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Mon Feb 27, 2012, 03:00 PM

Feds to curb improper payments to Medicare plans

By Associated Press | Associated Press Fri, Feb 24, 2012

http://news.yahoo.com/feds-curb-improper-payments-medicare-plans-214303872.html

WASHINGTON (AP) The Obama administration says it's taking steps to fix a longstanding problem of improper payments to private health plans that serve 1 in 4 Medicare beneficiaries.

So-called Medicare Advantage plans face tighter audits under a policy issued Friday. The rules say Medicare must pay the plans a higher rate to care for sicker beneficiaries. But previous government audits discovered many claims were not backed up by proper medical documentation.

Medicare deputy administrator Jon Blum says he doesn't call it fraud, but it is a problem. The estimated error rate of 11 percent added up to $12 billion in improper payments last year.

The Obama administration says it wants to gradually reduce erroneous payments while maintaining quality. Medicare expects to save $370 million beginning this year, and more over time.

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Response to cbayer (Original post)

Mon Feb 27, 2012, 03:10 PM

1. Why did it take so long?

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Response to demosincebirth (Reply #1)

Mon Feb 27, 2012, 03:14 PM

2. Medicare is a huge beauracratic nightmare that has lacked good leadership

for a long time.

And the Medicare advantage plans have been exploiting it for as long as there has been Medicare advantage.

I think they needed to get the data, tighten the rules and hire a lot of people to do audits.

In the past, you submitted a bill to Medicare and they basically just paid it. They just didn't have the resources to look at it critically.

I think what is happening here is that Medicare is moving closer and closer to a well run program that can be the bedrock for a universal care program. IMHO, Obama deserves a lot of credit for this.

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Response to cbayer (Original post)

Mon Feb 27, 2012, 03:35 PM

3. i love medicare!

1057 dollar bill cost me 57 dollars. if i had an additional plan my payment would be 0. out of town or out of state? no problem..give them your ss number and you are on your way. i even have my own webpage for my benifits,payments,and reminder for my FREE yearly check ups.

medicare is basically administrated by insurance companies and other health care business.

oh yes..medicare is around 13% of the federal budget.

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Response to cbayer (Original post)

Mon Feb 27, 2012, 03:41 PM

4. Again? Politicians have been "fixing" this problem with Medicare for decades

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Response to badtoworse (Reply #4)

Mon Feb 27, 2012, 03:43 PM

5. I wish. The fact is that they have done very, very little

for a very long time.

The Obama administration, under Sibelius, has made more positive changes than any previous administration, imo.

And the Congress has done virtually nothing except put into place legislation that benefits the insurance and pharmaceutical companies.

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Response to cbayer (Reply #5)

Mon Feb 27, 2012, 03:50 PM

8. I left out the sarcasm thingy

I agree with you - very little has been done about this problem.

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Response to badtoworse (Reply #8)

Mon Feb 27, 2012, 04:02 PM

9. Oh, my sarcasm meter is really off today. Thanks for clarifying.

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Response to cbayer (Original post)

Mon Feb 27, 2012, 03:45 PM

6. "curb?" Why not eliminate or at least try to "eliminate?" nt

 

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Response to nanabugg (Reply #6)

Mon Feb 27, 2012, 03:50 PM

7. I would think that is the ultimate goal, but it requires a lot of workforce to do this.

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