MD Medicare Choice Under Receivership

MD Medicare choice in Tampa Florida has been placed in receivership by Leon County Circuit Court Judge P. Kevin Davey as reported here. Their Medicare Advantage plan had more than 16,000 members across 23 Florida counties. The company had already been under administrative supervision by the Office of Insurance Regulation, but following the difficulties in the stock market these past couple of weeks, the SEC has frozen the $27 million that MD Medicare Choice had as reserves in the Primary Fund of Reserve Management Corp. The current Medicare Advantage contract will be void as of today midnight, and policy holders will be switched to Humana policies. For more information call 1-800-758-4806 or 1-800-833-3301 if you are a beneficiary, or 1-800-882-3054 for information about receivership. You can also log on to http://www.myfloridacfo.com/Receiver/.

No Congress in Medicare Please

As this post in a WSJ blog states, the CEO's of Mayo and John Hopkins have given their opinion in an op-ed piece for the Chicago Tribune requesting Congress to but out of Medicare. They would like Congress to have less oversight and control, and instead, want to have a board providing guidance instead. To quote the article:

Decisions about coverage and payments are inappropriately subject to political influences and inefficiencies. Why should Congress spend time debating how much Medicare should pay for the rental of oxygen supplies? A non-political board could better fulfill the role of overseeing Medicare. The board should function like the Federal Reserve—with independent authority, but reporting to Congress.

Medicare fraud case at Cooper University

The Philadelphia Business Journal reported that Cooper University Hospital will pay $3.85 million plus interest to Medicare to settle allegations that it defrauded Medicare.

Supposedly, the the Cooper University Hospital increased Medicare charges to both in-patients and out-patients in order to receive higher reimbursements. Supplemental reimbursements occur when the bills are higher than normal and technically called outlier payments.

Brand-Name Drugs are Favored by Medicare Beneficiaries

According to this article in EmaxHealth, brand-name medications account for almost two-thirds of all prescriptions filled by Medicare beneficiaries. Patients are asking for brand-name drugs when the program provides coverage and are asking pharmacists for generic drugs when they have to pay out of pocket.

When patients switch from brand-name to generic drugs, more than likely they’ve reached the coverage gap in which they must cover the full cost of the prescriptions. Woody Eisenberg, Medco Chief Medical Officer mentions that when Medicare beneficiaries become aware of the coverage gap they "become acutely aware of the cost difference between brand-name and generic drugs and most make the switch."

Billions Paid in Medicare Suspect Claims

The National Center for Policy Analysis reports that billions of taxpayer dollars have gone to waste because Medicare has paid out claims with blank or invalid diagnosis codes over the past decade according to a new Senate report.

Claims for wheelchairs, drugs, and other medical supplies of Medicare patients were reviewed from 2001 to 2006. During these years, they found at least $1 billion of medical equipment which listed diagnosis codes that had little or no connection to the reimbursed medical items. Here are some findings from the report:

• Medicare paid millions of dollars to medical suppliers for blood glucose test strips -- used exclusively for diabetics -- based on non-diabetic diagnoses.
  
• Roughly $4.8 billion in payments were made from 1995 to 2006 despite invalid coding or nothing listed at all; about $23 million of that amount was paid after 2003, when federal rules made clear the codes were required.
• Based on a sample of 2,000 of those invalid coding claims, investigators found more than 30 percent could not be verified as legitimate and "bore characteristics of fraudulent activity."
• Federal regulations require that Centers for Medicare and Medicaid Services (CMS) pay only for items that are deemed "medically necessary," yet, CMS does not examine diagnosis codes to determine whether the equipment is actually necessary before making payment.
• Only 3 percent of claims are reviewed after payment is made.
  

Sources:
http://hsgac.senate.gov/public/
http://townhall.com/news/us/2008/09/24/probe_medicare_paid_billions_in_suspect_claims

Medicare Monthly Premium Costs Remain the Same for Elderly and Disabled in 2009

AHN reports that Medicare premiums for the disabled and elderly will remain constant at $96.40 next year, according to the U.S. Centers for Medicare & Medicaid Services.

The premium and deductible paid by consumers cover home health facilities, durable medical equipment, and cost of physicians. The Medicare Part B Program will also retain its costs at $135 this year. So far the only costs expected to rise is monthly premium payment for Part A coverage which will rise form $423 to $443 in 2009.

