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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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?

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.

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.

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."

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.