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Video: AARP Oklahoma Medicare Opinion Leader Forum 8-23-12
Another ObamaCare Medicare Gimmick
ObamaCare supporters sometimes like to talk about the legislation’s “delivery system reforms,” which are supposed to change the way health care services are organized in ways that make health care less costly and more efficient. The bulk of these delivery system reforms are essentially payment reforms — restructuring the way medical providers are reimbursed in hopes of changing their incentives. But the sheer complexity of the way Medicare pays providers means that these sorts of payment games are not only commonplace, but key drivers of administrative decisions in medical facilities. Medicare’s size also means that its decisions often have ripple effects throughout the medical payment ecosystem.
Significant Medicaid Cases
Commonwealth of Pennsylvania Department of Public Welfare v. Sebelius, 3rd Cir., March 15, 2012. The district court’s decision to sustain an HHS directive requiring the Pennsylvania Department of Public Welfare (DPW) to remit more than $5.6 million in overpayments it received under the Aid to Families with Dependent Children (AFDC) program was proper. Following the close-out of the AFDC program, HHS instructed the states to remit the federal share of recovered AFDC overpayments. The HHS Office of Inspector General conducted a nationwide audit, and pursuant to the audit, sent the directive to DPW. DPW challenged the authority of HHS to conduct its own audit on the grounds that §116(b)(3)(A) of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) prescribed a single audit procedure under the Single Audit Act of 1984 for the close-out of the AFDC program. However, the language of §16(b)(3)(A) of PRWORA did not apply to federal claims for recovered AFDC payments; the section focused on state claims for federal reimbursement. The district court’s judgment was affirmed.
Bipartisan Bill Would Repeal Medicare Hospital Payment Loophole
Sens. Claire McCaskill (D-Mo.) and Tom Coburn, MD (R-Okla.), have introduced a bill that would sunset Section 3141 of the Patient Protection and Affordable Care Act — a controversial provision that sets the Medicare hospital wage index floor for the entire country. Under Section 3141, the Medicare hospital wage index is adjusted so that a state’s urban hospitals must be reimbursed for wages paid to physicians and staff at least as much as rural hospitals. These reimbursements for hospital wages also come from a national pool of money, meaning that if one state receives higher Medicare wages, it will come at the expense of another state. In January, 20 state hospital associations — Alabama, Arkansas, Delaware, Georgia, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Virginia, West Virginia and Wisconsin — as well as the National Rural Health Association wrote a letter (pdf) to the White House arguing this provision is decimating their Medicare reimbursements. A Boston Globe report found that Massachusetts had received an estimated $367 million in additional Medicare funding due to Section 3141 because the state’s only rural hospital — Nantucket (Mass.) Cottage Hospital, based in an affluent area with a high cost of living — set an inordinately high floor for wage reimbursements. In total, nine states received higher Medicare wages under the provision, while the remaining 41 lost Medicare funds. Sens. McCaskill and Coburn called the provision “unfair” and said it only benefited hospitals in some states to the disadvantage of many others.
Oklahoma: Medicare Of Oklahoma
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ObamaCare uses billions to solve 50
“The challenge that Medicare has had is that they do demonstrations and pilots periodically, some of them are successful. Many of them don’t have quite the results that had been hoped for,” said Gail Wilensky, former head of Medicaid and Medicare from 1990 to 1992 and senior fellow at Project HOPE, an international health care foundation. “Even the ones that are successful, they don’t have a long history of seeing whether they can be scaled up represent a delivery system that would be relevant in many parts of the country and become part of a national program.”
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An Open Letter: Lankford misrepresents his voting record on SS and Medicare. FYI, With an Earl Mitchell Response :: Democrats of Oklahoma Forum
By ending Medicare as we know it, I was referring to your and other Republicans’ votes to give Medicare beneficiaries a set amount of money (a voucher or coupon) each year to buy coverage from competing health plans. That’s in contrast to the present program in which the federal government pays for as many services as beneficiaries use. The economies of scale by having the federal government pay would be lost in turning the responsibility for paying over to each person. That person would have to make up the difference when the cost of health insurance exceeds the amount of the voucher.
Oklahoma Medicare Fraud Continues to Rise
Over the last three years, Oklahoma fraud lawyers have seen a significant increase in the number of Medicare fraud cases. One recent news report claims that in Oklahoma, Medicare fraud has increased by 350% in the last three years, resulting in seven criminal cases and thirty eight civil suits totaling more than $22 million in settlements. According to the Coalition Against Insurance Fraud, nearly $24 billion dollars are spent on improper, inaccurate, or fraudulent Medicare and Medicaid claims annually in the United States. With such a heavy financial toll on the government and taxpayers, fraud cases are investigated and prosecuted vigorously. The United States Department of Health and Human Services reports that the federal government saves $1.55 for every $1 invested in fighting fraud.