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Posts Tagged ‘U.S. Health and Human Services’

2013 Medicare Physician Fee Schedule Released

July 10, 2012 1 comment

CMS has released the Physician Fee Schedule for 2013 has been released. The fee schedule will be officially published July 20th and will become finalized November 1. Primary Care will sill see a 16% increase in reimbursement and specialities will see a 33% decrease in reimbursement.  Here exactly is how it is broken down by specialty.

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Increase
———————-
Family Practice        7%
Internal Medicine    5%
Geriatricians              4%
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Decrease
————————–
Radiation Oncology     -15%
Radiology                       -4%
Anesthesiology            -3%
Cardiology                     -3%
Vascular Surgery        -3%
Pathology                     -2%
Urology                         -2%
Neurosurgery               -1%

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No Effect
———–
Allergy/Immunology
Gastroenterology
General Surgery
Plastic Surgery
Rheumatology

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Keywords: family medicine, family practice medicine, internal medicine, health care, medicare fee schedule, medicare, reimbursement, health plan, medical practice, U.S. Health and Human Services

Health Insurance Companies Fined $88.8 Million for Overcharging Federal Employee Health Benefit Plan

June 27, 2012 1 comment

Over the past decade, health insurers have been fined $88,800,000 for overcharging the Federal Employee Health Benefit Plan on purpose. Blue Cross Blue Shield was fined $1,500,000 (Source 1) and United Healthcare (Source 2) was fined $87,300,000 for their deeds.

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Sources:
1. http://www.govexec.com/federal-news/2005/08/fehbp-contractor-agrees-to-pay-15-million-settlement/19982/  2. http://www.californiahealthline.org/articles/2002/4/15/pacificare-pays-87m-to-settle-fehbp-overcharges-case.aspx

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Keywords: health care, health insurance, employee health, health benefits, federal government, blue cross blue shield, united healthcare

Health Insurance Companies Fined $5 Billion for Medicare Fraud and Other Fraud Violations!

May 14, 2012 3 comments

Health Insurance companies have been getting caught red-handed deliberately defrauding Medicare and Medicaid and other medical organizations for more than a decade. This is all due to insurance execs trying to get as much profit for their shareholders as possible. As a direct result of their felonious behavior,  insurance companies have been fined $2.694 billion for Medicare/Medicaid fraud and $2.435 billion for non-Medicare/Medicaid fraud (overcharging, not paying physicians, slow payments). This comes to a total $5 billion that health insurers have been fined for. The Department of Health and Human Services as well as the Office of Inspector General have officially declared “war” on health insurer fraud and are taking action to make sure this ceases.

Below is a listing of how much an insurer has been fined.

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Aetna

Q1 2012 Revenue: $8.92 billion    (cnbc.com)

