Bayer to Pay $97.5 Million to Settle Kickback Claim

From Bloomberg.com:

A unit of Bayer AG agreed to pay $97.5 million to settle accusations that it paid kickbacks to diabetic-equipment suppliers, the U.S. Justice Department said.
Bayer Healthcare LLC was accused of giving $2.5 million to Liberty Medical Supply Inc. to persuade Liberty to provide its patients with Bayer diabetic-testing equipment such as testing strips and glucose monitors, the Justice Department said in a statement.
Bayer also was accused of paying $375,000 in kickbacks to 10 other diabetic suppliers and causing them to submit false claims to Medicare, the government said. From 1998 through 2007 the suppliers filed false claims on the sales to get Medicare reimbursements, the statement said.
“Paying health care suppliers to place a particular brand of device with Medicare beneficiaries violates the law and will not be tolerated,” said Gregory G. Katsas, assistant attorney general for the Civil Division.
Bayer spokeswoman Susan Yarin said the payment puts the matter behind the unit, based in Tarrytown, New York.

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Update: Medicare Advantage Payments

This post on GOOZNEWS.com discusses how several reports have recently taken aim at Medicare Advantage. The NY Times states that payments to health insurance organizations on average are 12 percent higher than what the government would spend on beneficiaries in traditional Medicare, and payments to Medicare Advantage plans are 17 percent higher.

How will the new administration deal with Medicare Advantage, since payments are ridiculously higher than traditional Medicare?

Medicare Advantage Paid Too Much

Fierce Healthcare reports that studies form the Medicare Payment Advisory Commission suggest that private health care plans for Medicare beneficiaries may be a good place to start cutting. The studies also show that private insurance plans are driving up costs because they are paid on average 13 percent more than allocated for traditional Medicare. Do you think private health care plans should be cut?

Miami physicians sentenced for Medicare fraud

From BizJournals.com:

Two Miami physicians were sentenced to prison on Thursday for their roles in an HIV infusion scheme that defrauded the Medicare program out of $6.8 million.
A Miami federal court judge sentenced Carlos Contreras, 61, to three years and Ramon Pichardo, 58, to four years in prison. They also were ordered to repay $4.2 million in restitution to the Medicare trust fund.
Contreras and Pichardo each pleaded guilty to one count of conspiracy to commit health care fraud. Contreras was owner and a doctor at CNC Medical Corp. in Miami. Pichardo was a doctor there.
Contreras and Pichardo admitted that, between November 2002 and April 2004, they conspired with others to file $6.8 million in false claims to the Medicare program for HIV infusion services that were not provided or medically necessary.

Medicare Part D Drug plans

At US News, they have the new prices for most popular Medicare Part D stand alone drug plans. Most have increased a significant amount. See the prices here.

Medicare Troubles with Part D

From USNews.com:

Phillip Moeller writes,

Besides premium increases, many Part D plans have added other fee hikes, reduced covered drugs, and backed off on other protections as well. These changes are extensive and are layered onto a program with mind-numbing variables. The nation is broken up into 34 coverage regions, for example, and most states offer roughly 50 different private insurance plans with huge ranges of coverages and costs.
Whew! Paul Krugman may have won a Nobel Prize for economics, but I bet even he would have a hard time figuring out the best Part D plans for his elderly relatives. This year, more than ever, though, it will pay to look carefully at Part D choices. So, grab another cup of coffee, and bear with me.
The Part D program began with much fanfare and confusion in 2006. Since then, more than 16 million people ages 65 and over have signed up for the stand-alone Part D plans, and they've tended to stick with their original choices despite many plan changes in 2007 and 2008.

For the rest of this article, please click here.

Medicare drug benefits cause confusion

In a survey released by MedCo Health Solutions today, we find out that of the 1,000 Medicare beneficiaries selected, that 62% do not understand the doughnut hole when it comes to prescription drugs. More alarming is that 28% of those surveyed stated they weren't aware it existed.

For more information, read here.

6 Wks for Seniors to Sign up For Medicare Drug Plan

From the Chicago Sun Times

Starting today, seniors have six weeks to sign up for another year of Medicare Part D -- the prescription drug benefit -- that goes along with Medicare Part A (hospitalization), Part B (outpatient and doctor costs) and Medigap (the supplement that covers other costs including co-payments and deductibles).

For more information click on the US Government's website.

