Medicare pays doctors even after they're sanctioned

Apr 17 2014

A ProPublica report finds that the agency continued paying doctors, pharmacists and other health professionals even after they were charged with bilking the program. Meanwhile, a report recommends that Medicare pay hospitals less for low-risk outpatient surgeries.

ProPublica: Even After Doctors Are Sanctioned Or Arrested, Medicare Keeps Paying 
In August 2011, federal agents swept across the Detroit area, arresting doctors, pharmacists and other health professionals accused of running a massive scheme to defraud Medicare. The following month, several of those arrested -;including psychiatrist Mark Greenbain and podiatrist Anmy Tran -;were suspended from billing the state's Medicaid program for the poor ... But the indictment and Medicaid suspensions didn't deter Medicare from continuing to allow the doctors to treat elderly and disabled patients -; and billing taxpayers for their services (Ornstein, 4/16).

Modern Healthcare: Cut Prices For Low-Risk Hospital Outpatient Surgeries: HHS Report 
Medicare should pay hospitals less for low-risk outpatient surgeries, the program's fiscal watchdog suggests in a report published this morning (Carlson, 4/17).

Kaiser Health News: Capsules: Hospital Visits Fell When Seniors Got Drug Coverage
Researchers at the University of Illinois and the Johns Hopkins University have made the broadest test yet of Medicare Part D prescription drug program's promise -; that covering drugs would keep seniors out of the hospital. Comparing national records from before and after 2006, when Part D kicked in, they found that drug coverage was associated with an 8 percent drop in hospital admissions and nearly as much in hospital-cost savings -; an amount they calculate to be $1.5 billion a year (Hancock, 4/16).

Meanwhile, a conservative group says seniors will see Medicare Advantage benefit reductions even though the government reversed proposed rate cuts -

National Journal: Study: Cuts To Medicare Advantage Top $1,500 Per Senior
Obamacare's Medicare Advantage cuts will lead to benefit reductions of about $1,500 per beneficiary, according to a new analysis from a conservative think tank. The American Action Forum, founded by former Congressional Budget Office Director Douglas Holtz-Eakin, said almost all Medicare Advantage beneficiaries will feel the effect of cuts to the program. The federal Medicare agency recently backed off a proposal to make additional cuts to Medicare Advantage-;the second year in a row it has proposed and then abandoned such reductions. But the AAF analysis says the reductions mandated in the Affordable Care Act will still affect benefits for most seniors who use the program (Baker, 4/17).