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—————————————————————————————-
History of Non-Medicare Fraud:
Fined $750,000         – February 2010    (Source 12)
Fined $256,500         – November 2009  (Source 11)
Fined $20 million       – February  2009   (Source 24)
Fined $5.1 million      – February 2009    (Source 79)
Fined $6.25 million   – August 2003         (Source 10)
Fined $50,000            – June 2002           (Source 49)
Fined $1.4 million      – September 2001 (Source 7)
Fined $1.15 million   – November 2001  (Source 9)
Fined $1.9 million      – December 2000 (Source 8)
Fined $4.5 million       – December 1995  (Source 6)
Fined $89 million        – December 1994  (Source 6)
——————————————————————————————
 Medicare Fraud Fines:
Non-Medicare Fines:      $129,546, 500
Total Fraud Fines:        $129,546,500
 —————————————————————————————————————————-
AmeriGroup
History of Medicaid Fraud
Fined $225 million        – July 2008  (Source 79)
Fined $144 million        – July 2006   (Source 79)
Fined $190 million       – July 2006   (Source 79)
—————————————————————————————
Total Fraud Fines:     $559 million
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Blue Cross Blue Shield
BCBS Illinois 2011 Revenue:  $1.1 billion
BCBS TN       2011 Revenue:  $5.2 billion
————————————————————————-
History of Medicare Fraud:
Fined $25 million   – February 2011 (Source 21)
Fined $225,000     – August 2010 (Source 18)
Fined $131 million  – April 2007   (Source 3)
Fined $1.5 million   – August 2005 (Source 82)
Fined $40 million   –  June 2003  (Source 1)
Fined $9.3 million  – July 2002   (Source 83)
Fined $74 million   –  December 1999  (Source 1)
Fined $261 million  – July 1999      (Source 16)
————————————————————————–
History of Non-Medicare Fraud:
Fined $480,000      – May 2012              (Source 43)
Fined $3.7 million – May 2012               (Source 78)
Fined $1.5 million   – March 2012          (Source 20)
Fined $1.6 million   – February 2012    (Source 14)
Fined $325,000       – April 2011           (Source 23)
Fined $5 million      – November 2010 (Source 13)
Fined $20 million   – September 2010 (Source 77)
Fined $95,000    – January 2010     (Source 22)
Fined $1 million      –  February  2009  (Source 19)
Fined $542,000      – August 2008        (Source 15)
Fined $2.1 million  – August 2008        (Source 50)
Fined $2.8 million   – March 2008         (Source 31)
Fined $1.25 million  – September 2006   (Source 85)
Fined $128 million  – May 2006            (Source 17)
Fined $23.7 million  – November 2005 (Source 85)
Fined $1.5 million      – August 2005     (Source 86)
Fined $150,000       – July 2005            (Source 47)
Fined $1.8 million   –  December 2003 (Source 48)
Fined $135,000      – June 2002            (Source 49)
 ———————————————————————————————
 Medicare Fraud Fines:                   $542,025,000
Non-Medicare Fraud Fines:          $194,327,000
 Total Fraud Fines:                          $736,952,000
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CareMark  Advantage
 Q1 2012 Revenue:  $30.8 billion   (cnbc.com)
 ———————————————————————
 History of Medicare Fraud:
 Fined $5 million         – May 2012 (Source 68)
Fined $7.5 million      –  February 2003  (Source 1)
 ———————————————————————–
Total Fraud Fines:                $12.5 million
 ——————————————————————————————————————————————
Cigna
Q1 2012 Revenue:  $6.9 billion (cnbc.com)
—————————————————————————-
History of Medicare Fraud:
Fined $24.5 million  – December 2002 (Source 25)
Fined $9 million       – March 2000         (Source 63)
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History of Non-Medicare Fraud:
Fined $1.2 million  –     April 2011             (Source 62)
Fined $20 million    –    February 2009    (Source 24)
Fined $97 million    –    July 2007             (Source 26)
Fined $150,000      –    January 2006      (Source 61)
Fined $540 million  –    September 2003 (Source 27)
Fined $80,000         –    June 2002            (Source 49)
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Medicare Fraud Fines:            $33.5 million
Non-Medicare Fraud Fines:   $657, 200,000 million
 Total Fraud Fines:                    $690,700,000 million
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First Health Services Corporation
 ————————————————–
History of Medicaid Fraud:
 Fined $13 million  –  April 2004   (Source 1)
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History of Non-Medicare Fraud
Fined $150 million   –  June 2011 (Source 69)
 —————————————————-
Total Fraud Fines:         $163 million
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HighMark Inc
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History of Medicare Fraud:
Fined $1.5 million   – April 2004  (Source 1)
 ————————————————-
History of Non-Medicare Fraud
Fined $10 million   – October 2007 (Source 70)
 —————————————————–
Total Fraud Fines:       $11.5 million
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 Humana
Q1 2012 Revenue: $10.2 billion
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Breaking News:
 Dept of Justice probing Humana for Fraud –   May 2012  (http://www.fiercehealthpayer.com/story/feds-probe-humana-claims-doc-loans/2012-05-04)
 Physician Exposes Humana Scam:   http://www.wejonesmd.com/Pages/Ins/humana.html
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 History of Medicare Fraud:
Fined $3.4 million    –  August 2011  (Source 29)
Fined $133 million  – October 2005 (Source 4)
Fined $8 million       – June   2001 (Source 1)
Fined $14.5 million  –  June 2000 (Source 1)
Fined $8 million        – November 1999 (Source 28)
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 History of Non-Medicare Fraud:
Fined $45,000,000  – May 2012 (Source 84)
