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Secure Horizons, the nation's largest Medicare HMO, said Thursday it will freeze membership next year in 41 counties nationwide, most of them in California. The announcement that new members will not be accepted in 24 California counties, among them Riverside, San Bernardino, Santa Barbara, Kern, Alameda and Contra Costa, came as Secure Horizons' parent company reported disappointing results for the third quarter, though they beat estimates. Santa Ana-based PacifiCare Health Systems Inc.
April 13, 2014
Re "How Medicare pays MDs," Editorial, April 10 It's wrong to blame physicians for Medicare's fiscal woes. Doing away with fee-for-service as a way to "reward quality and efficiency" is unworkable. The federal government could never figure that out. The small, shriveled carrot it would offer as the "reward" would be an insult to the medical profession. Medicare's problems, as evidenced by the testimony of physicians fingered in the recent revelations, have to do with outrageous drug, laboratory and facility charges.
January 19, 2006 | Michael Hiltzik
One recent afternoon in Los Alamitos, I watched Marcy Zwelling-Aamot, M.D., pick her way through a government website designed to help elderly patients select the right Medicare drug plan, based on their prescription needs and hometown. The website, created for the launch of Medicare's new prescription drug benefit, identified 48 individual plans available for Southern California residents.
April 11, 2014
Re "Medicare lifts the veil on payments," April 9 Wednesday's news that Medicare is making public Part B payments to doctors received mixed reviews. That's to be expected when healthcare's economic black box is pried open. Sadly, one doctor's full scope of competent and caring services may result in unusually high reimbursement compared to his or her peers. And just as easily, one doctor's modest billings to Medicare could contain a disproportionate share of fraud. Publishing the numbers doctor by doctor doesn't tell the complete story; it's not holistic because it focuses on only one area of medicine, Medicare Part B. But it's a start.
August 23, 2013 | By Lisa Zamosky
After an outpatient procedure last summer, Sidney Fallender was expecting to go straight home. But when two nurses tried to get the 93-year-old Sherman Oaks resident on his feet, they discovered he was unable to walk on his own. "The doctor told her assistant to call the paramedics," Fallender recalled. He was taken to Cedars-Sinai Medical Center by ambulance, less than a mile from his doctor's office, for possible emergency surgery. "A couple of weeks later I got a bill for the ambulance service in the amount of almost $1,000," he says.
August 13, 2012 | David Lazarus
We've been hearing - and will continue to hear - a lot about how Paul Ryan's plan to overhaul Medicare and Medicaid would cripple the safety-net healthcare programs. Fair criticism? The answer, as Bill Clinton might say, depends on what your definition of "cripple" is. The Ryan plan has been around for months. It's taken on new heft since Ryan, a conservative congressman from Wisconsin, was tapped over the weekend by Republican presidential candidate Mitt Romney to be his running mate.
October 26, 1995
Medicare is like Humpty Dumpty. If the Republicans push it, we will never be able to put it together again! BOB MORGAN Van Nuys
August 24, 2012
Re "Ryan plan may hurt disabled the most," Column, Aug. 21 Without Medicare, those of us who have pre-existing conditions will have difficulty getting health insurance. After we lost coverage because of a layoff, Blue Shield, which was at the time one of the three companies in California's program for high-risk patients, would not insure my husband because he has acid reflux and takes medication for it. I was turned down because I was a six-year cancer survivor. Apparently, Blue Shield forgot it was part of the high-risk program.
August 30, 2012
Re "It's Medicare vs. the economy," Opinion, Aug. 26 Doyle McManus says that neither the GOP nor the Democrats wants to focus on saving money from Medicare, and that for candidates it's a choice of either talking about Medicare or the economy. With Mitt Romney's choice of Paul Ryan as his running mate, the GOP ticket has boldly opened up a national discussion on Medicare and entitlement reform. Democrats can try to frighten and demonize Romney's and Ryan's ideas, but at least they are taking a leadership position that is totally lacking from the president and the Senate.
November 30, 2011 | By Melissa Healy, Los Angeles Times/For the Booster Shots blog
Medicare, the nation's medical safety net for seniors, on Wednesday announced it would extend its coverage for obesity screening and "intensive behavioral therapy," ensuring that roughly 30% of the 42 million people insured by the program can undertake a weight-loss program supervised by their doctor. The decision by the federal government to cover face-to-face doctor visits as an aid to weight loss is likely to prod private insurers, many of whom have been reluctant to cover medically supervised obesity treatments, to follow suit.
