December 15, 2019 Recent News




There is an article describing how those with Medicare Part C who want to switch to Part A and B may have a problem.  There is no problem with Part A but Part B plans do not have to take you or if they do it can be with higher premiums.  This is true in all but four states.  The only guaranteed time to get into Part B at the published rates is within the first 12 months of turning 65.  

The OIG is recovering almost $6 Billion this year in fraudulent payments.  A small amount is from audits and the rest from investigations.  

There is a major problem in the Rhode Island EMS.  Apparently there have been at least 11 patients that received erroneous esophageal intubations in the field and all had died.  This is the only New England state that allowed non-paramedics to intubate in the field.  The firefighters union fought back saying they were the experts not the physicians.  This was also the only New England state where 911 operators are not allowed to provide guidance over the phone on how to perform CPR.  That changed after a death of a 6 month old.  However the state EMS is run by the firefighters and they are not willing to change the rules to the detriment of their constituents.  

UnitedHealth is instituting a policy that will not pay for outpatient surgery performed in hospital outpatient departments unless it is pre-approved.  They want surgery in the cheaper more efficient ambulatory surgical centers.

The HHS IG office is raising concerns about Medicare Advantage plans adding diagnosis to patients records with no medical back-up.  They also delete incorrect diagnosis less than 1% of the time.,  This has cost we taxpayers and additional $7 Billion.          Top


The FBI is looking into Texas Newark Beth Israel Medical Center's transplant program.  They are trying to determine if the center committed fraud by keeping a transplant patient in a PVS alive on life support for the sake of boosting its survival rate is fraud.  They kept a brain dead woman alive for one year and the staff was directed not to discuss hospice or other arrangements until after the one year post transplant anniversary.  There is a possibility that they did this with others as well.  

The Pennsylvania Department of Health shut down inpatient and ED admissions at the Ellwood City Medical Center.  The hospital has not fully paid their personnel either.  They are also behind in their taxes and utility payments.  

The Children's Hospital in Dallas has a mold problem that was found on routine air testing.  They have had no known infections but moved some patients to be sure.  Smart after what has happened at the Seattle Children's Hospital.

A new expose says that the VA has improperly cancelled thousands of orders for diagnostic tests.  They are cancelled since they could otherwise be considered delayed and count against them.        Top


 DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.