Today’s Hot Topics in Medicare News

Researchers teach ‘machines’ to detect Medicare fraud

BY FLORIDA ATLANTIC UNIVERSITY: Using a highly sophisticated form of pattern matching, researchers from Florida Atlantic University’s College of Engineering and Computer Science are teaching “machines” to detect Medicare fraud. Medicare, the primary health care coverage for Americans 65 and older, accounts for 20 percent of health care spending in the United States. About $19 billion to $65 billion is lost every year because of Medicare fraud, waste or abuse.

Like the proverbial “needle in a haystack,” human auditors or investigators have the painstaking task of manually checking thousands of Medicare claims for specific patterns that could indicate foul play or fraudulent behaviors. Furthermore, according to the U.S. Department of Justice, right now fraud enforcement efforts rely heavily on health care professionals coming forward with information about Medicare fraud. (read more)

New Drug Pricing Model Could Save Medicare Part B $17.2 Billion

BY THOMAS BEATON: A new drug pricing model with an international component could save Medicare Part B approximately $17.2 billion over five years, CMS says.  

The International Pricing Index (IPI) will test if using drug price benchmarks other developed nations can encourage vendors to negotiate lower drug prices with pharmaceutical companies.  The framework also includes policies that hold vendors responsible for up-front drug costs and encourage vendors to negotiate prices with providers.

CMS estimates that Medicare drug spending increased by $17.6 billion from 2011 to 2016, a growth rate of 9.8 percent each year. The agency found that Medicare spent roughly 1.8 times more than similar public payer programs in other countries during this time. (read more)

Medicare Advantage’s Popularity Shows Americans Won’t Like Single-Payer

BY SALLY PIPES: Democrats hope their advocacy of single-payer health care will help them in the upcoming midterm elections. More than half the Democrats running for seats in the House back Medicare for All.

It remains to be seen if their embrace of government-run health care, where private coverage is banned for anything considered medically necessary, will prove a winner. Historically, Americans have favored privately-administered health plans, when they’ve had the choice. That’s even true for progressives’ favorite government program, Medicare itself. (read more)

Quick guide: Do you need Medicare supplemental insurance?

BY DARREN WILSON: You’ve worked your entire life. All of that work has led up to you reaping the benefits of the Medicare program. Given the rich history of this program that’s been around since 1965, those benefits seem like a sure thing.

Now, quickly approaching the ripe old age of 65, you’re almost ready to claim your Medicare benefits. Have you ever asked yourself just how far those benefits will take you? More specifically, have you ever asked yourself:

Do I need Medicare supplemental insurance? (read more)

What seniors need to know before enrolling in Medicare

BY AMBER HANKINS: Choosing a Medicare plan is one of the most important decisions a person can make not only for their well-being, but also for their wallet. And for most people, this is their only chance to make changes to their Medicare coverage for next year.

Charlotte MacBeth, CEO, UnitedHealthcare Medicare & Retirement in Indiana, explains more: 

1.    For seniors and other people enrolled in Medicare, why is annual enrollment so important?

o    If they don’t make an enrollment decision, they may be locked into their current plan next year. If anything has changed this year, either with their current plan, health status or budget, that decision to do nothing could lead to unpleasant surprises or missed cost-savings in 2019. (read more)

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