Medicare confronts issues with prescription drug program and medical equipment purchases

Healthwatch: "Sen. Tom Carper (D-Del.) on Tuesday blasted the Medicare agency for what he considers an inadequate response to his concerns about the prescription-drug program's integrity. … Carper wrote to the Centers for Medicare and Medicaid Services on July 29 and requested the agency establish a process to ensure valid identification numbers on reimbursed prescriptions under the Part D program. The law requires the identification numbers to ensure drugs are being prescribed by legitimate health professionals, but an audit by the Health and Human Services Office of Inspector General found that $1.2 billion in reimbursements in 2007 — representing more than 18 million claims — contained invalid prescriber identification. … CMS said it would begin a prescriber identification project this month, while also allowing some prescriptions with wrong identifiers to go forward to avoid penalizing patients" (Pecquet, 9/14).

Congress Daily: "Two years after Congress stepped in to stop a flawed Medicare competitive bidding program for durable medical equipment, GAO is expected to tell a House committee today that HHS has improved the bidding process. But medical equipment firms and hospitals are warning lawmakers that the program will have an adverse impact on businesses, jobs and patients. … CMS now pays for durable medical equipment, which includes hospital beds, walkers and wheelchairs, on a fee schedule based on 1986 prices that are adjusted for inflation. GAO and the HHS inspector general have found that this payment system leads Medicare to overpay for equipment, sometimes by an estimated three to four times over retail cost" (McCarthy, 9/15).

U.S. News & World Report: "If you plan to sign up for a Medicare Advantage plan in retirement, the state you retire in could make a big difference in the quality of services you receive. The Centers for Medicare and Medicaid Services rates Medicare Advantage plans on a scale of 1 to 5 stars, with 5 being the highest rating. Medicare Advantage plans received an average of 3.32 stars in 2010. The average state-wide quality rating for Medicare Advantage plans ranges from 4 or more stars in Massachusetts and Minnesota to 2.5 stars in Alaska, Delaware, and Vermont, according to a new Kaiser Family Foundation analysis. … The majority of Medicare Advantage recipients are not currently enrolled in a highly-rated plan" (Brandon, 9/14). (Kaiser Health News is a project of the Kaiser Family Foundation.)

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.