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Understanding D-SNPs: Separating fact from fiction in dual-eligible health coverage
Read full article: Understanding D-SNPs: Separating fact from fiction in dual-eligible health coverageDespite their growing popularity and effectiveness, there are still several myths and misconceptions about Dual Special Needs Plans.
Walz unveils Harris' plan for rural voters as campaign looks to cut into Trump's edge
Read full article: Walz unveils Harris' plan for rural voters as campaign looks to cut into Trump's edgeDemocratic vice presidential nominee Tim Walz unveiled his ticket’s plans to improve the lives of rural voters as Vice President Kamala Harris looks to cut into former President Donald Trump’s support.
In South Texas congressional race, Monica De La Cruz and Michelle Vallejo spar over health care
Read full article: In South Texas congressional race, Monica De La Cruz and Michelle Vallejo spar over health careThe topic is playing a major role in one of Texas’ only competitive congressional races this year as the competitors debate Medicare, abortion and expanding coverage.
Medicare Advantage shopping season arrives with a dose of confusion and some political implications
Read full article: Medicare Advantage shopping season arrives with a dose of confusion and some political implicationsThinner benefits and coverage changes await many older Americans shopping for health insurance this fall.
An appeals court has revived a challenge to President Biden's Medicare drug price reduction program
Read full article: An appeals court has revived a challenge to President Biden's Medicare drug price reduction programA constitutional challenge to the Biden administration program enabling Medicare to negotiate lower prices for prescription drugs has been revived by a federal appeals court.
Legal expert breaks down settlement involving 3 TMC institutions
Read full article: Legal expert breaks down settlement involving 3 TMC institutionsThree Texas Medical Center institutions have agreed to pay a record $15 million settlement to resolve claims they billed for concurrent heart surgeries in violation of Medicare teaching physician and informed consent regulations, the U.S. Attorney’s Office announced.Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM) and Surgical Associates of Texas P.A. (SAT) are the three institutions that have agreed to the settlement.Court records show an investigation into the intuitions and three of its surgeons began in August of 2019 when a whistleblower filed a complaint.“Well it became apparent looking at the document that there was a whistleblower who was inside, looking at the organization and seeing that these very prominent doctors were going from operating room to operating and even to another operating room and charging for doing the complete procedure when they could not have done the complete procedure, just from a pure time standpoint but they certified that they did those procedures and that’s what the government alleged, and whistleblower alleged,” said Attorney Randy SorrelsThose prominent surgeons named in court documents include Dr. Joseph Coselli, 71, Houston, and Dr. Joseph Lamelas, 63, Miami, Florida. SAT is a medical practice group affiliated with various cardiothoracic surgeons, including Dr. David Ott, 77, HoustonThe U.S. attorney’s office said the allegations also included the doctors delegating key aspects of extremely complicated and risky heart surgeries to unqualified medical residents.and failing to attend the surgical “timeout”— a critical moment where the entire team would pause and identify key risks to prevent surgical errors, according to the allegations,”“Yeah, These are some of the most well known heart surgeons in the country and so students would come to Baylor to learn from the very best, and they would be putting their hands literally inside the chest of patients. And you should have the attending physician there, But the allegations are as they weren't there and present at all times,” Sorrels said.Sorrels said it’s important that patients know, they can try and keep that from happening by advocating for themselves.What you want to do as a patient, especially before you go under anesthesia, is let it be known in the paperwork, Only the attending physician, the doctor that, you know, does the entire procedure,” said Sorrels.KPRC 2 also asked Sorrels if there’s anything that can be done if you’re a former patient and believe your life was put at risk.“Yeah, Texas law is not very patient friendly. The allegations were between 2013 and 2019. And Texas law requires you to bring a claim against a doctor within two years. So if you didn't bring your claim by 2021 at the latest, you can't bring a claim against any of these doctors or Baylor itself,” said Sorrels.Sorrels added that after examining the settlement it appears nobody would be criminally charged.“This $15 million payments is to settle all issues,” Sorrels said.
Record settlement reached over allegations Houston surgeons violated regulations during heart surgeries
Read full article: Record settlement reached over allegations Houston surgeons violated regulations during heart surgeriesThree Texas Medical Center institutions have agreed to pay $15 million to resolve claims they billed for concurrent heart surgeries in violation of Medicare teaching physician and informed consent regulations, the U.S. Attorney’s Office announced.
