Archive for May, 2007

Authorities arrest 12 in HIV billing probe

The owners of a Belle Glade clinic and 11 of their employees were arrested today on charges they fraudulently billed medicaid and medicare more than $5 million for HIV treatments that were never delivered to patients. Read more here…

Belle Glade woman among nine arrested in $5 million health fraud scheme

Nine people, including a Palm Beach County woman, were arrested Thursday for their alleged roles in a $5 million criminal operation that billed Medicare and medicaid for fake HIV treatments, prosecutors said. Read more here…

Storan Technologies Releases New Version of Medicare Risk Adjustment Software

Storan Technologies Inc. is announcing the immediate availability of Merlin Risk Adjustment 5.0, a Web-based solution that helps health plans and medical groups efficiently and accurately document an individual patient’s diagnoses to ensure full Medicare reimbursement. Read more here…

Medicare To Deny Coverage Of Artificial Spinal Disks

Federal regulators on Friday announced that Medicare planned to deny coverage of artificial disks implanted in the lower spines of beneficiaries older than age 60, the New York Times reports. Artificial disks “were seen as a potential alternative” for up to a quarter of the 220,000 spinal fusion surgeries performed annually, according to the Times. [...]

Bravo by Elder Health Names Gil Miller Its Executive Vice President of Sales

Bravo by Elder Health, a locally based Medicare Advantage health plan, announced today that Gil Miller has been appointed executive vice president of sales. In this new position, Miller will be responsible for sales and broker development in all markets Bravo serves, including Delaware; Maryland; Pennsylvania; Texas; and Washington, D.C. Read more here…

JEN Associates, Inc.: Data Suggests Fewer Deaths But More Complications and Higher Costs for Medicare’s HIV Caseload

According to a new study published by the American Journal of Public Health, improved HIV treatments continue to lower the death rate among Medicare patients with HIV, while total Medicare expenditures for this population are rising sharply. In addition, Medicare’s HIV patients, particularly African Americans, face growing non-HIV illnesses such as diabetes, heart failure and [...]

Insurers Launch Comprehensive Initiative To Strengthen Protections For Medicare Beneficiaries, USA

The Board of Directors of America’s health insurance plans (AHIP) today announced a new initiative to protect beneficiaries as they consider enrolling in the Medicare Advantage and Part D programs and ensure that brokers, agents and plan marketing staff meet new qualifications and requirements. [click link for full article] Read more here…

Debate over Reducing Medicare Advantage Plan Payments Continues

May 30, 2007 – Lawmakers continue to debate whether to reduce federal payments to private insurers that administer the fastest-growing type of Medicare advantage plans — private fee-for-service plans, the AP/Atlanta Journal-Constitution reports (Freking, AP/Atlanta Journal-Constitution, 5/30). Read more here…

The SCOOTER Store Will Provide Bravo by Elder Health Texas Members With Mobility Equipment

The SCOOTER Store announced today that it has contracted with Bravo by Elder Health, a Medicare advantage program, to provide power wheelchairs and scooters to the health plan’s Texas members in need of mobility assistance. Bravo has more than 3,500 members in Texas. Read more here…

Overweight Americans To Weigh On Nation’s Future Health Costs

Wary of tackling Social Security or Medicare reform, members of Congress are pitching a new prescription for the nation’s coming fiscal woes:… Read the rest: Read more here…

Many Small Physician Offices No Longer Provide Injected Medications Because Of Medicare Reimbursement Issues

Thousands of small physician offices are “getting out of the business of administering drugs for conditions ranging from anemia and cancer to arthritis and infections,” the Wall Street Journal reports. The shift is “an unintended consequence of a change in the way Medicare reimburses doctors” to administer medications that are injected or infused, according to [...]

MedPAC Names Three New Members, Reappoints Four Others

Three new members have been appointed to the Medicare Payment Advisory Commission, CQ HealthBeat reports. Bruce Stuart, a professor and executive director of the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland-Baltimore, was appointed to serve the remaining two years of the three-year term of Douglas Holtz-Eakin, who resigned on [...]

$101 million in Medicare fraud charges

Authorities announce criminal health care fraud charges against 16 defendants for fraudulently billing Medicare approximately $101 million. Read the rest: Read more here…

Scan Health Plan welcomes 100,000th member

LONG BEACH – What began 30 years ago as a health care co-op for frustrated Long Beach seniors has blossomed into one of the nation’s fastest-growing managed care programs for Medicare patients. Read the rest: Read more here…

Hospital Rescued: Watongans Played Big Role

By Jim Stafford, The Daily Oklahoman May 27–WATONGA — Watonga Municipal Hospital was in a death spiral in the autumn of 2002. The Medicare agency claimed it was owed millions in overpayments to a home health agency the hospital owned. Vendors were unpaid. Read the rest: Read more here…