Hospital Study: Greater spending linked to higher mortality

An extensive study of Medicare patients in California hospitals found that the more money spent on the care of the patients, the lower the mortality rate, according to Health Leaders Media.

The study, which was limited to patients with six common medical conditions, was published in this month’s Annals of Internal Medicine.

The study found that higher patient survival was linked with higher spending for each of the diagnoses.

Data was analyzed from Medicare patients who suffered from stroke, pneumonia, hip fracture, congestive hearth failure, gastrointestinal hemorrhage and acute myocardial infarction. The scope of the study included spending data from 208 hospitals over 9 years.

According to the study, during 1999 to 2003, for example, patients admitted with acute myocardial infarction to California hospitals in the highest quintile of hospital spending had lower inpatient mortality than did those admitted to hospitals in the lowest. The prediction of inpatient deaths would increase by 1,831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest. 

John Romley, of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, is lead author of the study. He says he and his colleagues worked to control factors like patient health status and hospital teaching affiliation.

The study contradicts findings from a previous Dartmouth Atlas of Health Care that spearheaded much of what is being looked at in healthcare reform regulations, that expensive care is not necessarily better care, and may in fact be worse care.

“If the results are real … that would suggest these reductions across the board in hospital spending might lead to worse outcomes for some patients,” Romley told Reuters Health. That doesn’t mean cuts wouldn’t still be cost-effective, if money elsewhere could better improve public health. But, he added, “it is important to understand the trade-offs.”

36 Arrested in Medicare Fraud Sting

In the most peculiar of these operations, a medical center in Brooklyn scammed $72 million from Medicare by submitting bogus charges for physical therapy for elderly Russian immigrants. Patients who sold the office their Medicare numbers were paid by a man in a back-room who did nothing but bribe patients all day. Authorities say the “kick back room” was decorated with posters resembling Russian propaganda, which read in Russian “Don’t Gossip” and “Be on the lookout: In these days, the walls talk.”

Sebelius and Holder commented at the healthcare fraud prevention summit in Miami that these busts are an important step toward conquering the larger problem of fraud which has seriously impacted the system in recent years. Lately, schemes have become more sophisticated. In the past, fraudsters (usually clinic owners) would bill Medicare multiple times for the same piece of medical equipment which no patient ever received. Today, schemes involve a more complex web of doctors, patients, clinic owners, and sometimes violent criminals. Mobsters and violent offenders have started getting in on the Medicare fraud action because they find it more lucrative and with less severe criminal penalties than other offenses like drug or gun trafficking.

Eliminating an estimated $60-90 billion per year in Medicare fraud is a key component of President Obama’s plan to pay for healthcare reform. In order to accomplish this, federal authorities have promised more man power and funding and are using new technologies to keep up with criminals. It used to take ninety days before the feds detected a scam, by which point criminals had usually slipped away with millions of dollars. Now, authorities monitor billing data in real time allows them to catch a scam almost immediately.

The most problematic area for authorities continues to be Miami, which has long been the epicenter of Medicare-related fraud. For example, according to a federal report Miami-Dade county received about $520 million from Medicare in home health payments in 2008. That’s more than the rest of the country received combined, even though Miami-Dade contains just 2% of patients eligible for those benefits. In 2007, authorities launched a strike force in the area to address this growing problem. The program which started there has expanded to seven cities around the country and has resulted in over 720 indictments for those who’ve defrauded Medicare for more than $1.6 billion.

Medicare Fraud Identity Theft

One issue plaguing the Medicare reforms is Medicare fraud. Every year, both seniors and the government lose quality health care and billions of dollars to corrupt providers.  Medicare fraud isn’t new (see my previous blogs on fraud and scams), but as the new health care reforms have passed, fraud has been in the spotlight. Medicare fraud affects everyone, from the government to seniors to taxpayers.

Cutting costs for health care is integral to health care reform. According to the United States government, taxpayers lose over 60 billion dollars every year due to Medicare fraud.  The government uses taxpayer money to finance Medicare, so when people abuse the system, it is the taxpayers who pay the price.

South Florida is the hotbed of these schemes, full of phantom pharmacies and providers, where criminals can earn tremendous amounts of money by cheating the government. Scammers sometimes purchase businesses like pharmacies, along with Medicare licenses and patient records, and use that information to charge Medicare for drugs and other services. According to a report by ABC news, one man’s Medicare card was used to purchase two prosthetic legs—even though the man had both of his legs, Medicare was slow to respond. Because Medicare moves very slowly, even when dealing with something like fraud, it is easy for con men to get away with their crimes.