Lost chances to treat overdose survivors are documented in new Medicare study
Read full article: Lost chances to treat overdose survivors are documented in new Medicare studyPeople on Medicare who survived a drug overdose were much more likely to later receive opioid painkillers than any medication to treat addiction — and some went on to die of an overdose.
Can Medicare money protect doctors from abortion crimes? It worked before, desegregating hospitals
Read full article: Can Medicare money protect doctors from abortion crimes? It worked before, desegregating hospitalsThe Supreme Court's decision regarding Idaho's abortion ban may hinge on whether federal spending power can protect doctors against a state's criminal code.
Medicare and Social Security go-broke dates are pushed back in a 'measure of good news'
Read full article: Medicare and Social Security go-broke dates are pushed back in a 'measure of good news'The go-broke dates for benefit programs Medicare and Social Security have been pushed back as an improving economy has contributed to changed projected depletion dates, according to the annual Social Security and Medicare trustees report.
CVS Health chops 2024 forecast as cost struggles with Medicare Advantage persist
Read full article: CVS Health chops 2024 forecast as cost struggles with Medicare Advantage persistCVS Health missed first-quarter expectations and chopped its 2024 outlook more than a dollar below Wall Street’s forecast.
About 1 in 4 US adults 50 and older who aren't yet retired expect to never retire, AARP study finds
Read full article: About 1 in 4 US adults 50 and older who aren't yet retired expect to never retire, AARP study findsAbout one-quarter of U.S. adults age 50 and older who aren't yet retired say they expect to never retire and 70% are concerned about prices rising faster than their income.
Clinic owner at center of multi-million dollar fraud scheme in Houston area sent to prison
Read full article: Clinic owner at center of multi-million dollar fraud scheme in Houston area sent to prisonProsecutors say Gwendolyn Gibbs, 72, the owner of Daybreak Rehabilitation Center, submitted fake claims to Medicare from 2007 until 2016 by pretending her patients were sicker than they really were.
Biden sees a $35 price cap for insulin as a pivotal campaign issue. It’s not that clear-cut
Read full article: Biden sees a $35 price cap for insulin as a pivotal campaign issue. It’s not that clear-cutPresident Joe Biden frequently cites insulin prices as he promotes a $35 price cap for Americans with diabetes who are on Medicare.
Make the most out of your Medicare plan with these tips
Read full article: Make the most out of your Medicare plan with these tipsLast fall, you may have been amongst the millions of Americans who made choices about their Medicare coverage, but being proactive about your coverage in care doesn’t end after enrollment. Learn more some of the many ways that you can and should get more from your Medicare benefits.
‘Too good to be true’: Surprise packages could be a sign you’re a fraud victim
Read full article: ‘Too good to be true’: Surprise packages could be a sign you’re a fraud victimWhen packages you didn’t order arrive with your name on them, that is a red flag, especially if what’s inside is something medical-related. Amy Davis has the warning about fraud that is happening in the Houston area.
The federal debt tops $34 trillion and some in Congress want a commission to find ways to tackle it
Read full article: The federal debt tops $34 trillion and some in Congress want a commission to find ways to tackle itA bill to create a bipartisan commission that would tackle the nation’s soaring debt and make policy recommendations to Congress has won approval from a House committee.
United Memorial Medical Center to pay $2M for alleged false claims violations, double-billing for COVID tests
Read full article: United Memorial Medical Center to pay $2M for alleged false claims violations, double-billing for COVID testsUnited Memorial Medical Center has agreed to pay $2 million and to make additional contingent payments to resolve alleged False Claims Act violations, the United States Department of Justice announced Wednesday.
Texas among states to see Medicare Part D prescription increases
Read full article: Texas among states to see Medicare Part D prescription increasesTime is running out for retirees to select their plan during Medicare open enrollment. Depending on the plan, licensed insurance agent Jasmine Alberto said it may cost more.
Missouri City couple gets prison time for defrauding Medicare out of over $8M
Read full article: Missouri City couple gets prison time for defrauding Medicare out of over $8MA Missouri City couple and owners of a home health agency have received prison time for defrauding Medicare out of over $8 million.
The percentage of uninsured Texans in 2022 dropped to the lowest in a decade
Read full article: The percentage of uninsured Texans in 2022 dropped to the lowest in a decadeTexas is still the state with the highest percentage of uninsured residents, at nearly 17 percent, according to the most recent U.S. Census Bureau survey released Thursday.