Fined $314,000     – June 2011  (Source 60)
Fined $299,000     –  June 2011 (Source 30)
Fined $100,000     –  January 2011 (Source 32)
Fined $55,800       – October 2010  (Source 60)
Fined $2.8 million  – March 2008 (Source 31)
Fined $500,000      – January 2008 ( Source 60)
Fined $500,000     – August 2007   (Source 60)
Fined $4,190,000 million – July 2005 (Source 60)
Fined $1,013,259 million – July 2005 (Source 60)
Fined $3.5 million   – May 2005    (Source 60)
Fined $10.2 million – November 2003 (Source 60)
Fined $106 million – October 2003 (Source 60)
Fined $78.5 million – January 2000 (Source 33)
Fined $10 million    – July 1999     (Source 33)
 ——————————————————————–
Medicare Fraud Fines:               $166,900,000 million
Non-Medicare Fraud Fines:      $264,740,859 million
Total  Fraud Fines:                      $431,640,859 million
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Lovelace Health Plan
—————————
History of Medicare Fraud:
Fined $24.5 million  – December 2002 (Source 1)
 ——————————————————-
Total Fraud Fines:                    $24.5 million
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Medco Health Solutions
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History of Medicare Fraud:
Fined $29 million  –  April 2004  (Source 1)
Fined $115 million – October 2006  (Source 1, Source 2)
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History of Non-Medicare Fraud
Fined $2.75 million  – March 2012 (Source 71)
Fined $29.3 million  – April 2004 (Source 72)
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Medicare Fraud Fines:            $144 million
Non-Medicare Fraud Fines:   $32,050,000
 Total Fraud Fines:                    $176,050,000 million
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 Rocky Mountain Health Plans
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Fined $1.5 million    –  August 1999 (Source 1)
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Total Fraud Fines:     –  $1.5 million
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Tenet Choices Inc
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History of Medicare Fraud:
Fined $8.25 million –  March 2004  (Source 1)
Fined $54 million    –  August 2003 (Source 1)
Fined $4 million    –  February 2003 (Source 1)
Fined $115 million  –  January 2003 (Source 1)
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Total Fines:               $177,650,000 million
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 UnitedHealthcare
Q1 2012 Revenue: $27.23 billion (cnbc.com)
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History of Medicare Fraud:
Fined $3.5 million –  December 2004 (Source 34)
Fined $4 million   –   September 2002  (Source 1)
Fined $2.9 million –  November 2000   (Source 36)
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History of Non-Medicare Fraud:
Fined $1.3 million  – May 2012           (Source 42)
Fined $20 million    – May 2012          (Source 39)
Fined $350 million  – October 2010  (Source 35)
Fined $457,000       – October 2010   (Source 38)
Fined $750,000      – November 2009 (Source 54)
Fined $500,000       – August 2009     (Source 40)
Fined $50 million    – January 2009   (Source 37)
Fined $250,000       – July 2008          (Source 41)
June $50,000          – June 2008         (Source 74)
Fined $2.8 million   – March 2008      (Source 44)
Fined $3.5 million   – January 2008  (Source
Fined $4.4 million   – December 2007  (Source 51)
Fined $12 million    – September 2007 (Source 45)
Fined $650,000      – May 2007              (Source 55)
Fined $59,500         – February 2007 (Source 43)
Fined $364,750       – March 2006      (Source 46)
Fined $350,000      – March 2006       (Source 52)
Fined $5,000          – January 2005    (Source 53)
Fined $2.8 million – January 2005    (Source 54)
Fined $150,000     –  May 2002         (Source 56)
Fined $87.3 million   –  April 2002 (Source 1)
Fined $35,900       – November 2000 (Source 59)
Fined $175,000     – April 2000         (Source 57)
Fined $127,400     – March 2000      (Source 58)
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Medicare Fraud Fines:            $10,400,000
Non-Medicare Fraud Fines:   $538,024,550 million
 Total Fraud Fines:                    $548,424,550
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 WellCare
 —————————-
History of Medicare Fraud:
Fined $138 million            March 2012   (Source 75)
Fined $80 million             May 2009       ( Source 80)
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History of Non-Medicare Fraud
Fined $120,000   –  August 2009  (Source 76)
 ——————————————-
Total Fraud Fines:    $218,120,000
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 WellPoint
Q1 2012 Revenue: $15.42 billion  (cnbc.com)
 —————————————————-
History of Medicare Fraud:
Fined $6 million       –  October 2005 (Source 81)
Fined $198 million  –  July 2005  (Source 5)
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History of Non-Medicare Fraud:
Fined $100,000    – August 2008 (Source 64)
Fined $1 million   – March 2007    (Source 66)
Fined $80 million    – May 2005    (Source 67)
Fined $448 million  – July 2005      (Source 65)
 ——————————————————
Medicare Fraud Fines:             $204,000,000 million
Non-Medicare Fraud Fines:    $529,100,000 million
 Total Fraud Fines:                    $733,100,000
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 Total Medicare Fraud Fines:                    $2,694,475,000 billion
Total Non-Medicare Fraud Fines:           $2,506,958,859 billion
Grand Total Fraud Fines:                           $5,219,493,859 billion
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Sources:
10. http://articles.latimes.com/2003/aug/20/business/fi-rup20.4

