First Edition: August 18, 2014

Today's headlines stories about the pervasive nature of Medicare fraud and the difficulties involved in fighting it.

Kaiser Health News: Hospitals Reconsider Charity For Patients Who Decline Health Coverage
Kaiser Health News staff writer Julie Appleby reports: "As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn't. The move is prompted by concerns that offering free or discounted care to low-income uninsured patients might dissuade them from getting government-subsidized coverage" (Appleby, 8/18). Read the story, which also appeared in The Washington Post.

Kaiser Health News: In Study, Questions About Who Should Perform In-Office Surgeries
Kaiser Health News staff writer Shefali Luthra reports: "One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation's shortage of primary care providers. But a new study questions whether that's actually happening in doctors' offices. Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for dermatological surgeries" (Luthra, 8/18). Read the story. 

Letters To The Editor: Searching For 'Big Ideas'; Patients Soliciting Bids For Care Online; Training Doctors
Read this a Kaiser Health News regular feature in which readers respond to KHN original stories (8/15). Check out the comments. 

The Associated Press: Have Insurers Found New Ways To Avoid The Sick?
Ending insurance discrimination against the sick was a central goal of the nation's health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers.The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors. ... Coverage of expensive drugs tops [the patients'] concerns. (Alonso-Zaldivar, 8/17).

The New York Times: Medicare To Start Paying Doctors Who Coordinate Needs Of Chronically Ill Patients 
In a policy change, the Obama administration is planning to pay doctors to coordinate the care of Medicare beneficiaries, amid growing evidence that patients with chronic illnesses suffer from disjointed, fragmented care. Although doctors have often performed such work between office visits by patients, they have historically not been paid for it. Starting in January, Medicare will pay monthly fees to doctors who manage care for patients with two or more chronic conditions like heart disease, diabetes and depression (Pear, 8/16).

The Associated Press: Governors Tout Benefits Of Medicaid Expansion
Three governors who expanded Medicaid under the federal health care overhaul said Saturday there are economic and moral arguments for embracing a key part of the law, despite strong political opposition in their southern states. The Democratic governors of Arkansas, Kentucky and Maryland touted the success their states have seen in cutting the number of uninsured residents during a panel discussion at the Southern Governors' Association annual meeting in downtown Little Rock. Arkansas and Kentucky had the highest drop in the number of uninsured residents in a Gallup poll released earlier this month (DeMillo, 8/16).

NPR: Has Health Law Helped Young People Get Mental Health Treatment? Maybe
A popular provision of the Affordable Care Act that took effect in 2010 aimed to make it easier for young adults to get access to health care, by allowing them to stay on their parents' insurance until they turn 26. So, are more young adults getting help with mental health issues because of the provision? Maybe, suggests a study published in the September issue of Health Affairs. Before 2010, just over 30 percent of young adults with mental health issues said they were getting treatment. And that went up by about 2 percent in the two years after the ACA provision took effect (Singh, 8/15).

The New York Times: Pervasive Medicare Fraud Proves Hard To Stop
The Obama administration's declared war on health care fraud, costing some $600 million a year, has a remarkable new look in places like Baltimore and Miami. But even with the fancy computers and expert teams, the government is not close to defeating the fraudsters. And even the effort designed to combat the fraud may be in large part to blame. An array of outside contractors used by the government is poorly managed, rife with conflicts of interest and vulnerable to political winds (Abelson and Lichtblau, 8/15).

The Washington Post: A Medicare Scam That Just Kept Rolling
The wheelchair scam was designed to exploit blind spots in Medicare, which often pays insurance claims without checking them first. Criminals disguised themselves as medical-supply companies. They ginned up bogus bills, saying they'd provided expensive wheelchairs to Medicare patients -; who, in reality, didn't need wheelchairs at all. Then the scammers asked Medicare to pay them back, so they could pocket the huge markup that the government paid on each chair. A lot of the time, Medicare was fooled. The government paid (Fahrenthold, 8/16).

USA Today: 5 Reasons Health Insurance Didn't Pay Your Bill
How many times have you gotten a medical bill for more than you were expecting? Chances are, it's happened before, and you're not the only one who's been shocked at the price tag on a service that your insurance should have covered. Here are five possible reasons ... 1. Your insurance company made an error. ... 2. Your provider "accepts your insurance" -; but isn't in your plan's network. ... 3. Your free annual examination wasn't billed as a free exam. ... 4. Your insurance company practices "bundling." .... 5. There's missing information (Flynn, 8/17).

The Washington Post: A $10,000 Blood Test?!? Yes, Really.
Imagine walking into a hospital and being charged more than $10,000 for a blood test to check your cholesterol level. And going to another hospital in the same state and being charged $10 for the exact same blood test. That's what a team led by a University of California San Francisco researcher found when it looked at the prices California hospitals charge for 10 common blood tests (Sun, 8/15).

The Washington Post: Veterans Group: VA Secretary Has 'Already Gone Native With The VA Bureaucracy'
VA Secretary Robert McDonald said Thursday that the agency is working as fast as it can to remove bad workers under a new law that gives the VA greater authority to fire senior executives, but he added that the employees are entitled to due process. He declined to say how many employees the VA has disciplined or identify any of the individuals. Federal law restricts what an agency can say about such matters (Hicks, 8/15).

The Wall Street Journal: Pfizer Is Liable For Harm Caused By A Generic Version Of Its Drug: Court
Should brand-name drug makers be held liable if consumers are harmed by a medicine made by a generic rival? The Alabama Supreme Court believes the answer is yes. And the court has upheld its own controversial ruling that Pfizer can be sued by an Alabama man who claimed he was injured by a generic version of its Reglan heartburn medicine. Why? The brand-name drug maker purportedly failed to warn his physician about the risks. The decision is potentially significant, because this is one of the few cases in which a court has found that a brand-name drug maker can be sued, even though a consumer had taken only the generic version (Silverman, 8/15).

The New York Times: Hospitals In The U.S. Get Ready For Ebola
Hospitals nationwide are hustling to prepare for the first traveler from West Africa who arrives in the emergency room with symptoms of infection with the Ebola virus. Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, has said such a case is inevitable in the United States, and the agency this month issued the first extensive guidelines for hospitals on how recognize and treat Ebola patients. The recommendations touch on everything from the safe handling of lab specimens to effective isolation of suspected Ebola patients. But one piece of advice in particular has roused opposition from worried hospital administrators (Saint Louis, 8/15).

Los Angeles Times: Healthcare Chain's Bid For 6 Hospitals Draws Protest
Prime Healthcare Services Inc., a hospital chain that has come under fire for billing and patient privacy issues, is facing opposition over its potential acquisition of six California hospitals, including two medical centers in Los Angeles County. On Friday, hospital workers, union representatives and elected officials protested against Prime outside St. Vincent Medical Center near downtown Los Angeles, one of the six hospitals put up for sale this year by the Daughters of Charity Health System (Garland, 8/15).