Medicare

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The University of Miami School of Business hosted its yearly health care conference Monday. The main topic of discussion was “disruptive innovation,” which organizer and professor Steven Ullmann says means "to disrupt how we do health care provision in this country."

Ullmann says the health care system now is fragmented, and that makes it expensive.

As privately run Medicare health plans for seniors scramble to stave off proposed funding cuts, federal prosecutors in Florida are pursuing an unusual criminal fraud case that's likely to raise new concerns that some plans may be overcharging the government.

The criminal case is believed to be among the first to take aim at billing practices of Medicare Advantage plans, which are popular with seniors because out-of-pocket costs are lower and they provide more benefits than traditional Medicare.

Seniors On Medicare Patrol In Miami

Jun 27, 2014
Al Diaz / Miami Herald

It’s a crime that requires no guns. It frequently goes unnoticed until after the fact, and the victims are unwitting U.S. taxpayers duped to the tune of $68 billion a year. Medicare fraud has become one of the most profitable illegal activities in the country — and South Florida is the most likely place to get fleeced.

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A ProPublica investigation earlier this month looked at how Medicare providers charged for their services in 2012 and found unusual billing patterns among a number of Florida care providers.

On average, most providers only charged for the most complex, expensive level of care during office visits about 4 percent of the time. But in Florida, nearly 100 Medicare providers with relatively high volume billed at the most expensive rate 100 percent of the time.

Today on WLRN-Miami Herald News, you heard:

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A group of Florida doctors has been charging Medicare at a surprisingly high rate.

A ProPublica investigation analyzed a recently released Medicare database and found unusual billing patterns in Florida and elsewhere. ProPublica used that same data to create an online tool that lets patients see how individual doctors compare to their peers when it comes to procedures and billing patterns.

Florida Power & Light

Governor Rick Scott and his cabinet approved two more nuclear reactors to the Turkey Point power plant on Biscayne Bay. But neighbors are worried about the construction of 88 miles of transmission lines, and environmentalists question why Florida Power & Light wants more nuclear facilities by the coast.

A ProPublica investigation reveals unusual billing patterns among Florida’s Medicare providers. We ask how this connects to Florida’s history of Medicare fraud.

Florida Docs Charge Medicare Top Rate For Office Visits

May 15, 2014
Vichaya Kiatying-Angsulee / freedigitalphotos.net

Office visits are the bread and butter of many physicians’ practices. Medicare pays for more than 200 million of them a year, often to deal with routine problems like colds or high blood pressure. Most require relatively modest amounts of a doctor’s time or medical know-how.

Wilson Sayre

The Miami-Dade County Parks and Recreation Department is trying to do its part to help seniors navigate the health insurance maze.

Yesterday, the department kicked off a series of health fairs to be held all over the county as part of their Active Adults program.

Health service providers gave short presentations about how they can help to navigate the complicated health system -- tips about how to get the most out of coverage and ways to avoid health care fraud.

Thousands of retirees covered by company health insurance plans will soon see their benefits shifted toward private health-insurance exchanges.

IBM and Time Warner announced the change last week. They’ll provide retirees money to buy Medicare Advantage or supplemental Medigap policies instead, part of a push by businesses to move away from the increasingly costly group-coverage model.

American Airlines may follow. Its parent company, AMR Corp., is seeking approval to make the change from a federal bankruptcy court judge.

Hear the words health care and Congress, and you think fight, right?

And you'd be forgiven, particularly because the House has now voted some 40 times in the past two years to repeal or otherwise undo portions of the Affordable Care Act.

http://www.floridashine.org/

08/15/13 - Thursday’s Topical Currents begins with a look at SHINE (Serving Health Insurance Needs of Elders) it’s a statewide, volunteer-based program offering free Medicare and health insurance education to people and their caregivers. And more, Linda Gassenheimer speaks with Mandy Baca about her book,

C. DiMattei

Palm Beach County wants your drugs.

Actually, the county only wants the medications taking up space in your bathroom cabinet, the ones that might end up in the wrong hands. 

At first glance, the receptacles cropping up all over Palm Beach County look like the donation bins that collect old clothes for charity.  But printed on the front of each drop-off box is the urgent instruction to “Deposit Your Unwanted Prescription Drugs Here!” 

Health Exchange Outreach Targets Latinos

Jun 25, 2013

Andrea Velandia, 29, is just the sort of person the architects of the new health insurance marketplaces had in mind when they were thinking about future customers.

She's young, in good health, uninsured and Latino.

"We're very healthy. We don't have many issues," she says of her family. For the most part, she and her husband avoid the health system. "It's very expensive to go to the doctor to get a regular checkup," she says. "And you only have an option to go to the emergency room, which is even more expensive."

When the blood pressure drug Bystolic hit the market in 2008, it faced a crowded field of cheap generics.

So its maker, Forest Laboratories, launched a promotional assault on the group in the best position to determine Bystolic's success: those in control of prescription pads. It flooded the offices of health professionals with drug reps, and it hired doctors to persuade their peers to choose Bystolic — even though the drug hadn't proved more effective than competitors.

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