Federal vaccine mandate countdown for unvaccinated health care workers begins
The countdown clock for unvaccinated workers in health care facilities has begun as Thursday marked the day they must have their first dose of vaccine in order to meet the deadline of a federal mandate to be fully vaccinated. The deadlines for the vaccines were staggered by the Centers for Medicare & Medicaid Services (CMS) after those states brought court challenges to the mandate set out by the Biden administration. If health care workers do not get vaccinated, the facility they work at risks losing Medicare and Medicaid funding. The court struck down a similar plan for mandatory vaccination of employers with more than 100 workers. The mandate for health care workers covers about 10 million workers at hospitals and nursing homes that receive Medicare or Medicaid funding.wftv.com
Medicare posts key nursing home staffing info for consumers
The move by the Biden administration comes as COVID-19 cases and deaths at nursing homes have risen again, despite extensive efforts to vaccinate residents and staff. To find the new information, consumers must go to the Care Compare website, select a particular nursing home, and then click on "View Staffing Information." The Centers for Medicare and Medicaid Services, or CMS, said it has researched the links between staff turnover and quality of care. Nurse turnover is defined as the percent of nursing staff that stopped working at a facility over a 12-month period. It would also set in motion a process that could lead to federal staffing requirements for nursing homes.wftv.com
The Social Security Retirement Age Increases in 2022
While you can start Social Security payments at age 62, your monthly checks are reduced if you begin collecting benefits at this age. To claim your full benefit, you need to sign up for Social Security at your full retirement age, which varies by birth year.news.yahoo.com
Medicare limits coverage of $28,000-a-year Alzheimer's drug
WASHINGTON — (AP) — Medicare said Tuesday it will limit coverage of a $28,000-a-year Alzheimer's drug whose benefits have been widely questioned, a major development in the nation's tug-of-war over the fair value of new medicines that offer tantalizing possibilities but come with prohibitive prices. Medicare's national coverage determination would become final this spring, following a public comment period and further evaluation by the agency. The drug has sparked controversy since its approval by the Food and Drug Administration last June, which came against the recommendation of the agency’s outside advisers. Faced with skepticism over its medication, Biogen recently slashed the price to $28,200, but Medicare enrollees were already on the hook for the $170.10 premium. Health and Human Services Secretary Xavier Becerra has directed Medicare to reassess the premium increase.wftv.com
Medicare told to reassess premium hike for Alzheimer's drug
Biogen is slashing the price of its Alzheimer’s treatment months after the drug debuted to widespread criticism for an initial cost that can reach $56,000 annually. The drugmaker said Monday, Dec. 20, 2021 that starting in January it will cut the wholesale acquisition cost of the drug by about 50%. (AP Photo/Steven Senne, File) (Steven Senne)WASHINGTON — (AP) — 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 move came after prominent Democratic senators urged the Biden administration to take immediate steps to cut rising drug costs for seniors. But with Aduhelm, the pain would be spread among Medicare recipients generally, not just Alzheimer’s patients needing the drug.wftv.com
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
Medicare Alzheimer’s Drug FILE - The Biogen Inc., headquarters is shown March 11, 2020, in Cambridge, Mass. 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. Without further action, the monthly premium increase would swallow up a significant chunk of seniors' 5.9% cost of living increase. “Uncertainty” over the drug's financial impact on Medicare appeared to be driving much of the calculation of the new premium, Wyden noted. The Medicare premium increase would hit first.wftv.com
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
How Gov. DeSantis’ proposed budget would impact Florida hospitals
ORLANDO, Fla. — Hospitals all over the state can keep their current staffing and level of care in place, if Gov. He wants to keep the Critical Care Fund intact. READ: DeSantis proposes $99B ‘Freedom First’ state budget: See what it includesIn order to break even, they need the state to make up the difference in reimbursement. If the Critical Care Fund is not cut, that would be good news for places like Orlando Health. The legislature also has to have its say on the budget, and some believe hospitals make too much money.wftv.com
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
$56K Alzheimer’s drug avoiding Biden’s cost curbs, for now
Medicare Alzheimer’s Drug FILE - The Biogen Inc., headquarters is shown March 11, 2020, in Cambridge, Mass. A new $56,000-a-year Alzheimer’s medication that’s leading to one of the biggest increases ever in Medicare premiums is highlighting the limitations of President Joe Biden’s strategy for curbing prescription drug costs. A nonprofit think tank focused on drug pricing estimated Adulhelm's value at between $3,000 and $8,400 per year, not $56,000, based on its unproven benefits. Supporters of the Democratic drug pricing legislation are mostly staying quiet about the controversy. Their opposition almost killed the Democrats' drug pricing plan, and in the end led to a compromise limiting Medicare negotiations.wftv.com
Sanders to Biden: Cut back looming Medicare premium hike
