Medicare Coverage Gap May Cause Seniors to Forgo Antidepressants

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'Virtual' Colonoscopy Safe, Effective for Medicare Patients: Study

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Fewer Medicare Patients Being 'Admitted' to Hospitals: Study

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U.S. charges more than 100 for Medicare fraud schemes

Reuters – 4 hrs ago WASHINGTON (Reuters) - U.S. authorities have charged 107 people, including doctors and nurses, for trying to defraud the federal Medicare healthcare program for the elderly and disabled of about $452 million, the biggest Medicare fraud sweep to date, the Obama administration said on Wednesday.

At least 91 people were arrested in Miami; Houston; Baton Rouge, Louisiana, and four other cities on a variety of charges: from submitting false billing for home healthcare, mental health services, HIV infusions and physical therapy to money laundering and receiving kickbacks.

Justice Department and Health and Human Services Department officials were unable to say how much Medicare actually paid out, but a review of 34 complaints and indictments found that authorities were seeking to recover at least $59.5 million of allegedly ill-gotten gains.

"These fraud schemes were committed by people up and down the chain of healthcare providers - from doctors, nurses, and licensed clinical social workers, to office managers and patient recruiters," said Lanny Breuer, assistant attorney general for the Justice Department's criminal division.

President Barack Obama's administration has been pushing to squeeze out fraud from federal programs like Medicare as part of a broader attempt to stem soaring healthcare costs, arguing fraud can contribute to rising prices for services.

Breuer said that it is the single largest Medicare billing fraud sweep by the Justice Department's special task force in its five-year history. In September, the Obama administration charged 91 people in connection with a variety of schemes aimed at bilking Medicare out of $295 million.

The FBI said it is investigating more than 2,600 cases of healthcare fraud with more than 500 agents and analysts. Since March 2007, the Justice Department said, it has charged more than 1,300 people for falsely billing Medicare more than $4 billion.

Health and Human Services Secretary Kathleen Sebelius sought to use the arrests to defend Obama's controversial healthcare law passed in 2010, arguing that additional resources provided under the law helped authorities root out fraud.

"Today's actions are another example of how the Affordable Care Act is helping the Obama administration fight fraud and strengthen the Medicare program," Sebelius said.

Republicans and 26 out of the 50 U.S. states have challenged the law and are seeking to have it invalidated as unconstitutional because it would require Americans to have health insurance coverage or pay a penalty.

SEVEN ARRESTED IN BATON ROUGE

The biggest cases were in Baton Rouge where seven people were arrested and charged with eight counts, including conspiracy and healthcare fraud for billing Medicare for some $225.6 million in unnecessary services and in some cases not providing services billed.

They ran and worked at two community mental health centers in Louisiana where they billed for more group therapy sessions than were provided, including recreational and education psychotherapy, according to court records.

Medicare paid out more than $37.9 million for the services to the two centers in Baton Rouge, identified as Shifa Community Mental Health Center and Serenity Center, according to the records.

U.S. prosecutors sought to have two of the owners of the centers, Hoor Naz Jafri and Roslyn Dogan, held without bond pending trial. Dogan was also accused of stealing evidence from the prosecutors' office in a bid to obstruct the investigation, according to a detention memo.

Four others who worked as therapists at the centers pleaded guilty last month to one count of conspiracy to commit healthcare fraud for purporting to provide group therapy and document patients' attendance, the court documents said.

In one case out of Miami, 10 people were charged with allegedly seeking $63 million in reimbursements from Medicare as some therapists altered their paperwork to try to justify services for patients who did not need them.

In another Florida case, one person was accused of receiving kickbacks to refer patients to a company that offered home health and physical therapy services, submitting $60 million in claims. Medicare reimbursed that group, NANY Home Health Inc, $40 million.

Last month, the three operators of NANY Home Health were sentenced to lengthy prison terms for their roles in the scheme and were ordered to pay $40 million in restitution.

(Editing by Jackie Frank and Mohammad.zargham)

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U.S. watchdog blasts Medicare quality insurance project

Reuters – 28 mins ago WASHINGTON (Reuters) - Medicare, the U.S. healthcare program for the elderly, is spending $8.3 billion on a test project that is supposed to improve the quality of private health coverage but has mainly rewarded mediocre insurance plans, a government watchdog said on Monday.

A report by the Government Accountability Office, a nonpartisan investigative arm of Congress, recommends canceling the Medicare Advantage quality bonus payment initiative. The three-year project is seen as the largest-scale test of an effort to improve Medicare services to date.

The watchdog agency said the U.S. administration should instead pursue quality improvement measures under the Patient Protection and Affordable Care Act, President Barack Obama's healthcare reform law.

Separately, the administration released its own report predicting that the entire Medicare program would save more than $200 billion through 2016 due to the effects of Obama's reforms. Beneficiaries in traditional Medicare would enjoy $59.4 billion in lower costs.

The two reports underscore an ongoing struggle between the administration and its critics to control the public message about government involvement in healthcare, as the Supreme Court considers whether to strike down the overhaul law in a ruling expected in June.

The GAO report calls into question Medicare's ability to improve care delivery, reduce costs and combat waste at a time when the $523 billion-a-year program, along with its 48 million elderly and disabled beneficiaries, face an uncertain future due to efforts in Congress to reduce the federal debt and deficit.

Senator Orrin Hatch, the top Republican on the Senate Finance Committee, said the study raised questions about whether the administration overstepped its authority in creating the program.

"The White House does not have the authority to green light spending on whatever program it wants. This report is just the beginning," Hatch said in a statement.

The administration defended the program as a necessary effort to determine how best to improve quality and reduce costs in Medicare Advantage, which provides about one-quarter of Medicare beneficiaries with coverage from private insurers.

"Without this demonstration, more than 550 plans serving the majority of those in Medicare Advantage would no longer have an incentive to improve the quality of their healthcare," the Department of Health and Human Services said in a statement.

MORE COSTLY THAN TRADITIONAL MEDICARE

The demonstration project, designed to promote quality by awarding performance bonuses to private insurers that offer coverage through Medicare, was undertaken to test whether annual quality improvements could be achieved more quickly than under Obama's healthcare overhaul.

Its aim is to provide strong incentives for Medicare Advantage plans with as few as three out of five stars to improve performance at various star rating levels. The program ensures that all qualifying plans receive bonuses at least as great as those that would occur under the healthcare law, rather than just the highest-performing ones.

Medicare Advantage was adopted under George W. Bush as a way to bring market efficiency to the sprawling government program. Some of the largest providers of Medicare Advantage plans are UnitedHealth Group and Humana Inc.

But Medicare Advantage has proved more expensive than traditional Medicare, with payments in private insurers equaling 114 percent of the fee-for-service program.

The administration said it remained on track to bring Medicare Advantage into line with traditional Medicare by 2020, despite the cost of demonstration.

GAO found that the program's design serves to undermine the administration's ability to achieve its stated goal.

"Rather than rewarding only high performing plans, most of the additional payments made under the demonstration will accrue to average performing plans," GAO healthcare Director James Gosgrove said in a letter to Senator Hatch.

"The design shortcomings of the demonstration may undermine its ability to achieve (the administration's) stated research goal," he added.

The GAO study circulated just ahead of an annual report by the Medicare trustees, which is expected to provide a new forecast for the program's long-term financial health.

(Editing by Maureen Bavdek)

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Minorities, Medicare Recipients Less Likely to Get Antidepressants

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