Medicare told to reassess premium hike for Alzheimer's drug
U.S. health secretary Xavier Becerra on Monday ordered Medicare to reassess a big premium increase facing millions of seniors this year, attributed in large part to a pricey new Alzheimer's drug with questionable benefits. Becerra's directive came days after drugmaker Biogen slashed the price of its $56,000-a-year medication, Aduhelm, to $28,200 a year — a cut of about half. “With the 50% price drop of Aduhelm on Jan. 1, there is a compelling basis ... to reexamine the previous recommendation,” Becerra said in a statement about his directive to the Centers for Medicare and Medicaid Services.news.yahoo.com
Medical Equipment Company Owners Sentenced to More Than 12 Years for $27 Million Fraud Scheme
A Texas woman and an Austrian national were sentenced yesterday to 151 months in prison for a $27 million Medicare kickback conspiracy. From those claims, Medicare paid the defendants more than $27 million. The DME claims submitted by the defendants to Medicare were for services that were medically unnecessary and not provided as represented. Assistant Deputy Chief Adrienne Frazior and Trial Attorneys Brynn Schiess and Catherine Wagner of the Criminal Division’s Fraud Section are prosecuting the case. The Fraud Section leads the Health Care Fraud Strike Force.justice.gov
Medicare urged to flex its power and slash back premium hike
The head of a Senate panel that oversees Medicare says the Biden administration should use its legal authority to cut back a hefty premium increase soon hitting millions of enrollees, as a growing number of Democratic lawmakers call for action amid worries over rising inflation. Last month, Medicare announced one of the largest increases ever in its “Part B” monthly premium for outpatient care, nearly $22, from $148.50 currently to $170.10 starting in January. The agency attributed roughly half the hike, about $11 a month, to the need for a contingency fund to cover Aduhelm, a new $56,000 Alzheimer's drug from Biogen whose benefits have been widely questioned. “Rather than assessing the current $21.60 per month ... premium increase in full, I urge you to reduce the amount,” Senate Finance Chairman Ron Wyden, D-Ore., wrote health secretary Xavier Becerra.news.yahoo.com
Fugitive Extradited from Cameroon to the United States to Serve 80 Year Prison Sentence
After the first week of trial, Tilong pleaded guilty to one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiracy to pay and receive health care kickbacks, three counts of payment and receipt of health care kickbacks, and one count of conspiracy to launder monetary instruments. In August 2017, Neba was sentenced to 75 years in prison the Medicare fraud scheme at Fiango. Prior to his removal from Cameroon, Tilong was wanted by the FBI and listed among HHS-OIG’s Top 10 Most Wanted Fugitives. The interagency team combines the resources of federal, state, and local law enforcement entities to prevent and combat health care fraud, waste, and abuse. Strike Force teams have shut down health care fraud schemes around the country, arrested more than a thousand criminals, and recovered millions of taxpayer dollars.justice.gov
Pharmacist and Two Pharmacies Agree to Pay $1 Million to Resolve Allegations of False Claims for Anti-Overdose Drug
Riad “Ray” Zahr, a pharmacist in Dearborn, Michigan, along with two specialty pharmacies that Zahr formerly owned and operated, have agreed to pay the United States $1 million to resolve allegations that they submitted false claims for the drug Evzio. At times, Zahr and the pharmacies initiated Evzio prescriptions based on rudimentary patient lists with only basic biographical details. On Nov. 9, the department announced that kaléo agreed to pay $12.7 million to resolve allegations that kaléo caused the submission of false claims for Evzio. The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act.justice.gov
Sanders to Biden: Cut back looming Medicare premium hike
Sen. Bernie Sanders is asking the White House to cut back a big Medicare premium hike set to take effect in weeks and tied to a pricey Alzheimer's drug whose benefits have been widely questioned. In a letter Friday to President Joe Biden, the Vermont Independent called on the president to act immediately to prevent the portion of an “outrageous increase” in Medicare premiums that's attributable to Aduhelm, a newly approved Alzheimer's medicine from drugmaker Biogen priced at $56,000 a year. If Biden agreed and found a way to do it, a planned January increase of $21.60 a month to Medicare's “Part B” premium for outpatient care would be slashed closer to $10.news.yahoo.com
Flower Mound Hospital to Pay $18.2 Million to Settle Federal and State False Claims Act Allegations Arising from Improper Inducements to Referring Physicians
Both the Stark Law and the Anti-Kickback Statute are intended to ensure that medical judgments are not compromised by improper financial inducements. In connection with the settlement, Flower Mound Hospital entered into a five-year Corporate Integrity Agreement (CIA) with the HHS-OIG. The CIA requires, among other things, that Flower Mound Hospital maintain a compliance program and hire an Independent Review Organization to review arrangements entered into by or on behalf of the hospital. The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Leslie Jennings, M.D., a physician-owner at Flower Mound Hospital. Jennings v. Flower Mound Hospital Partners, LLC, et al., Civil Action No.justice.gov
