In This Edition:
From Kaiser Health News:
A pioneering program in southern California provides ongoing care and housing to homeless people who are “super-utilizers” of hospital emergency rooms. The effort is reducing ER visits and saving a lot of money. (David Gorn, 6/23)
Hospitals share patient records of “super-users” to save money and avoid duplicating medical treatment. (Jenny Gold, 6/22)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'DIY Health Care'" by Steve Kelley and Jeff Parker, from 'Dustin'.
Here's today's health policy haiku:
THE GOP’S ‘BETTER WAY’ TO REPLACE OBAMACARE
The GOP plan:
Six years to craft this framework …
But what’s really new?
If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
Summaries Of The News:
The nationwide sweep exposed alleged kickbacks, embezzlement and fake claims, and involved various kinds of fraud in diverse areas of health care, ranging from prescription drugs to home health care to physical therapy, the Department of Justice announced.
The Associated Press: Feds Charge 300 In Nationwide Health Care Fraud Sweeps
Health care fraud sweeps across the country have led to charges against 300 people including doctors, nurses, physical therapists and home health care providers accused of bilking Medicare and Medicaid, the government announced Wednesday. The sweep spread from southern California to southern Florida and Houston to Brooklyn, New York, with arrests being made over three days. (6/22)
The Wall Street Journal: Justice Department Announces Biggest Medicare Fraud Crackdown
Federal agents have arrested roughly 300 suspects in what officials call their largest crackdown on Medicare fraud, with charges ranging from taking illegal payments for marketing medications to false physical-therapy claims. (Barrett, 6/22)
Reuters: U.S. Completes 'Takedown' Of Medicare Fraud: Officials
The national sweep resulted in charges against doctors, nurses, pharmacists and physical therapists accused of fraud that cost the government $900 million, the department said. The cases involved an array of charges, including conspiracy to commit health care fraud, money laundering and violations of an anti-kickback law. This year's sweep exceeded last year's record in which 243 defendants faced charges in a combined $712 million in government losses. (6/22)
The Fiscal Times: Doctors And Nurses Charged In Massive $900 Million Medicare Fraud
In some cases, doctors took part in schemes to submit claims to Medicare and Medicaid for treatments that were not necessary and were never provided. In others, health care providers offered kickbacks to “patient recruiters” to help assemble beneficiary information that could be used in phony filings. One of the biggest scams involved phony billings for costly prescription drugs at a time when Medicare’s drug costs are spiking. (Pianin, 6/23)
The Washington Post: Feds Allege $900 Million In Fake Medical Bills, Kickbacks And Other Health Care Fraud
"They submitted dishonest claims, they charged excessive fees and they prescribed unnecessary drugs," Attorney General Loretta Lynch said at a news conference. "As this takedown should make clear, health-care fraud is not an abstract violation. It’s not a benign offense. It’s a serious crime." (Johnson and Zapotosky, 6/22)
And media outlets report on the sweep on a state level —
Los Angeles Times: Nation's Biggest Healthcare Fraud Probe Nets 301 People, Including 22 In Southern California
In Southern California, five physicians were among those arrested in cases involving $125 million in elaborate fraud schemes that targeted Medicare and the military’s medical plan and involved medical billing, unnecessary procedures and high-priced specialized compound medications. The charges in 13 criminals cases filed in federal courts in Los Angeles and Santa Ana include conspiracy, money laundering, kickback schemes and identity theft, according to several federal indictments. (Winton, 6/22)
The Columbus Dispatch: Hilliard-Area Couple To Plead In Home-Health-Care Fraud Case
A Hilliard-area couple who operated a home-health-care agency have agreed to plead guilty to federal charges in a scheme that defrauded the Medicaid program and helped them build a million-dollar luxury home. State and federal officials revealed the local case today, as the U.S. Justice and Health and Human Services departments also announced a nationwide sweep that has led to charges against 301 people — including 61 doctors, nurses and other licensed medical professionals — involved in $900 million worth of false billings. (Price, 6/22)
The Houston Chronicle: 'Largest Medicare Fraud Takedown In History' Nabs 22 In Houston Area
More than 300 people across the nation - including 22 in the Houston area - have been charged with stealing more than $900 million in what federal investigators say is the "largest Medicare fraud takedown in history." The 301 people facing criminal and civil charges of health care fraud include 61 doctors, nurses and other medical professionals, according to the Department of Justice. (Banks, 6/22)
The Dallas Morning News: $5 Million Ear Care Scam In Dallas Part Of Nation’s Biggest Medicare Bust
Three Garland residents accused of operating a more than $5 million ear care scam are among dozens of people across the country arrested as part of the biggest Medicare fraud bust in history. Nine others in the Dallas area linked to three separate home health care scams also were charged. (Krause, 6/22)
St. Louis Public Radio: Four In St. Louis Charged As Part Of A Nationwide Crackdown On Health Care Fraud
Four St. Louis-area residents are among hundreds across the nation facing charges of federal health care fraud. The U.S. Department of Justice announced the allegations on Wednesday. All told, more than 300 people in 30 states, the District of Columbia and Puerto Rico have been accused of defrauding Medicare and Medicaid. (Lippmann, 6/22)
The Philadelphia Inquirer: Delco Podiatrist Among 301 Charged In Massive Medicare-Fraud Bust
A Delaware County podiatrist is one of 301 individuals charged in a nationwide Medicare-fraud bust spanning 36 federal districts and involving approximately $900 million in fraudulent payments. (Chadha, 6/22)
Under current projections, trustees said automatic cuts in the program mandated under a controversial provision of the Affordable Care Act could take effect for the first time in 2019. Meanwhile, the presidential candidates have largely avoided talking about the problem.
The New York Times: Medicare And Social Security Trustees Warn Of Shortfalls
The Obama administration said Wednesday that the financial outlook for Medicare’s hospital insurance trust fund had deteriorated slightly in the last year and that Social Security still faced serious long-term financial problems. The report, from the trustees of the two programs, could inject a note of fiscal reality into a presidential campaign that has given scant attention to the government’s fiscal challenges as the population ages. Hillary Clinton, the presumptive Democratic presidential nominee, has proposed increasing Social Security benefits and allowing people age 55 to 64 to “buy into” Medicare, while Donald J. Trump, the presumptive Republican nominee, has repeatedly said he would not cut either program. (Pear, 6/22)
Modern Healthcare: Trustees' Report Says Medicare Will Be Insolvent By 2028
The Medicare trust fund will be insolvent by 2028, according to the 2016 Medicare trustees' report released Wednesday. The prediction is a departure from the 2030 date the Obama administration outlined in the previous two reports. The estimate is still later than the timeline released by the Congressional Budget Office in January, which estimated the program would be solvent only until 2026. (Dickson, 6/22)
The Wall Street Journal: Social Security, Medicare Face Insolvency Over 20 Years, Trustees Report
The annual report card from the programs’ trustees said Medicare’s hospital-insurance trust fund, which provides coverage to more than 55 million Americans, will exhaust its reserves by 2028, two years sooner than estimated last year. (Timiraos, 6/22)
Reuters: Medicare Program Spending Within Target Rate: Trustees
The Medicare program, which provides health coverage for more than 55 million older as well as disabled people, said that the projected growth rate for per capita spending has not exceeded its target. That put aside the need for the program's regulator, the Centers for Medicaid and Medicare Services, to establish a savings target and to initiate mandatory spending cuts, their annual financial report said. As such, the government would not need to immediately set up an Indepen
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