Company in Harris County to pay $5.7M after submitting false claims to Medicare to receive travel reimbursements
Read full article: Company in Harris County to pay $5.7M after submitting false claims to Medicare to receive travel reimbursementsBestCare Laboratory Services LLC, will pay $5.7 million to settle an outstanding False Claims Act judgment after the company lied to Medicare to receive travel reimbursements, the United States Department of Justice said in a news release.
3 arrested in $142M genetic testing fraud scheme using Houston company; $7.1M in assets seized
Read full article: 3 arrested in $142M genetic testing fraud scheme using Houston company; $7.1M in assets seizedThe Office of the Attorney General’s Medicaid Fraud Control Unit has arrested three people associated with the genetic testing company ApolloMDx for their alleged involvement in a major healthcare fraud scheme to fraudulently bill Medicare approximately $142 million.
Looking to save money? You might qualify for free weatherization updates for your home
Read full article: Looking to save money? You might qualify for free weatherization updates for your homeWe are always looking for ways to save you money. The Texas summer heat means you are probably using more electricity to cool off your home. Viewer Don Conger emailed Investigator Amy Davis and said his utility bills are sky-high. He’s looking for a company that will do a home energy audit to show him things he can do in his home to conserve electricity.
Merck sues federal government, calling plan to negotiate Medicare drug prices extortion
Read full article: Merck sues federal government, calling plan to negotiate Medicare drug prices extortionMerck is suing the federal government over a plan to negotiate Medicare drug prices, calling the program a sham equivalent to extortion.
Richmond man sentenced to nearly 5 years in Medicare home health fraud scheme, agrees to pay back $1.4M in restitution
Read full article: Richmond man sentenced to nearly 5 years in Medicare home health fraud scheme, agrees to pay back $1.4M in restitutionA 47-year-old home health company owner has been sentenced to nearly five years in prison for a $1.4 million Medicare home health fraud scheme, the United States Department of Justice announced Tuesday.
Debt limit deal is in place, but budget deficit is still a multi-decade challenge for US government
Read full article: Debt limit deal is in place, but budget deficit is still a multi-decade challenge for US governmentEven with new spending restraints included in the congressional debt limit deal, the U.S. government’s deficits are still on course to keep climbing to record levels over the next few decades.
Biden says he's expanding some migrants' health care access
Read full article: Biden says he's expanding some migrants' health care accessPresident Joe Biden says his administration is expanding eligibility for Medicaid and the Affordable Care Act’s health insurance exchanges to hundreds of thousands of immigrants who were brought to the U.S. illegally as children.
Most oppose Social Security, Medicare cuts: AP-NORC poll
Read full article: Most oppose Social Security, Medicare cuts: AP-NORC pollAmericans are deeply opposed to cutting into Medicare or Social Security benefits, and most support raising taxes on the nation’s highest earners to keep Medicare running as is.
Medicare, Social Security could fall short over next decade
Read full article: Medicare, Social Security could fall short over next decadeAn annual report on Social Security and Medicare says the financial safety nets millions of older Americans rely on and millions more young people are counting on will run short on funds to pay full benefits within the next decade.
Poll: Cut federal spending — but not big-ticket programs
Read full article: Poll: Cut federal spending — but not big-ticket programsIn the federal budget standoff, the majority of U.S. adults are asking lawmakers to pull off the impossible: Cut the overall size of government, but also devote more money to the most popular and expensive programs.
Haley wants entitlement program changes for younger people
Read full article: Haley wants entitlement program changes for younger peopleRepublican presidential candidate Nikki Haley is proposing changes to entitlement programs for younger generations, opening the door to potential cuts to Social Security and Medicare if elected.
Sen. Rick Scott alters policy plan causing heartburn for GOP
Read full article: Sen. Rick Scott alters policy plan causing heartburn for GOPRepublican Sen. Rick Scott of Florida has amended a plan to overhaul how the federal government works after Democrats repeatedly seized on it to accuse Republicans of looking to cut Medicare and Social Security.
Biden warns of GOP plans for Medicare, Social Security cuts
Read full article: Biden warns of GOP plans for Medicare, Social Security cutsWhen President Joe Biden suggested that Republicans want to slash Medicare and Social Security it brought howls of protests from the GOP side of the aisle during the State of the Union address.
