The U.S. Department of Justice said on Thursday that 243 people have been arrested across the country, charged with submitting fake billing for Medicare, a government health care program that totaled $712 million. Attorney General Loretta Lynch described the arrests as the largest criminal health care fraud takedown in the history of the Justice Department. Those arrested included 46 doctors, nurses, and other licensed medical professionals. The charges are based on a variety of alleged fraud schemes, the government said, including submitting claims to Medicare and Medicaid, the health care program for low-income individuals, for treatments that were medically unnecessary…
Americans are living longer, so why not lower the eligibility age for Medicare? That prescription might sound upside down: rising longevity often is used as an argument for delaying Medicare eligibility past age 65. However, one of the country’s top experts on geriatric medicine actually thinks Medicare should start covering preventive health care when we turn 50. Dr. Linda Fried, dean of the Mailman School of Public Health at Columbia University in New York, says that could help people not just live longer, but enjoy more healthy years. Meanwhile, Medicare would save money on treatment of chronic illnesses in seniors….
Nearly 20 years after such videoconferencing technology has been available for health services, less than 1 percent of Medicare beneficiaries use it. For example, Anthem Health and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient. Congress has maintained such restrictions out of concern that the service might increase Medicare…
Medicare beneficiaries who are admitted to a hospital and then discharged to a nursing home have been getting charged for care they thought Medicare would cover. A new self-help packet from the Center for Medicare Advocacy explains how beneficiaries can fight for the coverage they need. The problem arises if a hospital places you in “observation status” instead of formally admitting you. Observation status triggers Medicare Part B, a part of the Medicare law that does not pay for post-hospital care. Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted…
The Centers for Medicare and Medicaid Services (CMS) has released the new Medicare premiums, deductibles, and co-payments for 2014: Basic Part B premium: $104.90/month (no change from 2013) Part B deductible: $147 (no change from 2013) Part A deductible: $1,216 (was $1,184 in 2013) Co-payment for hospital stay days 61-90: $304/day (was $296 in $2013); Co-payment for hospital stay days 91-150: $608/day (was $592 in 2013) All costs for each day beyond 150 days Skilled nursing facility co-payment, days 21-100: $152/day (was $148 in 2013) Also, note that individuals with annual incomes over $85,000 and married couples…
Medicare only covers home health care if, among other requirements, the beneficiary is homebound. As of Nov. 19, 2013, the Centers for Medicare & Medicaid Services (CMS) will require new criteria for purposes of meeting the homebound requirement. These new requirements will leave many Medicare beneficiaries without access to the medically reasonable and necessary home care coverage. The new policy states: For purposes of the statute, an individual shall be considered "confined to the home" (homebound) if the following two criteria are met: The patient must either 1) because of illness or injury, need the aid of supportive devices such…
Both the Affordable Care Act (ACA) Health Insurance Marketplace and Medicare are open for enrollment. Your clients may be confused about Medicare and the Marketplace. Learn more using the CMS Open Enrollment Center and NCOA "What You Need to Know." Read more about Medicare and the Marketplace from AARP and NCOA.
With the Health Insurance Marketplace underway, there is information available for those on Medicare about what the Marketplace means to them. The Centers for Medicare and Medicaid (CMS) and the National Council on Aging (NCOA) have developed helpful factsheets for your clients who are 65+ and for people ages 55-64. View the CMS fact sheet and NCOA fact sheet. View the NCOA fact sheet for people under 65.
In another sales-sapping blow to Eli Lilly and Co., the Centers for Medicare and Medicaid Services has decided not to pay for patient use of a Lilly imaging drug used in Alzheimer’s assessments. The Indianapolis drugmaker said that it’s disappointed in the decision, which it called “contrary to expert opinion.” The CMS decision is a financial blow to Lilly’s Amyvid, a new drug marketed for use in brain scans to evaluate patients for Alzheimer’s disease and other brain dysfunctions. Approved by the Food and Drug Administration last year, Amyvid is the only drug of its kind on the market. In…
Medicare is currently undergoing its second round in the penalty program. The campaign works toward reducing the numbers of patients readmitted within a month and hospitals will have their reimbursements reduced for poor performance. The majority of hospitals with high readmission rates serve low-income patients. Kaiser Health News discovered that 1,371 hospitals are receiving a lower fine than before. Learn more in the Washington Post.
Frederick, MD 
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