Medicare

Defying a threatened presidential veto, the House approved a bill Friday to require federal officials to negotiate with drug companies for lower prices for the 23 million senior citizens who have signed up for Medicare's prescription drug coverage. Although the bill is unlikely to become law, it is likely to help shape the debate that could result in a more limited measure that allows some dickering between the government and the pharmaceutical industry over drug costs.

Garden Grove resident In Sook Yeo was stunned last August when her Medicare prescription drug benefits were denied by her local pharmacist. Soon after, she received a letter from the state regarding her death. Her husband, Woon Seung Yeo, had recently passed away after suffering heart problems for years. But through a bureaucratic mix-up, Medicare listed In Sook Yeo as the deceased. "How can this be?" recalled Yeo, 76. "You have no idea how many tears I shed. It was too much for me to bear."

The federal government has notified four more heart transplant programs, including one in California, that their federal funding may be pulled because they performed too few transplants in recent years to remain proficient. Slated to lose their Medicare certification in 30 days are programs at Sutter Memorial Hospital in Sacramento, Hartford Hospital in Connecticut, Washington Hospital Center in Washington, D.C., and BryanLGH Medical Center East in Lincoln, Neb.

The budget President Bush proposed Monday calls for the deepest Medicare cuts of his six years in office and falls short in expanding health coverage to uninsured children -- a top priority for congressional Democrats this year. Health and Human Services Secretary Mike Leavitt acknowledged the budget's austere tone, but said action was needed to rein in programs growing at an unsustainable pace.

Nine doctors, six healthcare administrators and three associates were indicted Wednesday in a scam in which doughnuts, candy and other gifts were used to lure elderly and mentally ill patients into more than $12 million worth of unnecessary respiratory treatments that were fraudulently billed to Medicare, federal officials said. The alleged insurance scheme is outlined in two separate indictments handed up by a federal grand jury in Santa Ana.

At least one company that administers Medicare plans has decided to stop paying for the use of Amgen Inc.'s drug Aranesp to treat a certain type of anemia, citing safety concerns. Noridian Administrative Services, which administers Medicare plans in several states including Oregon and Washington, will no longer pay for Aranesp's use in anemia of cancer, medical director William Mangold said Monday.

In response to concerns that some babies may be missing out on essential healthcare, a federal agency said it would issue a rule allowing infants of noncitizens to receive services covered through Medicaid. Newborns of Medicaid beneficiaries had been deemed automatically eligible for the healthcare program during their first year as long as the mother remained eligible.

From the day the new Medicare drug plan was introduced, critics warned that it had a big loophole -- the "doughnut hole" -- a coverage gap that leaves some recipients with $3,000 in costs to pick up themselves. The private sector was supposed to help. And last year, Sierra Health Services, an insurer based in Las Vegas, announced it would do so. In exchange for higher monthly premiums, Sierra offered comprehensive coverage of brand-name medications for patients who had to fill the cost gap.

Tenet Healthcare Corp. agreed to pay a $10-million penalty to settle Securities and Exchange Commission charges that it inflated its earnings by fraudulently billing the Medicare system, company and federal officials announced Monday. The accord closes the book on government actions against the nation's second-largest hospital operator related to its alleged Medicare fraud, which took place while it was based in Santa Barbara.

Democrats will renew efforts to let the government negotiate drug prices on behalf of Medicare participants, Senate Majority Leader Harry Reid said Tuesday. Reid (D-Nev.) said the Senate would turn its attention to the new drug benefit once it finished with a bill that would loosen federal funding restrictions on stem cell research.