Medicare Premiums Sanders FILE - Sen. Bernie Sanders, I-Vt., speaks during a news conference on Capitol Hill, Nov. 3, 2021, in Washington. 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. Democrats run the risk that seniors smarting from one of the biggest increases ever in Medicare premiums will turn against them in the 2022 midterm elections. With Democrats in control of the White House, the House and the Senate we cannot let that happen.” A copy of the letter was provided to The Associated Press. Sanders asked Biden to order Medicare to hold off on approving coverage of Aduhelm until there is scientific consensus about its benefits.wftv.com
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
Cap on drug price hikes for privately insured sparks battle
Business groups are paying close attention, and the issue has divided them in a fierce lobbying battle. The issue is dividing business groups in a fierce lobbying battle. Polls show that Americans across the political spectrum overwhelmingly favor government action to reduce drug prices. Gremminger said his group estimates that the privately insured market could save $250 billion over 10 years under the inflation caps currently in the bill. “It's true that not all the business groups are in the same place,” Gelfand said of divisions in the business community.wftv.com
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
$2.5M cash found in PVC pipes in alleged Miami Medicare scam
MIAMI – Federal agents found $2.5 million in cash hidden in PVC pipes in the bedroom closet of a Miami man charged with bilking the government in a massive $49 million Medicare fraud scam. The cash was found sealed with plastic wrap inside pipes buried under the closet floor at Jesus Garces' home during a raid Wednesday, according to the U.S. Attorney's Office. Federal authorities have spent the last decade cracking down on the multi-billion Medicare fraud scams cheating taxpayers, but they rarely find cash stockpiles like this. Agents also found another $75,000 in a safe and another $280,000 in a safe at another home linked to Garces, along with seven Rolex watches. Federal investigators said he received $100,000 in cash a week over a two-year period from one of the money launderers, according to a 2019 detention order.
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 tries to revive stalled election-eve drug discounts
FILE - In this Oct. 10, 2020, file photo, President Donald Trump speaks from the Blue Room Balcony of the White House to a crowd of supporters in Washington. (AP Photo/Alex Brandon, File)WASHINGTON – The Trump administration is trying to revive the president's stalled election-eve plan to send millions of Medicare recipients a $200 prescription discount card. White House spokesman Judd Deere confirmed the administration is continuing to move forward. “It’s simply good policy, and demonstrates President Trump is continuing to deliver on his promises to our nation’s seniors to lower drug prices." Pallone dismissed the latest White House push.
Trump makes late-term bid to lower prescription drug costs
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 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. The Food and Drug Administration has put a priority on approving generics, which cost less.
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.
U.S. government to pay for coronavirus vaccine costs
The United States government is planning to pay for a future coronavirus vaccine for all Americans. The Centers for Medicare and Medicaid Services made the announcement on Wednesday and said it will pay for any vaccine authorized or approved by the Food and Drug Administration. [TRENDING: ‘Smell of rotting flesh’ leads to body in trunk | How to celebrate Halloween during pandemic | 98 ‘murder hornets’ removed]While the federal government is paying for the vaccine, insurers including Medicare, Medicaid and private plans must cover the cost of administering it. This is a costly undertaking the agency says. If the 62 million people in the Medicare program got vaccinated it would cost around $2.6 billion.
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.
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.
Walmart launches health insurance plans for seniors
Walmart is launching healthcare plans that will be available for seniors for the first time. It comes in time for Medicare open enrollment. Walmart announced the move on Tuesday. It comes as insurance companies compete for the growing number of seniors eligible for Medicare benefits. [TRENDING: Newlywed couple killed in plane crash | Ballot for dead wife meant to ‘test system’ | FSU president tests positive for COVID-19]Walmart says the insurance services will help people with the historically confusing process of enrolling in insurance plans.
News 6 teams up with WellMed to host virtual Medicare phone bank
Open enrollment for Medicare kicks off Thursday, Oct. 15, so News 6 is partnering with representatives from WellMed Medical Group and Medicare experts for a virtual phone bank to answer your questions. The phone bank will run Wednesday, Oct. 7, from 9 a.m. to 7:30 p.m. The number to call with questions is 888-664-9564. The virtual phone bank is an opportunity for the Central Florida community to get updated information on any changes to plans and policies from 2019 and all the information for newly eligible Medicare recipients. Doctors encourage anyone signing up for a Medicare plan to ask questions now, ahead of the deadline, which is Dec. 7, 2020.
Annual Medicare enrollment period is just around the corner. Here's what you need to know.
The annual Medicare enrollment period starts on Oct. 15. Learn about your options when it comes to Medicare supplement or a Medicare advantage plan. The advertiser paid a fee to promote this sponsored article and may have influenced or authored the content. The views expressed in this article are those of the advertiser and do not necessarily reflect those of this site or affiliated companies.
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.