Medicare

Congress approved a $3-trillion spending plan that proposes modest increases for domestic programs such as education, energy and veterans benefits -- and marks the first time in eight years that lawmakers have managed to adopt a budget in an election year. Democrats hailed the feat as a demonstration of their ability to govern. Republicans acknowledged the accomplishment but blasted Democrats for raising spending on government agencies to historic levels and for failing to slow the growth of Social Security, Medicaid and Medicare.

Insurance companies often fail to properly reimburse doctors, needlessly adding more than $200 billion a year to the nation's healthcare tab, the American Medical Assn. said Monday. An analysis of 3 million medical claims over a six-month period beginning in October also found that doctors in the U.S. spend 14% of the fees they receive from insurers and Medicare on the process of collecting those fees, the AMA said in a report issued at its annual meeting in Chicago.

The Bush administration said it would put in place a rating system for nursing homes by the end of the year. It's designed to give consumers another tool to consider when shopping for a nursing home. The ratings would be placed on a government website. The Centers for Medicare and Medicaid Services said it would seek comment from the industry and consumers to determine what criteria to use. Federal officials also unveiled new regulations that would require all nursing homes to have sprinkler systems by 2013.

The government is putting millions of Medicare dollars at risk by authorizing fictitious sellers of wheelchairs, prosthetics and other medical supplies to submit reimbursement claims with only limited review, congressional investigators say. A Government Accountability Office study, obtained by the Associated Press, sought to follow up on oversight gaps that have plagued the Centers for Medicare & Medicaid Services since at least 2005.

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.

The government paid more than $1 billion in questionable Medicare claims for medical supplies that showed little relation to patients' conditions, including blood glucose strips for sexual impotence and special diabetic shoes for leg amputees, congressional investigators say. Billions more in taxpayer dollars may have been wasted over the last decade because the government-run health program for the elderly and disabled paid out claims with blank or invalid diagnosis codes, such as a "?"

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.

www.cahealthadvocates.org If you're among the 4 million Californians on Medicare, understanding your coverage can benefit your body and your wallet. Medicare, the federal health insurance program for those over age 64 and the disabled, can help pay many doctor and hospital bills, but it also comes with significant limitations. The website of California Health Advocates, a Sacramento-based nonprofit group, aims to guide Californians through the Medicare maze.

The new Democratic majority in the House is expected to pass a bill today that directs Medicare to negotiate lower drug prices for 23 million seniors, setting up a clash with President Bush that could help determine the direction of changes in healthcare -- whether the government plays a major role or relies on private enterprise. The prescription drug bill repeals a Republican-approved ban on letting the government negotiate with manufacturers for lower prices.

Federal regulators have delayed pulling Medicare funding from two small heart transplant programs, stepping back from a move that they had said was meant to signal a crackdown on centers that didn't meet their standards. The U.S. Centers for Medicare and Medicaid Services said Wake Forest University Baptist Medical Center in Winston-Salem, N.C., and Montefiore Medical Center in New York were submitting corrective plans, which the agency needed to review.