general for the Department of Health and Human Services. But Medicare estimated the error rate at less than 10 percent, citing its own contractor, AdvanceMed of Richmond, Virginia. The review was not comprehensive and consisted of a sample of just 250 payments.
Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services, said Tuesday that the agency "has made significant changes to how it measures the error rate and, in addition, has clarified its medical review instructions for contractors."
Ashkenaz added that AdvanceMed is reviewing fiscal 2009 payments to make sure all errors are accurately counted. A company spokesman could not immediately comment on the report Tuesday afternoon.
Sen. Charles Grassley, R-Iowa, requested the review after uncovering similar discrepancies with the agency's fiscal 2006 error numbers.
"This report reveals that the way the government is tracking erroneous Medicare payments for durable medical equipment still isn't working," Grassley said in a statement. "Medicare officials owe it to taxpayers and beneficiaries to get a handle on the level of waste, fraud and abuse."
Medicare officials estimated their total payment error rate for fiscal 2008 was 3.6 percent. That figure includes payments to doctors and hospitals, along with payments for medical equipment.
An error does not necessarily mean the government was defrauded, but it can leave the program open to fraud.
More than 100,000 companies are registered as suppliers for Medicare. Acting as government contractors, they generally handle the logistics of submitting a claim and obtaining government payment for patients' medical equipment.
The largest equipment suppliers include companies like Lincare Holdings Inc., which provides home oxygen equipment, and Invacare Corp., which distributes wheelchairs, adjustable beds and other supplies.
The majority of last year's errors occurred because Medicare contractors reimbursed suppliers despite incomplete documentation that the the equipment was necessary, according to the inspector general. Instead of relying on patient medical records and physician prescriptions, Medicare's contractors often used documents from supply companies and prior Medicare claims.
Medicare's own rules state that information from a patient's medical records must show the need for the reimbursed device.
However, Medicare officials acknowledged those rules are "vague," when it comes to how contractors may interpret medical information.
"Contractors have interpreted the manuals differently, especially regarding the use of clinical judgment," Charlene Frizzera, acting head of the Centers for Medicare and Medicaid Services, said in a letter responding to the report.
Frizzera said the agency plans to clarify how much interpretation contractors are permitted when processing payments. She also said the agency plans to bolster its review of claims that are most vulnerable to fraud — including those for scooters and oxygen machines — by conducting interviews with the requesting patients. She added, however, that "it would be very resource-intensive for us to do this type of review" for all types of equipment.
Copyright 2009 The Associated Press. The information contained in the AP news report may not be published, broadcast, rewritten or otherwise distributed without the prior written authority of The Associated Press.
2009-05-18 16:50:36

IRS Sets HSA Amounts

Study: Disability Discriminates

Tuesday, May 5, 2009

When you hear advocates of Universal Health Care...

...think about this:

Who amongst us would:
- take a car back to a mechanic who already screwed up the last service, and made it worse each and every time he messed with it;
- take laundry to a laundry mat where the washers stained the last batches of clothes;
- go eat where the service is lousy and the food tastes worse each time we go?

Am I missing something here?

Yes - I agree the current health insurance system is not working to the best level it could.
But I'd rather be on it than the current Universal Care System for the over 65, called Medicare, or Medicaid, for the under 65.

We sometimes forget, in all the hype that anyone who needs Emergency care can still get it if they go to a hospital.
Note that because of what is happening, this may change in UTAH

People who want Universal Health Care need to be asked to explain why the following is happening with the Government Universal Health Care system we already have.

They should also be reminded that before we do a political biased change to scrap what we have now, and create another Government system, prudence and (un?) common sense would point out that we need to get the current Government systems fixed, first.

If not, Doctors, Nurses and Providers that are not enslaved to the Government have the right to refuse to treat patients. Hospitals that are not federally owned will have the right to refuse all but emergency care to those on Medicare.

