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.

Living Near Highways Can Increase Risk of Low-Birth Weight

The NY Times reports that a recent Canadian study shows that mothers who live near highways are more likely to give birth to low-weight and preterm babies. The study, which was published in Journal of Epidemiology and Community Health, looked at medical records of nearly 100,000 births in Montreal from 1997 to 2001. Researchers measured distances to the nearest highways and determined socioeconomic and education levels from census data.

Researchers found that compared to wealthy neighborhoods, mothers who lived within 220 yards of a highway were linked to a 58 percent chance of preterm birth, and a 81 percent chance of increased risk of low-birth weight.

Dr. Mélissa Généreux, a resident physician at the University of Montreal mentions:

“Low-income mothers are exposed to more risk factors — smoking, poor nutrition, poor access to prenatal care, domestic violence. More advantaged mothers are protected from these risk factors, so they might be more affected by the addition of a single new risk factor, pollution from highways.”