Millions to lose Medicaid coverage under Congress' plan
Read full article: Millions to lose Medicaid coverage under Congress' planMillions of people who enrolled in Medicaid during the COVID-19 pandemic could start to lose their insurance plans by April 1 if Congress passes the $1.7 trillion spending package leaders unveiled Tuesday.
Ask Amy show notes: New tricky ways thieves are targeting senior citizens
Read full article: Ask Amy show notes: New tricky ways thieves are targeting senior citizensThieves work overtime to target everyone, but especially our aging parents. From free health screenings to calls about medical devices or easy part time jobs - Jennifer Salazar, Executive Director of The Better Business Bureau Education Foundation, explains what you need to know to avoid falling victim.
Medicare enrollees warned about deceptive marketing schemes
Read full article: Medicare enrollees warned about deceptive marketing schemesWith Medicare’s open enrollment underway, health experts are warning older adults about an uptick in misleading marketing tactics that might lead some to sign up for Medicare Advantage plans that don’t cover their doctors or prescriptions and drive up their out-of-pocket costs.
Ask Amy: Medicare fraud warning signs
Read full article: Ask Amy: Medicare fraud warning signsIt’s the week a lot of people have been waiting for. Medicare open enrollment opens Saturday but with that, a warning about thieves using this time to target people. Amy Davis has what you should look out for!
Millions of Americans will save on Medicare fees next year
Read full article: Millions of Americans will save on Medicare fees next yearFor the first time in a decade, Americans will pay less next year on monthly premiums for Medicare’s Part B plan, which covers routine doctors’ visits and other outpatient care.
Ask Amy show notes: Medicare 101
Read full article: Ask Amy show notes: Medicare 101Whether you are helping a parent or you need it yourself - healthcare, as you get older, is a topic we get a lot of questions about. In this week’s episode, Amy Davis and Guest Alex Rischan from the Houston-Galveston Area Agency on Aging break down what we need to know about Medicare.
Ask Amy: How to get help figuring out the best healthcare coverage options as we age
Read full article: Ask Amy: How to get help figuring out the best healthcare coverage options as we ageTopic: healthcare coverage as we get older. You may need it or you might be helping a parent. Investigator Amy Davis gets answers to common questions about Medicare. Are those TV ads legit? Plus, learn how to apply for free help.
Houston woman sentenced to federal prison after creating bills for fake patients in $10M Medicare fraud scheme, DOJ says
Read full article: Houston woman sentenced to federal prison after creating bills for fake patients in $10M Medicare fraud scheme, DOJ saysA 59-year-old Houston woman has been sent to federal prison following her conviction of committing and conspiracy to commit health care fraud, the U.S. Attorney’s Office announced.
Medical company to pay $16M to resolve false billing claims
Read full article: Medical company to pay $16M to resolve false billing claimsA national medical testing company has agreed to pay $16 million to resolve allegations that it submitted claims for payment for medically unnecessary tests to federal health care programs.
Pharmacies can't discriminate on reproductive health scripts
Read full article: Pharmacies can't discriminate on reproductive health scriptsThe Biden administration is warning pharmacies not to discriminate against women who may seek reproductive health prescriptions, including some that might be involved in ending a pregnancy.
Go-broke dates pushed back for Social Security, Medicare
Read full article: Go-broke dates pushed back for Social Security, MedicareA stronger-than-expected economic recovery from the pandemic has pushed back the go-broke dates for Social Security and Medicare, but officials warn that the current economic turbulence is putting additional pressures on the bedrock retirement programs.
2 charged in $10M Medicare fraud, kickback scheme in Houston area: US Attorney
Read full article: 2 charged in $10M Medicare fraud, kickback scheme in Houston area: US AttorneyThe indictment alleges that from 2015 to 2022, the owner of Elitte Healthcare and Service Inc. billed Medicare for home health care services that were never provided and created false medical records.
Medicare weighs premium cut after limiting Alzheimer's drug
Read full article: Medicare weighs premium cut after limiting Alzheimer's drugMedicare says it’s considering a cut in enrollee premiums, after officials stuck with an earlier decision to sharply limit coverage for a pricey new Alzheimer’s drug projected to drive up program costs.
