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July 2015

Government’s Medical Billing Comes under Scrutiny

Washington Watch

 

After news reports revealed that billions of Medicare dollars have been wasted by overcharging the government for services that didn’t cost as much as they were billed for, two U.S. senators are pushing federal officials to increase oversight of privately-run Medicare Advantage health plans treating seniors.

 

Medicare Advantage programs, the popular private health plans, cover about one in three people eligible for Medicare – at an annual cost topping $150 billion. The alleged fraud, first revealed by whistle-blowers and recent news reports by the non-profit investigative reporting group, the Center for Public Integrity, documented how these private plans have added on billions of dollars in overcharges and other suspect billings based on inflated assessments of how sick patients are.

 

A Government Accountability Office report recently estimated “improper payments to Medicare Advantage plans at more than $12 billion in 2014.” But that’s just the tip of the financial iceberg.

 

Federal officials even acknowledge that they’ve struggled for years to track this overspending since Medicare Advantage was created in 2004. A 2009 Medicare study found that some plans had exaggerated how sick patients were to boost their payments and current of the Centers for Medicare and Medicaid Services (CMS) officials acknowledge that this remains a costly problem.

 

Recently, Sen. Charles Grassley, R-Iowa, who chairs the Senate Aging Committee and Sen. Claire McCaskill, D-Missouri, the committee’s top-ranking Democrat, issued separate calls for action. They are worried about the accuracy of a billing tool called a “risk score” which is intended to pay Medicare Advantage insurers higher rates for taking sicker people and less for those with few medical needs.

 

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Waking Up With Lady Liberty

Puttin’ on the Gritz

 

It is 4:30 in the morning when our cruise ship pulls into New York Harbor. As wide awake as the city that never sleeps, I worm my way up to the open deck and find a space on the starboard side. New York City’s skyline seems to be kicking up her heels with more sass and bling than a chorus line of Rockettes. “Take a look at me,” she sings, “I’m the most exciting city in the world.”

 

As I hang onto the side of the ship, I cannot help but wonder how my great-grandfather felt when first he glimpsed Lady Liberty.”

 

I hope someone told him the story of how the statue came to be constructed from toe to crown, and how ships transported it piece by piece from France to America. He probably never heard it, but I am certain he wiped tears from his eyes as he stood at the railing and allowed The Lady’s glow to shine the light of freedom on him.

 

What might he have been thinking? What would he have said to his little brother standing next to him, both of them having recently fled the devastating potato famine in Ireland, and both of them scared out of their Irish britches?

 

“Look at er ovah dere, lad, the ol’ gurl hursef. That’s our noo mum. She’s gon’ tek’ caire of us naiw, she is. Don’t ye be frettin’.”

 

Lil’ brother likely whimpered at the mention of their mother, a victim of poverty and neglect, buried a mere month before the boys set sail. Perhaps he moved a wee bit closer to his big brother, the one who was charged with his welfare once they set foot on American soil, the one who would find work however he could in order to feed, clothe and properly school them in their new country.

 

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