August 25, 2016 |
PMA Medical Specialists L.L.C., a group of 54 physicians with offices in Chester, Delaware, Montgomery and Philadelphia Counties, has applied with a Maryland company to form an Accountable Care Organization with 7,800 Medicare beneficiaries, the group said Tuesday. Accountable Care Organizations, or ACOs, are designed to improve care and reduce costs by emphasizing coordination. Typically, Medicare and the ACO share the savings, if there are any. PMA's partner in Aledade Freedom ACO is Aledade, a Bethesda firm that in June announced the formation of a separate ACO with Gateway Medical Associates.
August 4, 2016 |
Enrolling in Medicare can be stressful and confusing, but delay signing up and it can also set you back a bundle. Late enrollment penalties can hike a monthly premium by 10 percent or more - for the rest of your life. More than 750,000 Medicare beneficiaries have made that mistake, boosting their Part B premiums, on average, by 30 percent, or an extra $440 a year . The problem is getting worse, too. With more people working past their 65th birthday and still getting health care coverage through their employers, they may not ask about Medicare until they miss their deadline.
July 25, 2016
A research letter published Wednesday in JAMA Psychiatry found that Medicare beneficiaries had the highest and most rapidly growing rate of "opioid use disorder. " Six of every 1,000 recipients struggle with the condition, compared with one out of every 1,000 patients covered through commercial insurance plans. The letter also concluded that Medicare beneficiaries may face a treatment gap. In 2013, doctors prescribed a high number of opioid prescription painkillers for this population, but far fewer prescriptions for buprenorphine- naloxone, the only effective drug therapy for opioid use disorder covered by Medicare Part D. More than 300,000 Medicare recipients battle with opioid use disorder, according to the study.
July 1, 2016 |
More than nine out of 10 doctors at the Hospital of the Fox Chase Cancer Center received payments from drug and medical-device firms in 2014, an analysis of Medicare payments data by ProPublica found. Its rate of 92 percent ranked Fox Chase highest in the Philadelphia region for the percentage of affiliated doctors accepting payments from pharmaceutical or medical-device firms, the data showed. Fox Chase, which ranked 10th nationally for its percentage of affiliated doctors receiving payments of any size, also had the region's highest percentage of doctors who collected at least $5,000.
June 24, 2016 |
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. Stephen A. Monaco, 59, of Broomall, was charged with submitting $5 million in false claims to Medicare, Medicaid, and four private insurers through his Havertown practice, A Foot Above Podiatry, U.S. Attorney Zane David Memeger announced Wednesday. Between 2008 and 2014, prosecutors say, Monaco submitted claims for procedures that did not take place, and procedures that were medically unnecessary and therefore not reimbursable by Medicare and other insurance companies.
June 6, 2016 |
When the feds closed Brotherly Love Ambulance Inc. in October 2011 amid allegations of Medicare fraud, the owner's son quickly opened his own ambulance company and picked up where his mother had left off. For a while, anyway. Bassem Kuran, who also was a driver for Brotherly Love, is to be arraigned this month for making false statements in a healthcare matter, related to his operation of VIP Ambulance Inc. For years, teams of federal officials have been trying to stamp out this "whack-a-mole" pattern of one fraudulent ambulance operator shutting down only to have another - sometimes headed by a friend or family member - replace it. But since 2014, authorities have hit on an effective strategy.
May 18, 2016 |
The owner of a defunct Northeast Philadelphia ambulance company was charged with Medicare fraud for transporting patients who could walk and did not meet the federal program's requirements for ambulance services, the U.S. Attorney for the Eastern District of Pennsylvania said Monday. Bassem Kuran, who was the sole owner of VIP Ambulance Inc., applied to participate in Medicare in October 2011, soon after his previous employer, Brotherly Love Ambulance Inc. was shut down for the same type of fraud.
May 15, 2016
Q. How can I be certain I'm picking a good nursing home? A. The majority of people entering a nursing home are doing so from a hospital, with guidance from a discharge planner. That said, knowing about long-term care facilities in your area will help ensure that you or your loved one is going to the most appropriate one. The website Medicare.gov offers a "Nursing Home Compare" section, searchable by city and state, where you can find information about the ratings of a particular facility.
May 8, 2016 |
The University of Pennsylvania Health System agreed to pay $75,787 to resolve allegations that its home health unit, Penn Care at Home, submitted claims to Medicare for services not rendered and for services that were not reasonable or necessary, the United States Attorney for the Eastern Disctrict of Pennsylvania said Friday. As part of the settlement, which orginated in a whistle-blower lawsuit, the health system agreed to implement new compliance measures and to submit annual compliance reports through 2019.
April 9, 2016
By Peter Ubel Even before Obamacare became the law of the land, the U.S. health-care system was undergoing a dramatic transformation. Millions of people were shifting from generous health-insurance plans to consumer-directed ones that pair low monthly premiums with high out-of-pocket costs. This shift has been encouraged by employers eager to reduce the cost of employee benefits. It has also been encouraged by market enthusiasts who contend that the U.S. health-care system needs to be more like the traditional consumer economy.