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.

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."