Medicare

Medicare is going to test new ways to reimburse doctors for medications, in hopes they'll choose less expensive drugs.

The plan would alter Medicare Part B, which pays for medicines administered in doctors offices or outpatient hospital clinics — to eliminate incentives for doctors to use the most expensive drugs.

Medicare recipients who have arthritis, cancer or other complex conditions may find they have to pay thousands of dollars a year for their medications, even if their insurance plan covers most prescriptions.

Remember so-called death panels?

When Congress debated the Affordable Care Act in 2009, the legislation included a provision that would have allowed Medicare to reimburse doctors when they meet with patients to talk about end-of-life care.

But then Sarah Palin loudly argued that such payments would lead to care being withheld from the elderly and disabled.

Her assertions greatly distressed Dr. Pamelyn Close, a palliative care specialist in Los Angeles.

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An estimated 16.4 million Americans have gained health insurance coverage since the passage of the Affordable Care Act, according to new data released Monday by the US Department of Health and Human Services.

Dr. Richard Frank, assistant secretary for planning and evaluation, said the drop in the uninsured rate is primarily driven by the Affordable Care Act.

Federal health officials were advised in 2009 that a formula used to pay private Medicare plans triggered widespread billing errors and overcharges that have since wasted billions of tax dollars, newly released government records show.

Federal officials are planning a wide range of audits into billing and government spending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly expanding under the Affordable Care Act.

The Health and Human Services Office of Inspector General, which investigates Medicare and Medicaid waste, fraud and abuse, said it would conduct "various reviews" of Medicare Advantage billing practices with an eye toward curbing overcharges. Results are due next year.

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Open enrollment for Medicare is October 15 through December 7. Plans will go in effect January 1. The Kentucky State Health Insurance Assistance Program (SHIP) is a free service that provides information, counseling and assistance to seniors and disabled individuals needing to sign up for Medicare. SHIP doesn't sell health insurance products, but offers guidance. Program Coordinator Kellie Oliver joins Kate Lochte on Sounds Good to explain the upcoming open enrollment.

The fraud scheme began to unravel last fall, with the discovery of a misdirected stack of bogus prescriptions and a suspicious spike in Medicare drug spending tied to a doctor in Key Biscayne, Fla.

Now it's led to two guilty pleas, as well as an ongoing criminal case against a pharmacy owner.

Medicare Frequently Overpays Doctors For Patients' Visits

May 29, 2014

Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a report from the inspector general of the Department of Health and Human Services.

But in its reply to the findings, the Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most expensive visits because it isn't cost-effective to do so.

Today on Sounds Good we meet Kellie Oliver, the new State Health Insurance Program (SHIP) Coordinator. SHIP provides information, counseling and assistance to seniors and disabled individuals, their family members and caregivers. The program seeks to educate the public and Medicare beneficiaries so they are better able to make informed decisions on healthcare.

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