Con men and fraudsters aren’t the only ones to participate in Medicare fraud schemes. Some corrupt health care providers overcharge Medicare for certain services that may or may have been performed improperly. Not only does this swindle the government out of millions of dollars, but also can harm the health of Medicare beneficiaries.  Most doctors and other providers are not involved in any of these scams, but the minority who do fraudulently charge Medicare waste government cash and harm senior health.

Preventing Medicare fraud could save the government—and taxpayers—billions of dollars annually, making it imperative to crack down on scammers and corrupt providers.  In the current system, responses to fraud are often slow and cumbersome, with little action taken. When Medicare cracked down on fraudulent equipment sales in South Florida, Medicare durable medical equipment claims dropped by $1.76 billion. By making more of an effort to combat fraud, it will be possible to save billions of dollars.

Recently the Department of Health and Human Services proposed that individual workers found responsible for Medicare fraud should be removed from the Medicare program.  Currently, only people who are still working for a company convicted of Medicare fraud can be excluded from the program, so employees can leave the company in order to evade exclusion.  Two Representatives from Florida proposed legislation that cracks down on individual executives, preventing them from working with Medicare after they have been convicted.

President Obama plans to sign a memo that would create a “do not fraud” list to combat Medicare fraud.  Consequently, the government would not send payments to deceased people, suspended contractors, or other delinquents to cut down on fraudulent payments. According to the Washington Post, within a three year time span, CMS sent approximately $182 million to dead people. CMS will use an online tool that will detect fraud, and provide more comprehensive background tests on providers, hoping to cut down on fake payments.

In general, I feel that the crackdown on such scams will be beneficial to the Medicare system. By preventing employees responsible for fraud from again working with Medicare, and keeping more detailed records of payments and providers, the government can save billions of dollars that will be better used elsewhere.  Hopefully these measures will improve the current health care environment in the United States.

The president will be using these to close your coverage gap.

1.)    The phrase “doughnut hole,” or “donut hole” if you prefer Dunkin Donuts to your average breakfast fare, refers to the coverage gap for seniors on Medicare prescription drug plans. After a prescription drug plan (PDP) pays a certain amount of cash for a beneficiary’s medication, the beneficiary is then responsible for paying out of pocket until they reach spending that requires catastrophic coverage, after which the plan will help cover prescriptions for the rest of the year.

2.)    AARP’s Doughnut Hole Calculator is a great tool that can help you avoid the doughnut hole. Type in the specifics about the drugs you need to generate a report for the year that will tell you if you are likely to hit the gap. If you are deemed likely to hit the gap, the calculator can show you alternatives that can reduce costs. It isn’t an instant cure-all, but knowing your needs can work wonders in closing your personal doughnut hole.

3.)    Some prescription drug plans cover generics within the gap, but often come with more expensive premiums. Remember, not all plans cover generics in the gap, so it’s crucial to understand what exactly your PDP or Medicare Advantage page covers.

4.)    In early June, the Department of Health and Human Sources sent out $250 doughnut hole rebates to seniors who fall into the coverage gap.  You’ll receive the checks automatically after you enter the doughnut hole, but keep record of prescription medication as backup just in case you don’t receive your rebate for some reason.

5.)    Scammers are preying beneficiaries who receive doughnut hole checks—which I like to think of as Munchkins. Remember, you don’t need to get your money through a third party, and you don’t have to tell anyone any personal information to receive a check. The Consumer Reports Money blog has a great overview of these scams. Help yourself or a loved one avoid fraud.

6.)    By 2020, the government hopes to close the doughnut hole completely. In 2011, the government will begin providing drug discounts to beneficiaries enrolled in Part D plans. Discounts will increase until 2020, when the doughnut hole will look more like a Boston cream doughnut than a regular ring doughnut.

While prescription drug plans can sometimes control costs, the wide expanse of the doughnut hole can really put a hurting on your wallet. Hopefully health care reforms will truly eliminate the coverage gap for seniors. Until then, the government will be taking baby steps to reduce drug costs for people with Medicare.

Medicare fraud is among the most common types of health care fraud. The Obama administration has requested a funding increase in an effort to cut down the Medicare fraud. These efforts have been successful in the Miami area, which has the highest rates of both Medicare fraud and prosecutions.

