Tags » Medicare/medicaid

Bleak future of primary care access

By Richard Young, M.D. – Special to the Star-Telegram, 09/22/14

Unfortunately, we have a preview in Dallas-Fort Worth and other communities of the effects of failed policies of Medicare/Medicaid, state government and insurance companies in how they value medical services and how they poorly support the first-contact primary care system. 530 more words

National Issues

US Representative Works To Eliminate Medicare Appeals Process.

Modern Healthcare (9/19, Herman, Subscription Publication) reported on US Representative Kevin Brady’s (R-TX) letter to HHS Secretary Sylvia Burwell in which he “urged” her to “explain how the government developed” the Medicare appeals “settlement process.” The request follows “surreptitious” Aug. 96 more words


Nursing Home System To Pay $3.8M Medicare Fraud Settlement.

The AP (9/6) reported that Life Care Services, of Des Moines, and a California nursing home company called ParkVista “agreed to pay a $3.8 million settlement for what federal officials say was overbilling of Medicare” for “unreasonable and unnecessary” rehabilitation services for nursing home residents. 67 more words


Medicare/Medicaid News - 09/02/14

Feds Join Whistleblower Suit Over UnitedHealth Hospice Billing

The U.S. Department of Justice has intervened in two False Claims Act lawsuits brought by whistleblowers who say that for years, UnitedHealth Group Inc. 21 more words


Medicare/Medicaid News - 08/08/14

HHS Agency Substantiates Watchdog Claim Of Rampant “Upcoding” in Medicare Advantage.
Fred Shulte of the Center for Public Integrity (8/7) reports on an investigation conducted by the Department of Health and Human Services Agency for Healthcare Research and Quality, which found that “Medicare made nearly $70 billion in ‘improper’ payments — mostly overcharges from inflated risk scores — to Medicare Advantage plans from 2008 through 2013 alone.” The Center for Public Integrity conducted an earlier investigation that uncovered the same billing inconsistencies, but also found that “risk scores rose much faster in some health plans than others and that federal officials repeatedly yielded to industry pressure to minimize efforts to recoup overpayments.” These overcharges are referred to as “upcoding.” 175 more words