Life-saving care at great cost. How did our nation’s most ambitious experiment in universal healthcare — comprehensive Medicare coverage for every kidney failure patient — descend from a “supremely hopeful moment” nearly four decades ago to a $20-billion-a-year “hulking monster” that kills thousands of patients? ProPublica tries to answer those questions in its latest investigative series.
Centers for Medicare and Medicaid Services (CMS)
Feds take down largest-ever Medicare fraud ring
Federal agents charged 44 people in New York, Los Angeles, Atlanta and Miami in what they’re calling the single largest Medicare fraud scheme ever, according to the U.S. Dept. of Justice.
The individuals allegedly set up 118 phantom clinics in 25 states and stole the identities of doctors and thousands of Medicare beneficiaries, intending to submit phony claims.
Grassley wants answers from Berwick, Sebelius on Medicare fraud
Sen. Charles Grassley is at it again.
The Iowa Republican, long concerned with healthcare-related issues including transparency, waste and fraud, sent a strongly-worded letter last week to Dr. Donald Berwick, head of the Centers for Medicare and Medicaid, and his boss Kathleen Sebelius, secretary of the U.S. Dept. of Health & Human Services. Grassley wants answers on how CMS polices the contractors it uses to process Medicare claims and those charged with finding and eliminating fraud and waste.
Medicare anti-fraud bill takes aim at corporations
The U.S. House passed a bill with bipartisan support yesterday that would give the Dept. of Health and Human Services more power in prosecuting corporations that commit Medicare or Medicaid fraud.
Medicare Advantage rates to drop, not rise
Older Americans enrolled in privately administered Medicare Advantage plans will see their rates drop slightly, thanks to federal negotiators who shot down contracts for high-cost plans.
Predictions that Medicare Advantage rates would rise did not take into account the new authority delegated to the Centers for Medicare and Medicaid Services under the Affordable Care Act, which begins taking effect this week.
Medicare fraud prevention measures target docs
As the Affordable Care Act took effect this week, the Centers for Medicare and Medicaid Services unveiled a set of measures designed to prevent doctors from defrauding federal healthcare programs.
Provider and supplier abuse of Medicare, Medicaid and CHIP contributes to part of the $55 billion dollars per year that goes missing from federally funded healthcare programs. Congress and the Obama administration built increased oversight for the programs into the healthcare reform legislation.
Medicare, FDA team up to look at medical products
The Food & Drug Administration and the Centers for Medicare and Medicaid are opening up their plans for concurrent evaluations of pre-market, FDA-regulated medical products to public comment.
The two agencies are working to promote data-sharing between themselves and signed a memorandum of understanding over the proposed collaboration June 23. A partnership between FDA and Medicare could make the approval process for new drugs and devices more efficient. A 90-day public comment period on the possible collaboration begins tomorrow.
CMS sends $7 million to four states for EMR adoption
The Centers for Medicare and Medicaid Services are doling out more than $6.9 million to four states as part of the federal government’s push to hasten the adoption of electronic medical records.
Massachusetts, Ohio, Hawaii and North Dakota are all in line for a piece of the action, which will go toward determining how far health information technology has penetrated their healthcare systems.
Clinical Science coughs up $525,000 to settle Medicaid fraud allegations
Clinical Science Laboratory Inc. agreed to pay Massachusetts $525,000 to settle allegations that the company defrauded Medicaid.
Attorney General Martha Coakley’s Medicaid fraud division found that the Mansfield, Mass.-based diagnostics firm billed the federal and state-funded social welfare program for unauthorized urine drug tests between 2004 and 2009, the AG’s office said.
CMS CMO: Berwick’s appointment “a breath of fresh air”
Dr. Donald Berwick’s appointment as head of the Center for Medicare and Medicaid Services came as “a breath of fresh air” at the agency, according to CMS chief medical officer Dr. Barry Straube.
During a presentation on patient safety at the National Quality Colloquium today in Cambridge, Mass., Straube took a moment to note the arrival of his agency’s new head.
"Don Berwick is our administrator, finally," Straube said. "It’s a breath of fresh air to all of us."
CMS to probe bone morphogenetic proteins
The Centers for Medicare and Medicaid Services are planning a September meeting to examine the on- and off-label uses of bone-morphogenetic proteins used in several prominent spinal implants and procedures.
The Sept. 22 meeting of the agency’s Medicare Evidence Development & Coverage Advisory Committee will look to answer a number of questions about the products, including "the clinical benefits and harms of on-label and off -label use of BMPs," according to its website.