The Disabled Have a Long Waiting Time Before Qualifying for Medicare

Stuart recently posted on MS Related News that Congress and the Obama administration should put an end to the 2 year waiting period people deemed as “too sick” have to face before qualifying for Medicare. Medicare covers both disabled and elderly people, but approximately 1.5 million disable people find themselves waiting for a very long time before receiving any benefits from Medicare.

Of the 1.5 million, 40% are uninsured for part of the wait and 25% are uninsured for the full 24 months. There is new legislation proposed by Rep. Gene Green, D-Texas, and Sen. Jeff Bingaman, D-N.M that would eliminate waiting time gradually over 10 years. Will the Obama campaign help get this legislation passed?

New Rules are Imposed on Medicare Advantage Plan Sales

Yesterday’s article on ModernHealthcare.com discusses that the Centers for Medicare and Medicaid Services have issued compensation requirements for sales agents that sell Medicare Advantage plans and prescription drug plans to Medicare beneficiaries.

Some of the rules include paying compensation to all agents according to fair-market value and adjusted for inflation for similar products in the same geographic area. To make sure that everyone is compliant with the new rules, agents will have to CMS their compensation structures for the previous three years as well as the compensation structure they are implementing for 2009.

Medical News Today: MedPAC Adopts Recommendations To Improve Transparency Of Financial Ties Between Industry, Physicians

The Medicare Payment Advisory Commission on Thursday adopted five recommendations to Congress that would require disclosure of the health care industry's financial ties to physicians and other health care professionals, CQ HealthBeat reports. MedPAC will present the recommendations to Congress in March. According to the recommendations:

• Congress should require all manufacturers, distributors and their subsidiaries to report to HHS financial relationships with physicians, pharmacists, pharmaceutical benefits managers and their employees, as well as with hospitals, medical schools and medical or health organizations;
  
  
• Congress should direct the HHS secretary to post the information on a public Web site;
  
  
• All details regarding no-cost drug samples provided to physicians should be posted on the Web site so researchers can study the impact samples have on prescribing decisions;
  
  
• Congress should require all hospitals and other entities that bill Medicare for services to "annually report the ownership shares of each physician who directly or indirectly owns an interest in the entity (excluding publicly traded corporations)" and post the information on the Web site; and
  
  
• Lawmakers should require HHS to submit a report on the "types and prevalence of the financial relationships between hospitals and physicians."
  

MedPAC Chair Glenn Hackbarth said, "This is about transparency. It's not about condemnation" (Reichard, CQ HealthBeat, 11/6).

For more information please visit the original article here.

Private Plans for Medicare that Cover Dental Care

This post on AMPSYS discusses how Medicare does not cover dental care, but there are ways around this. There are many private plans for Medicare that do offer such coverage for dental expenses. Some of these private plans include the basic Medicare coverage, and also offer savings in eyeglasses, hearing devices, and dental care as well. The post gives an example of how Humana pays for about 25 percent of fillings, 75 percent of the cost of examinations, cleanings and X-rays, and 50 percent of extractions.

Physicians Receive Medicare Incentive for e-Prescribing

Pizaazz reports in this article that the Centers for Medicare and Medicaid Services have announced an incentive plan for physicians so that providers will receive a 2% bonus on total Medicare charges during 2009 for using qualified e-prescribing system.

According to CMS, providers must use the e-prescribing systems that:
-Communicate electronically with the patient’s pharmacy,
-Remind physicians about cheaper alternatives (if available),
-Provide Medicare formulary information, and
-Alert prescribers about allergies, improper dosing and drug interactions.

Home Health Care Agencies will Receive a Slight Medicare Payment Increase in 2009

EmaxHealth recently reported that CMS will slightly increase Medicare payments on average to home health agencies in 2009. It will also take steps to remedy cases in which providers bill Medicare unusually large amounts.

Home health agencies on average are expected to receive an increase of 2.9% or an additional $490 million for changes in costs of goods and services. Agencies will have to report quality data on a regular basis to avoid a 2% reduction in payments.

Medicare Co-Pays and Premiums Expected to Rise

FierceHealthcare reports today that a recent study conducted by Avalere Health LLC found that for the largest 10 drug companies, premiums are expected to rise up an average of 31 percent next year. It is also speculated that this in term might cause insurers to increase drug co-payments 75 percent (about $7) for generic drugs and a 60% increase (about $40) for brand drugs.

A spokesperson from Humana, an insurer, mentions:

“Prices reflect the experience we've seen over the past three years, and our expectations around what will most interest our members and potential members going forward."