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The Palm Beach Post's veteran Washington correspondent, Larry Lipman, tracks policy makers and interest groups who are shaping the future of the federal health insurance program for the elderly.Medicare Web Resources
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Medicare at a glance
Medicare is the federal health care system that covers about 36 million people age 65 and older, plus 7 million disabled. It has four parts:
Financed by a 2.9 percent payroll tax divided equally between employees and employers.
Financed by beneficiary premiums and federal general revenue. Current monthly premiums are $93.50. Starting this year, individuals whose taxable income is more than $80,000 will pay a higher premium.
Financed by Medicare and beneficiary premiums, which vary among plans.
The plans are private and financed by Medicare and beneficiary premiums, which vary among plans.
-- Larry Lipman
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All the entries posted in September.
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Home > Medicare Monitor > Archives > 2007 > September
September 2007
Most Medicare beneficiaries to have access to cheaper Part D plans
Medicare officials say 90 percent of beneficiaries in a standalone Part D prescription drug plan will 
have access to at least one plan in their area offering lower premiums than they are paying now.
That’s the good news, because in August Medicare announced that the average premium would increase nearly 14 percent from $22 to $25 a month.
Health and Human Services Secretary Michael O. Leavitt said beneficiaries in every state will have access to at least one plan with a monthly premium below $20 and at least five plans with premiums below $25.
Beneficiaries who enroll in private managed careMedicare Advantage plans will have an average premium about $11 a month lower than those in prescription only plans. More than 90 percent of beneficiaries will have access to a managed care prescription drug plan that carries no premium and no deductible for drugs.
“The 2008 options show that beneficiaries will continue to enjoy excellent value and choice in the Medicare prescription drug program,” Leavitt said in a statement. “The benefit continues to receive high marks from people who participate in the program.”
Open enrollment for beneficiaries to chose a plan for 2008 begins Nov. 15 and ends Dec. 31. Beneficiaries who do not actively switch from one plan to another will remain in their current plan.
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Satisfaction with Medicare call line drops
Customer satisfaction with Medicare’s toll-free hotline has dropped 13 percentage points to 71 percent in the past three years, according to a report released today by the Department of Health and Human Services’ inspector general’s office.
The hotline number, 1-800-MEDICARE, received nearly 50 million calls last year, compared to nearly 30 million calls in 2004, its first full year of operation.
Callers hung up without getting a satisfactory answer about 21 percent of the time, nearly twice the 12 percent rate in 2004, the report said. Two-thirds of those who hung up told the inspector general’s office that they considered the wait time to talk to a customer service representative too long.
This year, as in 2004, 44 percent of callers said they had difficulty accessing information: 31 percent complained that the automatic voice system was difficult to navigate; 19 percent said they felt they had not received the information they needed.
Of those who completed their calls, 12 percent said they did not get answers to their questions as quickly as they desired.
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Private fee-for-service plans OK’d
Seven health care sponsors may now resume marketing their private-fee-for-service (PFFS) plans after what Medicare officials called “a rigorous review” of their marketing practices proved satisfactory.
Earlier this year, several major health care sponsors including The United Health Group, Humana Inc., and Sterling Life Insurance Co., voluntarily suspended marketing of their PFFS plans, which allow beneficiaries to see physicians outside their network of providers for a fee. Those companies, as well as Coventry Health Care Inc., Universal American Financial Corp., WellCare Health Plans Inc., and Blue Cross Blue Shield of Tennessee, are now approved to market their PFFS plans.
“;CMS conducted a comprehensive review of these seven sponsors and found vast improvements to their internal controls and oversight processes consistent with regulations and guidance for Medicare private-fee-for-service plans,” said Kerry Weems, acting administrator for the Center for Medicare and Medicaid Services.
The CMS’ guidelines for the 2008 benefit year will impose stricter standards on and more closely monitor how PFFS policies are marketed and sold. Among other provisions, health care sponsors must telephone all beneficiaries requesting enrollment in a PFFS plan to confirm that they understand the terms and conditions of that plan.
In addition to the 2008 guidelines, CMS has more than a dozen new oversight activities in development including enrollment verification of new PFFS beneficiaries to ensure that they were not subject to inappropriate marketing activities.
“The best practice is prevention,” said Weems. “We believe the new requirements and compliance plans build a system that is designed to prevent marketing violations.”
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South Florida accounts for half of Medicare HIV/AIDS costs
Palm Beach, Broward and Miami-Dade counties accounted for half the drug costs billed nationwide for Medicare beneficiaries with HIV/AIDS in the last half of 2006, according to a government report released this week. The numbers were released as federal officials are already keeping a close eye on potentially fraudulent medical billings in South Florida. The report by Department of Health and Human Services Inspector General Daniel R. Levinson said the “aberrant claims patterns differentiated South Florida providers and beneficiaries from those in the rest of the country.” Although only 10 percent of all Medicare beneficiaries with HIV/AIDS live in the three South Florida counties, the report said the area accounted for half of the drug therapy costs billed nationwide - and 79 percent of the drugs themselves — and 37 percent of the HIV/AIDS services provided between July and December 2006.
Nationwide there are approximately 100,000 Medicare beneficiaries diagnosed with HIV/AIDS, according to the report.
“We recommend that the Centers for Medicare and Medicaid Services treat South Florida as a high-risk area and mandate site visits for certain types of providers before issuing provider numbers,” Levinson said in a statement.