Here is the current Universal Health Care system at work:

UT hospitals struggling under Medicaid cuts

By Anne Zieger

Hospitals in Utah are reeling under a 25 percent Medicaid reimbursement cut that was much larger than anticipated, and now are warning that they might be forced to offset costs by increasing fees on insured patients or cutting back on charity care.

Hospital association leaders said the hospitals failed to factor in the effects of using a funding stream to offset the cuts occurring in 2009. Meanwhile, technical changes in the payments to hospitals for "nonphysicians services" such as nursing care also had an impact on such reimbursement. To help address this huge change in funding, the state is looking at increasing its tobacco tax or imposing a tax on hospital stays.

If the state can't come up with a solution, state hospitals could theoretically refuse to treat Medicaid beneficiaries entirely, observers note.

To learn more about Utah's Medicaid situation:
- read this Kaiser Daily Health Policy Review item

Friday, May 1, 2009

Budget reconciliation process on Health Care affects your health.

Hopefully the plan for health care in the U.S. will be under bi-partisan craftsmanship. The Budget reconciliation process, if used here, will create a plan that will have almost 1/2 of the population left out of the creation process.

This would not be a good situation for a president who campaigned, in part, on his ability to reach across the isle.

It would not be a good for the population, as if it is fast tracked, the overall concerns of "We, the People" will not be fully heard.

Providers will choose alternative channels, since there is no way to force them to accept more patients and give less care for less money. Those with short memories need only look what happened in MD about 10 years ago, or what is happening in Massachusetts and other states, today.

If we've learned anything at all from the last year of Congress, with the Stimulus Bill and TARP, Congress moving quickly spells major expenses and lack of control for us now, and our future generations.

"We, the People" have an obligation, and a right to be heard, and be involved fully in the process. Do not let Congress adversely affect the quality of life just to "do something".

Those who have followed my posts know the risks we have if we allow "any" system to be put in place. A plan like used in most European nations, Canada, or our own VA or Medicare system will leave us with limited access to providers.

Such a system will have more Doctors retiring, more going to limited "boutique" access practices, and less accepting the public limited access and limited fee system.
Massachusetts's is on the leading edge, with several state mandates, and they are experiencing Doctor shortages, lack of care, and major increases in ER use.

Trends showing increased lack of care, denial of care, limited access to medications, denied coverage are well documented in Medicare recipients, as well as in Universal "one payer" (one controller of health care access) systems.

I, for one, with 5 family members as Medical providers, am scared to turn 65, because I loose coverage levels and access I enjoy now.

Please, follow the process, and remain active in the political agenda. Your health depends on it.

Health May Go On Fast Track

Democratic congressional leaders have come out with a 2010 budget resolution conference agreement that includes health reform and estate tax provisions.

Democrats and Republicans have posted separate texts and analyses of the 2010 budget resolution agreement on the Senate Budget Committee website, at

The conference agreement resolves differences between the Senate version, S. Con. Res. 13, and the House version, H.Con. Res. 85.

Here is a "side by side" comparison posted by the Republican members of the Senate Budget Committee.

Congress has agreed to handle health reform measures through the ordinary legislative process until Oct. 15, officials say. If no legislation passes by that date, Congress may consider health reform through the budget reconciliation process.

Supporters of a bill usually need to get the cooperation of 60 senators to get the bill to the Senate floor. When Congress includes a measure in the budget reconciliation process, supporters need just 51 votes in the Senate.

Robelynn Abadie, president of the Association of Health Insurance Advisors, Falls Church, Va., says she is disappointed that health reform could end up becoming part of the budget reconciliation process but welcomes the decision to let lawmakers try to craft a bipartisan health reform plan through the ordinary legislative process until October:

“A health care bill written entirely by Democrats would almost certainly create a new public health insurance program,” Abadie warned.

Continuing with bipartisan efforts offers the best chance of coming up with “an agreement on health care that will stand the test of time,” says John Greene, a vice president at the National Association of Health Underwriters, Arlington, Va.

“Reconciliation would make it difficult to achieve bipartisan health care reform that addresses the core issues of cost, access, and quality together,” says Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, Washington.