Two Arrested in Los Angeles for Their Roles in Hospice Fraud Conspiracy
Two California hospice facility owners were arrested today in Los Angeles on criminal charges related to their alleged participation in a kickback and health care fraud scheme. Doganyan and Arutyunyan are charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive kickbacks, and paying kickbacks. The FBI Los Angeles Field Office and HHS-OIG are investigating the case. Trial Attorneys Justin Givens and Helen Lee of the Criminal Division’s Fraud Section are prosecuting the case. An indictment is merely an allegation and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.justice.gov
Chicago Woman Sentenced to 56 months for Home Health Care Fraud
An Illinois woman was sentenced yesterday in the Northern District of Illinois to 56 months in prison and ordered to pay $6.3 million in restitution for her participation in a conspiracy to commit health care and wire fraud. According to court documents, and the evidence presented at trial, Angelita Newton, 43, of Chicago, worked at Care Specialists, a home health care company owned by Ferdinand Echavia and later his wife, Ma Luisa Echavia. While operating between 2011 and 2017, Care Specialists fraudulently billed Medicare at least $6.3 million. At trial, the government demonstrated that around 90% of the patients were not homebound and did not qualify for the types of care that Care Specialists billed Medicare for. On Nov. 5, 2021, Ma Luisa Echavia was sentenced to 60 months’ confinement and three years’ supervised release.justice.gov
Crossroads Hospice Agrees to Pay $5.5 Million to Settle False Claims Act Liability
Carrefour Associates LLC; Crossroads Hospice of Cincinnati LLC; Crossroads Hospice of Cleveland LLC; Crossroads Hospice of Dayton LLC; Crossroads Hospice of Northeast Ohio LLC; and Crossroads Hospice of Tennessee LLC (Crossroads Hospice), operating in Ohio and Tennessee, have agreed to pay $5.5 million to resolve allegations that they violated the False Claims Act by submitting claims to Medicare for non-covered hospice services. Hospice care is special, end-of-life care intended to comfort terminally ill patients. This settlement resolves allegations that Crossroads Hospice knowingly submitted false claims to Medicare for hospice services for patients who were not terminally ill. “Our agency is dedicated to safeguarding both the Medicare program and Medicare patients. David Weber v. Crossroads Hospice of Tennessee, LLC, No.justice.gov
How Democrats’ Proposed Millionaire Surtax Would Work
A surtax on millionaires is under consideration by Democrats in the U.S. Congress trying to pay for President Joe Biden’s $1.75 trillion social spending plan. The add-on could increase the top tax rate on income to as much as 45% for tens of thousands of well-off Americans, up from 37% currently. It’s an alternative to a series of proposals to tax wealth, not just income, including a proposed billionaire tax that was shot down almost as soon as it was raised.washingtonpost.com
Medicare Part B premium hike for 2022 is biggest dollar increase in history of Medicare
Medicare recipients are in for the biggest premium hike in the program’s history next year. Monthly premiums for Medicare Part B will increase by $21.60 in 2022, rising from $148.50 to $170.10. That’s an increase of nearly 15% and works out to a jump of $259.20 over the whole year.mlive.com
Alzheimer's drug cited as Medicare premium jumps by $21.60
Medicare's “Part B” outpatient premium will jump by $21.60 next year, one of the largest increases ever. Officials said Friday a new Alzheimer's drug is responsible for about half of that. The increase guarantees that health care will gobble up a big chunk of the recently announced Social Security cost-of-living allowance, a boost that had worked out to $92 a month for the average retired worker, intended to help cover rising prices for gas and food that are pinching seniors.news.yahoo.com
Medical Device Company Arthrex to Pay $16 Million to Resolve Kickback Allegations
Arthrex Inc., a Florida-based medical device company, has agreed to resolve allegations that it violated the False Claims Act by paying kickbacks that caused the submission of false claims to the Medicare program. According to the settlement, Arthrex Inc., which specializes in orthopedic products, has agreed to pay $16 million for allegedly paying kickbacks to a Colorado-based orthopedic surgeon. The settlement resolves claims brought in a lawsuit under the qui tam or whistleblower provisions of the False Claims Act by Joseph Shea. Shea will receive $2.5 million of the False Claims Act settlement. One of the most powerful tools in this effort is the False Claims Act.justice.gov
Biden’s infrastructure bill will bring jobs. Build Back Better is aimed at reducing inequities.