25. http://articles.latimes.com/2002/dec/05/business/fi-cigna5

Health Insurance Companies to Give Rebates to Consumers

May 2, 2012 Leave a comment

Health insurance companies in USA will be giving over $1,000,000,000 in rebates back to the consumer this year for failing to meet the required 80/20 medical loss ratio rule. This is a rule established in the Affordable Care Act that requires insurers to actually pay 80% of premium dollars to a patient’s care and not let it be used for greedy shareholder and executive profits. Profits and revenue of insurers are down nearly 5% (according to CNBC) as a direct result of the 80/20 rule. The insurance lobby can try to repeal this part of the ACA but their efforts will be futile since Health and Human Services has already implemented and adopted it as one of their own rules. The 80/20 provision (now rule) was brilliantly written by the Congressional Healthcare Caucus, Congressional Physician Caucus, U.S. Senate Health Education Labor and Pensions Committee, U.S. Senate Finance Committee, and U.S. Senate Commerce Committee back when I was writing health care policy in Congress in 2008.

Source:  CNBC

Source: http://commerce.senate.gov/public/index.cfm?p=PressReleases&ContentRecord_id=79f6f00b-1db6-4f49-b9df-663f532f94da

Details of Health Care Cuts and Spending in 2013 Federal Budget

February 14, 2012 Leave a comment

The Obama Administration has recently presented its 2013 Budget proposal to Congress. According to the White House and HHS websites, healthcare is expected to be effected in the following ways:

CUTS

$362 billion in cuts to Medicare and Medicaid over 10 years

Drug companies to provide $156 billion in discounts on top of $80 billion in discounts used to pay for healthcare reform legislation

$63 billion in cuts to long-term care facilities (i.e. Kindred Healthcare)

$177 million cut to Children’s Hospital Graduate Medical Education programs

$327 million cut to Community Services and Preventive Health grants

SPENDING

Medicare spending to increase by $45 billion in 2013 and total $523 billion.  Seniors to see premiums go up in order to save $28 billion by 2022.

SAVINGS

$385 billion in savings for Medicare and Medicaid over 10 years

INVESTMENT

$1 billion additional for implementation of healthcare reform

$2 billion for Administration on Aging

$599 million for “effectiveness” research

$8 billion for Head Start

REVENUE GENERATION

$1 trillion in new taxes (Buffet rule, etc)

EFFECT ON JOB FORCE

200,0000 pharma jobs to be lost according to Pharmaceutical Research and Manufacturers of America Association

278,000 hospital jobs to be lost according to American Hospital Association

Disease Management,Value-Based Payment Programs Fail to Cut Medicare Costs

January 19, 2012 Leave a comment

The non-partisan Congressional Budget Office and Department of Health and Human Services have come out stating that programs designed to cut Medicare spending have failed. Disease management coordination demonstrations and value-based payment demonstrations have not reduced Medicare costs one bit. The 34 disease management coordination programs specifically have had no affect on the reduction of hospital admissions. Value-based payment demonstrations, which allowed large multi-specialty physician groups to share in savings or offered bonuses for meeting quality metrics, created no Medicare savings at all. A complete report of CBO’S findings can be found here: http://www.cbo.gov/ftpdocs/126xx/doc12663/01-18-12-MedicareDemoBrief.pdf

Medicare and Medicaid spending/costs are dramatically rising. According to CMS, medicare spending will reach $1.038 billion by 2020. Medicaid spending will reach $458 billion by 2020 as well. Medicare and Medicaid spending is expected to grow at 7% between 2012-2020. Expect to see HHS Secretary Kathleen Sebelius authorize and implement cuts to the programs as deep as 30% starting January 2012. The cuts are the only option Secretary Sebelius has since the programs failed to produce savings.

