Medicare
Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill
Article Summary: A cost-cutting change in Medicare policy will reduce payments to hospitals for some surgical procedures and increase costs for patients. By Susan Jaffe, KHN, Mar 23, 2021. A cost-saving change in Medicare launched… Read More
Humana Inc. Overcharged Medicare Nearly $200 Million, Federal Audit Finds
Article Summary: Humana has overstated the severity of illness of some patients and has overcharged Medicare in a recent OIG audit finding. By Fred Schulte, NPR, Apr 20, 2021. A Humana Inc. health plan for… Read More
Medicare Upcoding – Medical Billing Fraud
When a provider treats a Medicare patient, the provider must tell Medicare what services were provided so that Medicare can reimburse the doctor the correct amount. Certain services have higher reimbursement amounts than others –a… Read More
Phantom Medicare Billing
What is Phantom Billing? By Berger Montague Attorneys. Medicare fraud broadly refers to any individual, company or corporation who acts intentionally to steal money from the federal government. “Phantom billing” is a specific kind of Medicare… Read More
The Problem with Medicare Advantage
Medicare’s Private Option Is Gaining Popularity, and Critics. As more Americans sign up for Medicare Advantage, detractors worry that it’s helping private insurers more than patients. When Ed Stein signed up for Medicare eight years...
For Medicare Patients, Costs of MS Drugs Rise Sevenfold Over 10 Years
By Amy Norton, U.S. News. Medicare patients with multiple sclerosis (MS) saw their medication costs soar by more than sevenfold over a decade, a new study finds. It’s no secret that the costs of MS… Read More
Costly Confusion – Medicare’s Wellness Visit Isn’t The Same As An Annual Physical
Medicare does not cover an annual physical exam and patients who get them may be on the hook for the entire amount. When Beverly Dunn called her new primary care doctor’s office last November to...
Medicare Advantage Organizations Overturn 75% of Their Denials
By Kelly Gooch, Beckers Hospital Review. A recent investigation by the U.S. Office of Inspector General found between 2014 and 2016, Medicare Advantage organizations overturned 75 percent of their preauthorization and payment denials upon appeal. The OIG’s… Read More
DaVita Settles Huge Whistleblower Lawsuit Over Medicare Fraud
By Fred Schulte, KHN News. One of the nation’s largest dialysis providers will pay $270 million to settle a whistleblower’s allegation that it helped Medicare Advantage insurance plans cheat the government for several years. The settlement… Read More