Medicare rates to stay the same for 2009

According to Elder Law Answer, it was announced recently that Medicare's monthly premium will stay the same for the first time in eight years. The monthly premium will remain the same, totaling $96.40 a month.

This fee covers portions of fees related to physicians services, outpatient hospital services, and other items.

More advertising dollars going to Medicare Advantage

In a recent study done by the Kaiser Family Foundation, detailed here at the Washington Post, they found that insurers spent three times more money promoting comprehensive Medicare plans rather than stand alone drug plans. The study was conducted between October 1 and December 31, 2007, with an increased effort looking at what's going on with Medicare marketing practices. For the most part, the commercials emphasized the benefits centered around preventative care, vision and hearing benefits.

Restrictions placed on cold calls by insurance agents

Effective October 1, insurance agents will no longer be able to cold call the elderly and disabled when trying to sell prescription drug plans. According to the AP, this new law will be enforced by an increased amount of surveillance on the agents as well as reviews of media and print ads published by those.

The new restrictions include:

- No unsolicited contacts with beneficiaries, such as visiting their home or calling them. The prospective customer must initiate the contact.

- No selling of other insurance products, such as annuities or life insurance, to beneficiaries.

- No free meals at promotional or sales events.

- New requirements for training or testing of agents.

Penalties for breaking these law could result in up to $25,000 worth of fines.

Medicare Hospice Protection Act

US Representative Maurice Hinchey has introduced a new bill to Congress to block a new bill from the Bush administration. According to The Ithaca Journal, a bill going into affect October 1 will begin reducing Medicare reimbursement rates by $2.2 billion over the next five years. This could result in hospice patients loosing their hospice care across the country, as it could cost certain hospices $50,000 next year across the country, and as much as $150,000 over the next three years. Hinchey is encouraging Congress to swift action due to the tight time frame they’re working with.

Welcome to Doughnut Hole Season

In a recent article at the Dallas Morning News, they discuss the current stress one in five seniors is now facing until the end of the calendar year. Doughnut Hole Season is the time of year when low co-payments reach their gap in the drug coverage provided by Medicare, and, as a result, they are faced with staggeringly high payments for their medication. In 2007, 3.4 million seniors faced this situation.

Through the current program, seniors are responsible for full costs once all of Medicare’s payments (co-pays and deductibles) have reached $2150. They do not pick up payments again until citizens spending exceed $5726. However, only one in five will reach this amount.

Senate Investigates Medicare Call Centers

Yesterday's Wall Street Journal reported on Senator Gordon Smith (R-OR) and his investigation into the quality of Medicare's call center brought to Capitol Hill. The call centers, run by Vangent, are under investigation because "In 50 test calls placed last month, wait times ranged from zero to 45 minutes, and six calls were disconnected while on hold. Call centers have provided at least one piece of incorrect information or been unable to provide a response to at least one question in 90% of test calls placed in the past year," reported the WSJ article. Vangent denies the allegations citing their high customer satisfaction percentages.

What do you think of Senator Smith's investigation?

Humana looses some Medicare Enrollees

As a result of premium bids that are higher than low income, government assigned members of Medicare, Humana expects to loose 10% of them at the beginning of 2009. However, according to the Wall Street Journal, they believe this could be positive for Humana due to the fact that higher prices would increase the bottom line, shares dropped 5% to $41.75 when it was announced that this could lead to a los of 380,000 eligible Medicare members. To ensure drug coverage for these dropped Medicare enrollees, the government will automatically re-enroll them in private drug care provider programs.

Nothing is Free: The Problem with Free Drug Samples

Many altruistic doctors give patient drug samples to uninsured patients; thereby, helping the patient to receive the proper medication and save the patient money. Doctors may not be aware that they are actually causing the cost of prescriptions to rise for the uninsured by having a plethora of prescriptions at hand in the office.

This problem does not affect Medicaid directly, as its common practice for Medicaid patients to receive generic prescriptions.

David P. Miller, M.D., lead researcher and internal medicine physician at Wake Forest Baptist said, that "One possible explanation, Miller said, is that because Medicaid patients rarely receive samples, doctors' prescribing decisions for these patients were based purely on what drug they thought was best and not on what samples happened to be available in the closet."