The $1.2 trillion infrastructure package and nearly $2 trillion "Build Back Better" plan are widely expected to lift growth and jobs in the coming years. Inflation could increase next year, but many costs would go down for lower-income households.washingtonpost.com
Here’s how you can ensure you have adequate health coverage, and ways you can save money
Dr. Alan Smith from WellCare talked with Jason Carr to help explain Medicare, Medicare Advantage, and what people can get covered. Medicare is the baseline federal health insurance program available for seniors and those with certain disabilities. Medicare Advantage includes Medicare Part A, B and D, plus additional benefits. Plans through Medicare Advantage can lessen out-of-pocket expenses, and can include benefits for hearing, dental and vision, depending on a plan. “We want to make sure every senior has adequate coverage, especially during the pandemic,” Smith said.
Biden's Medicare pick would be 1st Black woman to hold post
The agency oversees government health insurance programs covering more than 1 out of 3 Americans and is a linchpin of the health care system. CMS also plays a central role in the nation’s $4 trillion health care economy, setting Medicare payment rates for hospitals, doctors, labs and other service providers. The agency also sets standards that govern how health care providers operate. “She is well-respected and liked by the department veterans who have worked with her in the past.”Years ago, Brooks-LaSure worked with Biden's nominee to run HHS, California Attorney General Xavier Becerra. AdUnder Biden, Brooks-LaSure will be expected to grow Obamacare enrollment by promoting HealthCare.gov and trying to persuade holdout states to adopt Medicaid expansion.
Trump plan to curb drug costs dealt setback in court
The Trump regulation would tie what Medicare pays for certain drugs administered in a doctor's office to the lowest price paid among a group of economically advanced countries. Some opponents have likened the Trump policy to a form of socialist price controls. Trump came into office accusing drug companies of “getting away with murder” and promising to slash costs for American patients. Even if the Trump rule is ultimately blocked, the idea of using international prices to lower costs for Americans is very much alive. It's at the heart of House Speaker Nancy Pelosi's legislation to empower Medicare to negotiate drug prices.
Trump makes late-term bid to lower prescription drug costs
It is adamantly opposed by critics aligned with the pharmaceutical industry who liken it to socialism. The Trump administration disputes that and says its rule could potentially result in 30% savings for patients. It also would allow private insurance plans for workers and their families to get Medicare's lower prices. Trump has taken other action to lower prescription drug costs by opening a legal path for importing medicines from abroad. Also, Medicare drug plans that cap insulin costs at $35 a month are available during open enrollment, currently underway.
Biden has room on health care, though limited by Congress
And just like the Trump administration, Biden is expected to aggressively wield the rule-making powers of the executive branch to address health insurance coverage and prescription drug costs. With COVID-19 surging across the country, Biden's top health care priority is whipping the federal government’s response into shape. “We’re going to work quickly with the Congress to dramatically ramp up health care protections, get Americans universal coverage, lower health care costs, as soon as humanly possible,” the president-elect said earlier this week. A factor that may work in Biden's favor is that many Republicans want to change the subject on health care. Coronavirus relief legislation could provide an early vehicle for some broader health care changes.
