According to the Office of Inspector General (OIG) of the Department of Health and Human Services, Medicare overpaid for prescription drugs with new generic versions, because of delays in updating its pricing formula. (Kaiser Network) For example, Medicare overpaid $6.5 million for the cancer drug irinotecan. A generic version was approved, but new generic prices were not integrated right away. Medicare paid $126 a dose, although generic prices averaged $41. According to the 20-page … [Read more...] about OIG: Medicare Overpaid for New Generic Drugs
State of the Medicare Coverage Gap in 2007
The Kaiser Family Foundation has released a report on the costs and consequences of the Medicare Part D coverage gap in 2007. The coverage gap, also called the "doughnut hole," is the period of time during the year when a beneficiary is not covered and is responsible for paying drug costs out of pocket. The Kaiser study "quantifies…the number of Medicare Part D plan enrollees in 2007" who reached the doughnut hole. The study does not include low-income beneficiaries who received … [Read more...] about State of the Medicare Coverage Gap in 2007
CMS Reports Pay-for-Performance Pilot Success
The Centers for Medicare and Medicaid Services (CMS) announced last week that a pilot pay-for-performance program, which pays doctors based on quality of care, has lowered costs "in some cases" and improved quality of care for patients with congestive heart failure, coronary artery disease, and diabetes. According to CMS, four of the 10 groups participating in the program reduced costs to patients and CMS spending by $17.4 million. Kerry Weems, acting administrator for CMS, said, "We are … [Read more...] about CMS Reports Pay-for-Performance Pilot Success
Medicare Raises Nursing Home Payments; Part D Costs Lower Than Expected
The Centers for Medicare and Medicaid Services (CMS) has announced that payment rates for nursing homes will increase by $780 million next year. (Source) The payment increase (3.4 percent) is the result of a recalibration of the annual market basket calculation. CMS acting administrator Kerry Weems said CMS was "committed to providing high quality care to those in skilled nursing facilities and to paying those facilities properly for that care" and assures that CMS will continue evaluating … [Read more...] about Medicare Raises Nursing Home Payments; Part D Costs Lower Than Expected
Replace Medicare Part D?
Medicare Part D isn't even three years old, and a lawmaker already wants to replace it. Congressman Dennis Kucinich, a Democrat from Ohio, introduced a measure that would replace Medicare Part D with a new program ostensibly to lower costs. According to the bill, Medicare would negotiate directly with drug companies for prescription drug discounts and do away with co-payments, premiums, and deductibles. (CQ Politics) In a statement, Kucinich said, "The privatized drug plan has been given a … [Read more...] about Replace Medicare Part D?
GAO: CMS Lacks Oversight of Durable Equipment Medicare Funds
Talk about government waste! From April 2006 through March 2007, Medicare improperly paid $1 billion for durable medical equipment, prosthetics, orthotics, and supplies in part because of fraudulent companies. According to a new report by the Government Accountability Office (GAO), the Centers for Medicare and Medicaid Services (CMS) lacks oversight of millions of dollars in Medicare funds for durable equipment supplies. CMS allowed "sham companies" to fraudulently bill Medicare for … [Read more...] about GAO: CMS Lacks Oversight of Durable Equipment Medicare Funds
U.S. Hospitals Deporting Illegal Aliens?
The New York Times (via Kaiser Network) featured an article last Sunday about how U.S. hospitals are deporting uninsured illegal aliens, sending them back to their home countries for continued medical care. U.S. nursing homes are unwilling to take uninsured illegal aliens as patients, and Medicaid does not cover long-term care for them. Medicaid does cover a small portion of emergency services, however. According to federal law, hospitals that receive Medicare funds must transfer or refer … [Read more...] about U.S. Hospitals Deporting Illegal Aliens?
Medicare Pays Up to 30 Percent More for Medications Under Part D Plans
According to a report released by the House Committee on Oversight and Government Reform, Medicare Part D paid about 30 percent more for prescription drugs in the program's first two years than Medicaid would have paid for the same drugs. This has cost the program about $3.7 billion. (Kaiser Network) Drug company Johnson & Johnson received a whopping $615 million more from Part D than it would have received from Medicaid. Lawmakers already are trying to fix the problem. Congressman Henry … [Read more...] about Medicare Pays Up to 30 Percent More for Medications Under Part D Plans
Congress Delays Medicare Trigger Bill
Under the 2003 Medicare law, the president is required to propose a savings bill if Medicare trustees warn two consecutive years that the program will draw 45 percent of funding from the general government revenue. (Kaiser Network) Last Thursday, the U.S. House of Representatives voted 231-184 to delay the president's "trigger" bill for the rest of the 110th Congress. Democrats said they changed the rule, because the 45 percent threshold is "arbitrary" and would reduce Medicare spending or … [Read more...] about Congress Delays Medicare Trigger Bill
E-Prescribing and Lock-In Pricing
If a physician adopts e-prescribing technology in 2009 and 2010, he/she will receive a 2 percent bonus in Medicare payments. Those who don't will see reductions in reimbursements. (Kaiser Network) Contained in the bill that delays a 10.6 percent Medicare reimbursement rate cut are details of an electronic prescribing incentive program, which is designed to save money and reduce drug-related errors. The program will begin on January 1, 2009. Kerry Weems, acting administrator of the Centers … [Read more...] about E-Prescribing and Lock-In Pricing