Recently, the fraud teams have been set up in cities like Detroit and Brooklyn, area’s where Medicare fraud was starting to turn up more. Many of those cases were developed by the same Miami criminals who were looking to move to an area where there was less crackdown and scrutiny.

The schemes are constantly changing, however, making catching those involved difficult. One of the first popular scams was based on durable medical equipment like wheelchairs and walkers. Then HIV infusion clinics and home health care were targeted. The enforcement teams are often left simply trying to play catch up with the constantly changing schemes and locations.

It is very important to make sure you are using a legitimate carrier for your health plan and a reliable source for your health care needs. This is why choosing a plan is such an important decision. By going though MedicareSolutions.com you know you can trust your plan, we only represent the best rated carriers. You can be sure that any plan you buy through us is a genuine plan. You can call our representatives at 800-328-7305.

NPR – Miami Serves As Model In Medicare Fraud Crackdown

At the urging of Senate Finance chairman Max Baucus who describes Humana’s letters as “mislead[ing] seniors regarding the subject,” CMS ordered Humana to stop sending out such letters. Both Baucus and CMS have put a warning to Humana and any other insurer that might get mixed up in health care reform politics, Baucus stating “it is wholly unacceptable for insurance companies to mislead seniors,” but, as the Wall Street Journal points out, “Humana merely made the mistake of trying to tell seniors the truth about what will happen to their coverage.”

CMS does not currently have a model for how insurance companies should respond to health care politics but, clearly, attempting to inform your current customers is not allowed. It should be noted that Humana has been extremely supportive of health care reform, save these changes to Medicare Advantage, despite all the fingers pointed at the insurance companies and their growing reputation as the “bad guys.” Finally, Humana attempts to defend itself through these letters, pointing out that if benefits were to be cut, it is not a consequence of Humana’s actions, but of the government. But Humana gets slammed.

Rather than arguing over words, Senator Baucus should set reimbursement levels for Humana and other managed care providers, so that they perform the way they were intended to! Save the government and taxpayers money, while offering high quality health plans. Humana should stop the clumsy PR campaign and defend their program with how they help taxpayers and beneficiaries—not simply scaring their members—be their claims true or not.

Many people were victims of Bernard Madoff’s fraud and have lost a considerable amount of income due to this scheme. Originally, Madoff victims were not included in the above categories of life changing events. As of June 9, Social Security determined that “if someone had a reduction of income as the result of criminal theft or an investment scam, they can qualify as having a life-changing event.” Just like the above instances, you need to provide documentation to Social Security. Documentation would include an account statement from Madoff’s firm or a court document stating you as an alleged victim.

If you are an alleged victim or have had a life changing event recently, visit http://ssa.gov/online/ssa-44.pdf to fill out a form to request a reduction in your Medicare Part B premium.

For the full article, go to http://online.wsj.com/article/SB124546138795033219.html

Most Medicare fraud cases are easy to detect through investigating the money involved in bank transfers. However, this case was a little harder to track because the group owned two check cashing stores where they would cash between $30,000 and $80,000 several times a week. In order to deter authorities from the fraud, the defendants varied whose name the companies were kept under. If the defendants are convicted, they could face up to years in prison on each count of conspiracy, healthcare fraud and money laundering, and up to two years for each count of aggravated identity theft.

Medicare fraud is common in Florida due to things like its easy access to other countries as an escape route. In the past three years, $1.5 billion in health care fraud cases have been prosecuted. Miami single-handedly had 146 convictions since 2007 in Medicare fraud cases. This case exemplifies the crackdown on Medicare fraud. It was one of the fastest health care fraud turnabouts: it only took two months from the tip to the indictment. This shows that people are becoming more aware of the problem and trying to solve it.

The business owner contacted the FBI in Miami who contacted the bureau’s legal attaché in Madrid. Garcia was arrested by the Spanish National Police at a hotel near Madrid. He was flown to Miami just last week to face charges for submitting over $10.7 million in false claims to Medicare. Last September he had fled from Miami and had a $200,000 bond. The bond has been revoked.

Many Medicare fraud cases have shown up in the past few years. In just the last 5 years, over 60 defendants have escaped Miami to avoid charges. Together all these Medicare fugitives have submitted $404 million in fraudulent claims to Medicare and have received $156 million of that.