“Medicare continues to be highly vulnerable to fraud and abuse and immediate steps must be taken to protect the program and its beneficiaries,” he said.
Since May, the Justice Department and HHS have overseen a multi-agency strike force consisting of federal, state and local investigators to combat Medicare fraud in South Florida through the use of “real-time” analysis of Medicare billings. Since then, 23 defendants have pleaded guilty of Medicare fraud and three have been convicted in jury trials, according to HHS.
The report did not provide county-by-county data and it was not readily available from the inspector general’s office, a spokesman said.
The report found that the average amount billed to Medicare for beneficiaries with HIV/AIDS was 16 times higher in South Florida than the rest of Florida and 39 times higher than the rest of the country.
For HIV/AIDS drug therapy claims, the average amount billed in South Florida was 64 times higher than the rest of Florida and about 518 times higher than the rest of the country, the report said.
The average HIV/AIDS drug claim in South Florida was $197,453 compared the $3,070 in the rest of the state and $381 in the rest of the country.
Medicare officials did not have “any clinical explanation for the high level of billing in South Florida,” the report said.
Even before the inspector general’s report was issued, Medicare had launched a two-year demonstration project seeking to curb fraudulent billing for non-oral drug infusion therapy in South Florida.
HHS Secretary Michael Leavitt announced last month that Medicare would require infusion therapy providers in South Florida to resubmit their applications within 30 days. Those who failed to reapply would lose their billing privileges. Medicare also announced that it would more often visit infusion therapy providers’ sites and provide infusion patients with monthly — rather than quarterly — summaries of what Medicare has paid on their behalf.
A department news release last month labeled South Florida “one of the high-risk areas for fraudulent billing by providers of infusion therapy.”
Medicare officials this summer took similar action against providers of durable medical equipment, such as wheelchairs, prosthetics and orthotics, in the same three counties.
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Medicare says colorectal info corrected
Medicare’s Web site has been corrected to reflect the fact that beneficiaries no longer have to meet a $131 deductible before they can receive a colorectal cancer screening test.
Changes have been made to the site’s main page and are being made to other pages within the Medicare site to reflect the current law.
The error was brought to the agency’s attention by Sen. Ben Cardin, D-Md., who proposed the legislation eliminating the deductible requirement.
“We should have been on top of this earlier,” said spokesman Jeff Nelligan, who added that the agency appreciated the information.
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AARP: Keep Medicare provisions in SCHIP
AARP’s senior media relations manager, Drew Nannis, sent out a notice this morning trying to reverse the thrust of an article published in today’s Congress Daily that quoted him as saying AARP might be open to separating the SCHIP and Medicare issues if they had assurances that the Medicare package would not be left out in the cold.
While Nannis doesn’t dispute the fact that AARP’s position might eventually be just that, he said in a statement: “This does not reflect the hard work over the last several months by AARP and other organizations to keep Medicare provisions and SCHIP reauthorization together in the CHAMP Act. AARP has repeatedly been on the record in support of a CHAMP Act that contains both SCHIP and Medicare improvements.”
Whether Medicare remains a part of the State Children’s Health Insurance Program legislation is an open question. The Senate SCHIP bill did not include Medicare; the House bill (the CHAMP Act) did include Medicare with some controversial provisions related to Medicare Advantage.
President Bush has threatened to veto either measure. So here’s my question: why don’t the House Democrats just take the Senate version as is and pass it and send it to the president? That would put the president in the position of having to either accept or veto a bill that is purely devoted to the children’s health issue — without muddying the water with the controversial and unrelated Medicare provisions.
Cardin: Correct colorectal screening information
Sen. Ben Cardin, D-Md., says Medicare’s Web site has incorrect information related to colorectal screening, and he wants it corrected.
According to Cardin, President Bush signed legislation last year eliminating the requirement that Medicare beneficiaries had to meet a $131 annual Part B deductible before they could receive a colorectal cancer screening test. But the Medicare.gov Web site still listed the requirement.
“We know that early detection of colorectal cancer saves lives,” Cardin said in a statement. “Our seniors need to know that this financial barrier has been erased. Medicare beneficiaries still have high out-of-pocket costs for medical care, and elimination of the deductible requirement will help them get screened earlier.”
Based on statistics from the National Cancer Institute, Cadin’s office noted that more than 147,000 new cases are diagnosed and more than 57,000 people die from colorectal cancer each year. Screening can greatly improve chances of identifying pre-cancerous and cancerous cells before they develop into a more deadly form of the disease.
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AARP-AMA urge Senate SCHIP bill to include Medicare
Two of the most powerful lobbies in Washington urged the Senate to include Medicare reforms during negotiations to meld the vastly different House and Senate versions of the State Children’s Health Insurance Program reauthorization bill.
Simply put, the Senate bill doesn’t mention Medicare.
The House bill slashes payments to Medicare Advantage plans and eliminates a 10 percent Medicare cut in doctor payments scheduled to take effect Jan. 1.
The American Medical Association and AARP both like the House version better.
The letter glosses over cuts in Medicare Advantage and stresses additional benefits such as more preventive care and low income assistance in the House version.
“We urge Congress to part with ‘business as usual’ and take action to pay physicians fairly. Medicare improvements for physicians and protections for beneficiaries deserve to be addressed now, with responsible funding, rather than rushed through before Congress adjourns, as has been customary in years past,” the letter says.
Read the full letter here.