April 10, 2014 | By The Times editorial board
The news that a small percentage of the country's physicians collected billions of dollars from Medicare in a single year may or may not be a testament to individual greed; some of the top recipients are under investigation for allegedly bilking the system, while others work long hours delivering costly care. But it is a powerful reminder that the program needs to stop rewarding doctors for the quantity of care they deliver rather than the quality. Happily, there's a bipartisan plan to do just that; unhappily, lawmakers haven't been able to agree on how to cover its cost.
April 9, 2014 | By Chad Terhune and Doug Smith
Newport Beach oncologist Minh Nguyen woke up Wednesday wearing a dubious distinction: Medicare's highest-paid doctor in California and one of the top physicians nationwide. Some of his patients and fellow physicians immediately called him wanting an explanation of why newly released federal data show he got paid $11.3 million for treating Medicare patients in 2012. Like dozens of other doctors across the country, Nguyen was unwittingly thrust into the spotlight as federal officials listed for the first time what the government pays individual doctors to treat elderly Americans.
April 2, 2014
Re "Bickering over Medicare ," Editorial, March 27 Your assertion that the Medicare sustainable growth rate, or SGR, represents only "paper savings" is not supported by the actual history of the SGR and "doc fixes" enacted by Congress. Though it is true that most SGR cuts have not gone into effect as scheduled, the SGR has actually done a great deal to control healthcare costs by keeping physician payment updates modest and pushing policymakers to offset the cost of avoiding cuts.
April 1, 2014 | By Lisa Mascaro
WASHINGTON -- House Republicans will revive Rep. Paul Ryan's lightning-rod proposals to slash the federal safety net, beef up military spending and reduce taxes for the wealthy in a budget unveiled Tuesday -- an election-year calling card that Democrats are poised to use against the GOP. The blueprint from Ryan, the party's former vice presidential nominee, is expected to be met with stiff opposition not only from Democrats, but also from hard-line...
March 28, 2014 | By Michael Hiltzik
Let's acknowledge at the top that Abby Huntsman, one of the four anchors of MSNBC's youth-oriented news show "The Cycle," has taken on an ambitious task for herself: She's been trying to discuss U.S. fiscal policy, which is chock full of complicated concepts, in her allotted snippets of 3 1/2 minutes at a time. Under the circumstances, it's not surprising that some of these concepts get the once-over-lightly treatment. That's not bad in itself, and kudos to Huntsman for even trying.
March 27, 2014 | By The Times editorial board
Maybe it was too good to be true. A rare bipartisan healthcare reform proposal backed by leaders of three major House and Senate committees is foundering because Republicans and Democrats can't agree on how to pay for it. The irony is that the measure, which would change the way Medicare reimburses doctors, would slow the growth of healthcare spending and taxpayers' costs. Lawmakers should stop the partisan bickering and start working in good faith to find a way to enact the long-overdue and much-needed reform.
November 18, 2009 | By Richard Simon
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)
March 26, 2014 | By Michael Hiltzik
A big part of the argument made by enemies of the Affordable Care Act that the Act is hurting Medicare applies to a category of health plan known as Medicare Advantage. New evidence has just come in showing that Medicare Advantage is a ripoff that fattens the health insurance industry while scarcely helping its enrollees , all at public expense. Medicare Advantage plans differ from traditional Medicare by offering its enrollees ostensibly better care and sometimes broader services--free eyeglasses, even gym memberships--in return for reimbursements from the government that are 14% higher than traditional Medicare reimbursements, or more.
March 20, 2014 | By Soumya Karlamangla
Federal investigators say one of Medicare's most wanted fugitives , who was convicted in a $20-million fraud case, may be hiding out in the Los Angeles area. Authorities say Nuritsa Grigoryan fled last month after being found guilty for her role at a Glendale clinic where she was accused of posing as a doctor and writing prescriptions for pricey anti-psychotic medications. Investigators with the U.S. Department of Health and Human Services say the clinic often recruited homeless patients, used their information to bill Medicare and Medi-Cal for the drugs, and then resold the medications, such as Abilify, to rake in even more money.
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