Medicare looks to narrow discrepancy on what it spends in different parts of U.S.

Dec 3 2013

Medicare wants to narrow the discrepancy on what it spends on some health services in different parts of the country. In the meantime, UnitedHealthcare is dropping hundreds of doctors from its Medicare Advantage plans and the Government Accountability Office says Medicare doesn't know how well its contractors' anti-fraud efforts are working.

Kaiser Health News: Medicare Seeks To Curb Spending On Post-Hospital Care
After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital. Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital -- three times the rate in Phoenix (Rau, 12/1).

Kaiser Health News: UnitedHealthcare Dropping Hundreds Of Doctors From Medicare Advantage Plans
The company is the largest Medicare Advantage insurer in the country, with nearly 3 million members.  More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan's network of providers (Jaffe, 12/1).

Medpage Today: GAO: Medicare Lacks Info On Fraud Response
The Centers for Medicare and Medicaid Services (CMS) doesn't know how quickly its anti-fraud contractors respond to abuse, or how well they protect Medicare integrity, a government report found. CMS doesn't know the time between when its Zone Program Integrity Contractors (ZPICs) identify a suspect provider and when they take action to prevent potentially fraudulent Medicare payments, according to the Government Accountability Office (GAO). The contractors reported more than $250 million in savings to Medicare in 2012, with more than 130 investigations being accepted by law enforcement for potential prosecution, the GAO said in a report released Monday (Pittman, 11/29).