Feds issue coverage plan for COVID-19 vaccine and treatments
The regulations from the Centers for Medicare and Medicaid Services, or CMS, will also increase what Medicare pays hospitals for COVID-19 treatments. Under Wednesday’s announcement:Seniors with traditional Medicare will pay nothing for COVID-19 vaccines, and any copays and deductibles are waived. The government will pay private Medicare Advantage plans to administer the vaccine to seniors. Workplace and individual health insurance plans will cover the COVID-19 vaccine as a preventive service, with no cost sharing. State Medicaid and Children’s Health Insurance plans will have to provide vaccines for free for the duration of the coronavirus public health emergency.
Medicare finalizing coverage policy for coronavirus vaccine
WASHINGTON – Medicare will cover the yet-to-be approved coronavirus vaccine free for older people under a policy change expected to be announced shortly, a senior Trump administration official said Tuesday. It's questionable under normal circumstances if Medicare can pay for a drug that receives emergency use authorization from the Food and Drug Administration, as expected for the eventual coronavirus vaccine. A White House-backed initiative called “Operation Warp Speed” is pushing to have a vaccine ready for distribution in the coming months. States have already begun submitting their plans for vaccine distribution to the federal government. Initially, it's expected vaccines will go to people in high-risk groups such as medical personnel, frontline workers and nursing home residents and staff.
Trust Index: Separating fact from fiction in Michigan Senate race
DETROIT – We’re separating fact from fiction in one of Michigan’s most contentious and most expensive races. “He believes in no exception,” Peters said of James. As for hiding his plan, James is likely referring to amendments Peters made to congressional financial disclosures after initially not disclosing the state plan. We’re calling this Be Careful because James isn’t exactly correct on how Peters' plan works. James is referring to a statement Peters made in 2018 at a town hall where he said Medicare-For-All is likely down the road.
Trump's election-eve drug discounts for seniors get snagged
A White House official had no comment on the status of the prescription cards, which Trump announced with a flourish last month during a health care speech in Charlotte, N.C. We will provide more information about the prescription drug cards soon.”One administration official said the odds are 75-25 the plan will not happen. Among them:— The White House asserted that Medicare could legally send out the discount cards under its authority to conduct “demonstration programs” testing new ideas. The $200 would test if extra cash made seniors more likely to stay on their medications and avoid costly hospitalizations. “It would do relatively little for seniors with truly catastrophic prescription drug expenses,” she said.
Trust Index: Fact-checking claims on health care from first Trump-Biden debate
Health care remains a top issue for voters, particularly during the spread of the coronavirus as millions lost their jobs and health insurance over the course of pandemic. According to the non-partisan Kaiser Family Foundation roughly 25 million people get their health care through the federal ACA marketplace or the ACA’s Medicaid expansion. Here’s one from President Trump about Biden’s plan:“The bigger problem that you have is that you’re going to extinguish 180 million people with their private health care,” Trump said. While estimates differ, the Centers for Medicaid and Medicare Services do estimate that roughly 180 million Americans have private health insurance. Biden’s plan creates a public option for low income Americans but does not get rid of private insurance.
Trump's $200 prescription cards won't hit mailboxes just yet
Medicare enrollees can get prescription drug coverage by purchasing a “Part D” drug plan or by joining a Medicare Advantage plan. Announcing the savings cards Thursday at a speech in Charlotte, N.C., Trump called it a “historic provision” to benefit seniors. “These cards are incredible.”Using Trump's figure of 33 million people getting the $200 cards, the cost would work out to $6.6 billion, not including administrative expenses. The White House says the prescription cards are definitely coming. Oregon Democratic Sen. Ron Wyden, coauthor of the bipartisan drug cost bill that stalled even with the president's endorsement, called the whole exercise a gimmick.