Breaking News: If Healthcare Reform Repealed, Public Law 111-152 will Uphold It!

December 30, 2011 1 comment

If the healthcare reform law (P.L. 111-148 – Affordable Care Act) is overturned and repealed, P.L. 111-152 (The Health Care and Education Reconciliation Act of 2010) will uphold it. This particular piece of legislation is part healthcare and part education reform law and it is very heavy on financing. The legislation was passed and signed into law quietly by President Obama on March 30, 2010. Its sister law (P.L. 111-148 – Affordable Care Act) was signed into law by President Obama  on March 23, 2010. The Congressional Budget Office, U.S. Department of Health and Human Services, and U.S. Department of the Treasury have said the legislation will see a reduction in the federal deficit by $143 billion over 10 years (2010-2020). This figure comprises $124 billion in net reductions deriving from health care and revenue provisions and $19 billion from the education provisions. The provisions consist of new taxes, fees on health-related industries (medical device, IT, insurance) and cuts in government spending on healthcare programs such as Medicare, Medicaid, and Medicare Advantage.

Here is a summary of the provisions that are in P.L. 111-152.

Healthcare Provisions……………….

All U.S. citizens must purchase health insurance by 2014 or face a fine of $695 (reduced from $750) or imprisonment.

Senator Ben Nelson’s (D-Nebraska) special Cornhusker Kickback deal eliminated.

Closes Medicare Part D “donut hole” by 2020 and gives seniors a rebate of $250.

Tax on cadillac health-plans delayed until 2018.

Physicians who see Medicare payments required to be reimbursed at the full rate.

Medicare tax on unearned income of families that earn $250,000 a year.

Households below 150% of the federal poverty level would pay 2% to 4% of their income on premiums. Health plans would cover 94% of the cost of benefits. Households with incomes from 150% to 400% of the federal poverty level ($88,200 for a family of four) would pay on a sliding scale from 4% to 9.8% of their income on premiums, rest will be covered by government advanceable, refundable tax credit. Health plans would cover 70% of the cost of the benefits.

In 2014, if a company with more than 50 workers does not offer coverage, they will be obligated to pay $2,000 for each full time worker in the company, exempting the money due for the first 30 employees. For example, an employer with 53 workers will pay the penalty for 23 workers, or $46,000.

Would increase Medicaid payment rates to primary care doctors to match Medicare payment rates, which are higher, in 2013 and 2014.

The federal government would pay all of the costs of expanding Medicaid under the reform until 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% thereafter. Some states that already insure childless adults under Medicaid would receive more federal money for covering that group through 2018.

The Medicare patients will receive 50% discount on brand-name drugs would begin in 2011. By 2020, the government would pay to provide up to 75% discount on brand-name and generic drugs, eventually closing the coverage gap.

Would extend the ban on lifetime limits and rescission of coverage to all existing health plans within six months after signing into Law.

Education Provisions……..

Ends the process of the federal government giving subsidies to private banks to give out federally insured loans. Instead loans will be administered directly by the Department of Education.

Increases the Pell Grant scholarship award.

For new borrowers of loans starting in 2014, those who qualify will be able to cap the amount they must spend on loan repayment each month to 10% of their discretionary income (current cap is 15%.).

After 2014, loans will be eligible to be forgiven to those who make timely payments after 20 years (the current time-frame being 25 years).

Will make it easier for parents to take out federal PLUS loans for students.

Several billion will be used to fund historically poor and minority schools, as well as increasing community college funding.

You can read the bill in its entirety here: http://www.gpo.gov/fdsys/pkg/PLAW-111publ152/html/PLAW-111publ152.htm

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