Medicare

President Obama, struggling to discredit bogus charges that his healthcare overhaul would create "death panels," soon could face another emotionally charged obstacle -- a plan to trim the federal subsidy for a program used by nearly a quarter of Medicare beneficiaries. The program, known as Medicare Advantage, pays insurance companies a hefty premium to enroll senior citizens and provide their medical services through managed-care networks. But whether the higher payments are worth it is a matter of dispute.

Medicare's new prescription benefit will cover sexual performance drugs, like Viagra, in addition to medications for such ailments as high blood pressure and heart disease, program officials confirmed Monday. The move into what some consider "lifestyle" -- rather than life-saving -- pharmaceuticals is being criticized by conservatives, who see it as an unnecessary frill for a program that already is projected to cost at least $400 billion over its first decade.

The 1.4 million California seniors who belong to Medicare HMOs are getting more bang for their buck this year, reversing a two-year period during which benefits had eroded, according to a new study released today. "We're finally seeing some good news," says Dr. Mark Smith, president of the California Healthcare Foundation, an Oakland-based philanthropic group that along with Consumers Union produces the annual survey. "The past two years haven't been easy for seniors."

The new Medicare drug program is denying supplies that seriously ill patients need to administer intravenous antibiotics and other medications at home. As a result, some patients are being referred to nursing homes, and others have had to go into hospitals. Although no national estimates are available, the number of patients affected -- including some with life-threatening diseases such as cancer and multiple sclerosis -- could run into the thousands.

Federal investigators found scores of problems at UC Irvine Medical Center during a fall inspection that again put the troubled hospital's Medicare funding at risk, according to report released Thursday. In an 85-page report on their surprise October inspection, regulators said they observed poor oversight and mistakes by UCI doctors, nurses and pharmacists, leading to inadequate care that in some cases harmed patients. Among the findings: An 82-year-old man was mistakenly given a narcotic patch by a medical resident, without approval of doctors or pharmacists.

Doctors across California and in two other Western states are owed millions of dollars in backlogged Medicare reimbursements, leading some physicians to turn away elderly patients and pushing others to the brink of bankruptcy. In the most extreme cases, doctors have not been paid since February. Others are owed hundreds of thousands of dollars. Doctors who serve high numbers of Medicare patients say they are defaulting on rent, laying off staff and begging drug suppliers not to stop shipments.

A bill allowing Medicare to negotiate directly with prescription drug makers to get lower prices for senior citizens stalled in the Senate on Wednesday, but the setback is unlikely to be the last word on the issue. Allowing such negotiations won majority support, but the 55-42 vote was well short of the 60 needed to end debate and act on the legislation. Opponents, mostly Republicans, had warned that the bill would be the first step on a slippery slope toward government price controls.

The Mayo Clinic is no longer accepting some Medicare and Medicaid patients, raising new questions about whether it is too selective to serve as a model for healthcare reform. The White House has repeatedly praised Mayo and other medical centers, many of which are in the Upper Midwest, that perform well in Dartmouth College rankings showing wide disparities in how much hospitals spend on Medicare patients. The centers have capitalized on their status to insert into healthcare legislation provisions that would result in higher Medicare payments for hospitals that do well on the rankings, while punishing those elsewhere -- mostly in big cities and the South -- that spend the most per Medicare patient.

Fanning out through this city's old neighborhoods, doctors and nurses from a local medical center have adopted a practice that harks back to a bygone era: They're making house calls. Surprising as it may seem, this throwback approach may offer a path toward the elusive goal of providing better medical treatment at lower cost. And although the proposal has generated fewer fireworks than the proposed new government insurance plan, experts say it may help transform the nation's healthcare system.

For an ex-con fresh out of Chino State Prison, Donald Noyola seemed to be wildly exceeding expectations -- on paper, anyway. Noyola was listed as president, secretary and chief financial officer of Sycamore Medical Supply Co. in Los Angeles, a small firm so busy that it billed Medicare for more than $1.3 million in reimbursements over nine months last year, court records show.