Missouri City couple, who owned Houston group home, convicted in $1 million Medicare fraud scheme: DOJ
Read full article: Missouri City couple, who owned Houston group home, convicted in $1 million Medicare fraud scheme: DOJA Missouri City couple, who owned a group home in Houston, was convicted by a federal jury for a $1 million Medicare fraud scheme, including violations of the federal Anti-Kickback Statute, according to the U.S. Department of Justice.
$56K Alzheimer’s drug avoiding Biden’s cost curbs, for now
Read full article: $56K Alzheimer’s drug avoiding Biden’s cost curbs, for nowA new $56,000-a-year Alzheimer’s medication that’s leading to one of the biggest increases ever in Medicare premiums is highlighting the limitations of President Joe Biden’s strategy for curbing prescription drug costs.
Sanders to Biden: Cut back looming Medicare premium hike
Read full article: Sanders to Biden: Cut back looming Medicare premium hikeSen. Bernie Sanders is asking the White House to cut back a big Medicare premium hike set to take effect in weeks and tied to a pricey Alzheimer’s drug whose benefits have been widely questioned.
Cap on drug price hikes for privately insured sparks battle
Read full article: Cap on drug price hikes for privately insured sparks battleWorkers and families with private health insurance would reap savings on prescription drugs from a little-noticed provision in President Joe Biden's social agenda bill.
2 Houston-area doctors forced to pay more than $170M for abusing Medicare billing system, U.S. District Attorney says
Read full article: 2 Houston-area doctors forced to pay more than $170M for abusing Medicare billing system, U.S. District Attorney saysTwo Houston-area ophthalmologists were penalized for abusing the Medicare system by overcharging for glaucoma treatment, the U.S. District Attorney’s Office says.
Real Medicare drug savings in Dems' bill — but not overnight
Read full article: Real Medicare drug savings in Dems' bill — but not overnightMedicare enrollees who take expensive medicines could save thousands of dollars a year under the Democrats’ sweeping social agenda bill, but those dividends won’t come overnight.
Democrats reach drug price deal, Biden upbeat on Manchin
Read full article: Democrats reach drug price deal, Biden upbeat on ManchinDemocrats say they have sealed a deal to lower pharmaceutical drug costs for most older Americans as part of President Joe Biden’s sweeping $1.75 trillion domestic proposal.
Paid leave, immigration, tax changes added to Biden bill
Read full article: Paid leave, immigration, tax changes added to Biden billHouse Democrats have added paid family and medical leave, immigration law changes and a state-and-local tax break to their $1.75 trillion social services and environmental bill.
Dems see progress in adding drug cost curbs to budget bill
Read full article: Dems see progress in adding drug cost curbs to budget billTwo congressional aides say Democrats have made significant progress on adding compromise provisions curbing prescription drug prices to their massive social and environment package.
Medicaid issues, not Medicare's, get fixes in Biden budget
Read full article: Medicaid issues, not Medicare's, get fixes in Biden budgetMedicaid issues are turning up as winners in President Joe Biden’s social budget framework even as divisions force Democrats to hit pause on far-reaching improvements to Medicare.
New Medicare Advantage plans raise plenty of questions. Here are a bunch of answers.
Read full article: New Medicare Advantage plans raise plenty of questions. Here are a bunch of answers.Since plans and benefits change every year -- and there are so many options -- it makes sense to know what’s out there and what to look for.
Texas nursing homes turn to state for help with staffing woes as vaccine mandate looms
Read full article: Texas nursing homes turn to state for help with staffing woes as vaccine mandate loomsAbout 40% of Texas nursing home workers are unvaccinated and could face dismissal or quit their jobs under a federal vaccination requirement for the industry.
Agonizing choices as Dems debate shrinking health care pie
Read full article: Agonizing choices as Dems debate shrinking health care pieDemocrats are fretting about how they’d divide a shrinking pie amid signs that negotiations over President Joe Biden’s massive domestic policy bill could yield a smaller serving of health care spending.
COVID recession pushed Social Security insolvency up a year
Read full article: COVID recession pushed Social Security insolvency up a yearThe sharp shock of the coronavirus recession pushed Social Security a year closer to insolvency but left Medicare’s exhaustion date unchanged, the government reported Tuesday.
As COVID rises, a vexing hunt for nursing home vaccine stats
Read full article: As COVID rises, a vexing hunt for nursing home vaccine statsWith COVID-19 on the rise again and many nursing home staffers unvaccinated, families still lack easy access to crucial Medicare immunization data that will help them pick the right facility for their loved one.