Dem report: Medicare chief used fed money to bolster image
The consultants, many with Republican Party ties, billed taxpayers up to $380 per hour on work largely aimed at polishing the profile of Medicare administrator Seema Verma, the investigators wrote. The contractors were “handpicked” by Verma's aides, the report said, creating “a shadow operation" that sidelined the communications staff of the federal Centers for Medicare and Medicaid Services. “Congress did not intend for Administrator Verma or other senior CMS officials to use taxpayer dollars to stockpile CMS with handpicked consultants or promote Administrator Verma’s public profile and personal brand,” the report said. “Given the reckless disregard she has shown for the public’s trust, Administrator Verma should reimburse the taxpayers for these inappropriate expenditures,” it said. The report released Thursday was prepared by the Democratic staffs of two Senate and two House committees.
Fad or future? Telehealth expansion eyed beyond pandemic
Before the pandemic, Medicare rules required her make regular two-hour, one-way trips to New Hampshire to meet with her doctor to discuss her treatment. (AP Photo/Wilson Ring)WASHINGTON Telehealth is a bit of American ingenuity that seems to have paid off in the coronavirus pandemic. Telehealth visits dropped with the reopening, but they're still far more common than before. As the government's flagship health care program, Medicare covers more than 60 million people, including those age 65 and older, and younger disabled people. Expanded Medicare telehealth could:help move the nation closer to a long-sought goal of treating mental health the same as physical conditions.
Trump wants broader role for telehealth services in Medicare
The order President Donald Trump plans to sign Monday applies to one segment of Medicare recipients people living in rural communities. Taken together, the steps are modest far short of the health plan Trump promised when he was elected but has not been able to deliver. The telehealth measure directs the departments of Agriculture and Health and Human Services, as well as other agencies, to work together to promote the availability of services in rural communities. And it aims to permanently expand the kinds of services that can be provided via telehealth. Medicare has greatly expanded coverage of telehealth across the country as part of its emergency plan to confront the coronavirus pandemic.
Medicare coverage for Alzheimer brain scans in question
A big study to help Medicare officials decide whether to start covering brain scans to check for Alzheimers disease missed its goals for curbing health care costs, calling into question whether the pricey tests are worth it. Advocates for coverage say they hope to persuade the agency that the scans still offer benefits even if they dont save much or any money. They were given scans and compared to Medicare recipients who were similar in age, sex and other factors but not given scans. If it was any other disease, people would want a specific diagnosis" and the scans give that, he said. But with a blood test on the horizon for diagnosing the disease, relying on scans may become a moot issue, he said.
With no new law to curb drug costs, Trump tries own changes
At a White House ceremony Friday, Trump signed four executive orders. Friday's event was definitely not the bill-signing the White House had once hoped for. Neither side in Congress has had an incentive to deal, and the White House has been unable to work Trump's will. Another Gallup-West Health survey found 65% saying the Trump administration had made little or no progress limiting increases in prescription drug costs. Drugmakers are particularly leery of the approach, since Democrats want to use it more broadly to allow Medicare to directly negotiate prices.
With no deal to curb drug costs, Trump tries his own changes
WASHINGTON Unable to land the big deal with Congress to curb drug costs, President Donald Trump is moving on his own to allow imports of prescription medicines, along with other limited steps that might have some election-year appeal. At a White House ceremony, Trump is set to sign four executive orders. Neither side in Congress has had an incentive to deal, and the White House has been unable to work Trump's will. It had no path forward in the Senate, and the White House calls it unworkable. Another Gallup-West Health survey early in the year found 65% saying the Trump administration had made little or no progress limiting increases in prescription drug costs.
Watchdog report faults Medicare agency's contract management
The contracts, which are no longer active, were for strategic communications services, such as public engagement and interacting with the media. In a response that accompanies the report, she said CMS has deep concerns" with the conclusions, which are based on unsubstantiated assumptions and incomplete analysis." She also said the report relies on mischaracterizations of contractor tasks and duties and misrepresents federal acquisition rules. As head of CMS, Verma has enjoyed strong support from the White House but has clashed with health secretary Alex Azar. Vermas expansion of Medicare telehealth services may well be her most lasting accomplishment.