Federal investigators found scores of problems at UC Irvine Medical Center during a fall inspection that again put the troubled hospital's Medicare funding at risk, according to report released Thursday. In an 85-page report on their surprise October inspection, regulators said they observed poor oversight and mistakes by UCI doctors, nurses and pharmacists, leading to inadequate care that in some cases harmed patients. Among the findings: An 82-year-old man was mistakenly given a narcotic patch by a medical resident, without approval of doctors or pharmacists.

Healthcare legislation Re "How Harry Reid threaded a needle," Dec. 24 As the Democrats and most people in the nation applaud the passage of the Healthcare Reform Act in the Senate, the man who deserves the lion's share of the credit is Senate Majority Leader Harry Reid (D-Nev.), who kept hope alive when almost everyone else gave up. First it was Sen. Joe Lieberman (I-Conn.) refusing to support the expansion of Medicare, which he had previously advocated, and then it was Sen. Ben Nelson (D-Neb.

Last week, Senate Democrats reached a tentative agreement on a proposal to help move the healthcare overhaul forward. Many details will become clear after the Congressional Budget Office provides estimates of the proposal's cost. Here is a look at what is known so far. Would this proposal replace the "public option" in the bill? The public option, a government-run health insurer that would compete with private companies, faced staunch opposition from Republicans and some Democratic moderates.

Last week, Senate Democrats reached a tentative agreement on a proposal to help move the healthcare overhaul forward. Many details will become clear after the Congressional Budget Office provides estimates of the proposal's cost. Here is a look at what is known so far. Would this proposal replace the "public option" in the bill? The public option, a government-run health insurer that would compete with private companies, faced staunch opposition from Republicans and some Democratic moderates.

California HMO Kaiser Permanente has agreed to pay $3.75 million to resolve allegations that several of its California units submitted false bills to the federal government for treatment of Medicare and Medi-Cal patients, officials announced Thursday. The U.S. attorney's office in San Francisco contended that from 1996 through 2002, Kaiser units in California submitted bills that falsely claimed treatment had been provided by teaching physicians. In fact, the government said, the care had been provided by unsupervised residents.

The state's largest doctors group is opposing healthcare legislation being debated in the U.S. Senate this week, saying it would increase local healthcare costs and restrict access to care for elderly and low-income patients. The California Medical Assn. represents more than 35,000 physicians, making it the second-largest state medical group in the country after Texas. Its executive committee met last week to discuss the Senate legislation proposed last month by Majority Leader Harry Reid (D-Nev.

Contained in the nearly 2,000-page House healthcare bill is a little-noticed provision -- worth $300 million to California -- that would increase federal Medicare payments to doctors in a wide swath of the state in response to complaints that low reimbursement rates have kept them from taking new patients. Rep. Sam Farr (D-Carmel) was able to include a reimbursement calculation fix in the overhaul legislation. It was a testament to California's political muscle in the House, where its delegation is the largest of any state and includes Speaker Nancy Pelosi (D- San Francisco)

Pressing to begin the Senate's landmark floor debate on healthcare legislation this week -- and to finish by the end of the year -- Majority Leader Harry Reid (D-Nev.) is considering new ways to fund the bill by raising the payroll taxes that upper-income workers pay for Medicare. Reid is studying the idea, senior Democratic aides say, because of criticism of a plan approved by the Senate Finance Committee that would impose new taxes on insurance companies that offer expensive healthcare plans.

With budget anxieties pervading the congressional healthcare debate, the Senate on Wednesday sidetracked popular legislation to increase Medicare payments to doctors by nearly $250 billion over the next decade. Voicing concern about adding that much money to the federal deficit, a coalition of 12 centrist Democrats, one independent and all the Senate's Republicans voted to block consideration of the bill, at least for now. The goal of the bill -- to overturn a scheduled 21% reduction in doctors' fees under Medicare -- enjoys broad bipartisan support.

Federal officials have charged 20 people with fraudulent Medicare billing in seven cases that total $26 million in unneeded or undelivered medical equipment, the U.S. attorney's office in Los Angeles said Wednesday. The charges came out of a joint investigation by the FBI, U.S. Department of Health and Human Services and California attorney general's office. A 30-year-old Long Beach man was arrested for allegedly recruiting relatives and members of the Brook Street Gang, based in Santa Ana, to act as owners for fake medical supply companies, which billed Medicare $11.2 million for unneeded wheelchairs and equipment.