For the uninsured or those that receive free samples; they can be doing wonderfully on the prescribed drug given to them in sample form. But what happens when the samples at the doctor's office run out? Filling the prescription at the pharmacy would crash their budget and may cause health problems.

Overall, patients need to speak with their doctor about their financial and insurance situations. Doctors can then prescribe patients with low-cost/generic drugs for treatment; instead of what is readily available in the office supply closet.

How do you feel about free samples at the doctor's office? How do you think this will affect Medicare patients?

Sources:
News-Medical.Net
CNN
US News & World Report

Medicare Made Easy

In a latest release, Experion Systems has launched a new edition of their PlanPrescriber tool as reported by MarketWatch. Created by Glen Urban, a Professor at MIT, this new tool gives seniors access to “unbiased advice” for determining their Medicare Insurance plan. It is a free online tool designed to save seniors time, and money, and starts by simply entering a zip code. Those without access to Internet, can also call 877-900-4824. As Ross Blair, Experion Systems CEO, stated:

"The rising costs of prescription drugs is a real burden for seniors on a fixed income. PlanPrescriber allows seniors to switch to the optimal plan based on their individual needs. Seniors can typically save 25% to 50% of their annual prescription drug costs by joining the optimal insurance plan."

Marketing Documents for Medicare Prescription Drug Benefits is Confusing

The Wall Street Journal blog discusses how marketing brochures for Medicare prescription drug plans are doing a bad job of meeting guidelines set forth by the feds in this latest post.

A report published by the inspector general’s office in the Department of Health and Human Services found that 85% of marketing materials did not meet guidelines set out by the Center for Medicare and Medicaid Services. Some problems with the documents are that a lot of marketing documents that are produced in conjunction with an insurer and a pharmacy fail to mention that other pharmacies are available. This is required by law. Another problem is that some documents do not include required information on the subsidy that is available to beneficiaries with low incomes.

CDC and Columbia find no link between autism and MMR vaccine

According to this post at the Wall Street Journal Health Blog, the Center for Disease Control and Prevention and Columbia University did a study that found that there is no connection between the Measles, Mumps and Rebella vaccine and autism.

The two researchers conducted a study based on:

The measles virus from the vaccine could reproduce in the intestinal tract, leading to inflammation and bowel permeability. That leaky bowel could permit the release of chemicals that would make their way to the nervous system, causing trouble.

When conducting the research, they looked at children with gastrointestinal problems who had autism and children with gastrointestinal problems with no autism. Studies showed there was no difference between the two sets of children.

Satisfied Medicare Providers

In a survey conducted by CMS this year, which was administered to 35,000 randomly selected individuals and organizations including physicians, hospitals, and skilled nursing home facilities, Medicare health care providers are still satisfied with Medicare fee-for-service contractors. As indicated by this article, this shows that

"Medicare health care providers continue to be satisfied by Medicare fee-for-service contractors showing a relatively smooth transition to the new Medicare Administrative Contractors (MACs)".

This year the aver score was 4.51 based on a scale from 1 to 6, which is very close to last years score of 4.56. How Medicare contractors dealt with “provider inquires” continued to be the leading sign of satisfaction. This is the third year in a row where this has been the case

Medicare and Medicaid Rise to the Top

The Wall Street Journal blog reports that while the share of Americans that got health insurance through work or bought it on the private market last year declined, the number of Americans insured through Medicaid and Medicare has increased. These are numbers based on the latest report from the US Census Bureau.

This change shows that there is an overall decline in the percentage of Americans who are uninsured, and this goes against recent trends of rising uninsurance rates. See the full report here.

“Billing balance” stirs up controversy

Business Week recently collaborated with the CBS Evening News educate the nation on the nature of “billing balance.” When an insurance company covers less of the medical payments than doctors want them to, they turn to the customer for the rest of the payment. Since patients think that their unpaid bills will turn their credit bad, many automatically pay the bills. This has resulted in patients paying $1 billion more a year in medical bills than they’re supposed to. The California Association believes that 1.76 million policy holders paid $5.28 million more than they were suppose to, including 56% of those who were billed