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Billions Paid in Medicare Suspect Claims

The National Center for Policy Analysis reports that billions of taxpayer dollars have gone to waste because Medicare has paid out claims with blank or invalid diagnosis codes over the past decade according to a new Senate report.

Claims for wheelchairs, drugs, and other medical supplies of Medicare patients were reviewed from 2001 to 2006. During these years, they found at least $1 billion of medical equipment which listed diagnosis codes that had little or no connection to the reimbursed medical items. Here are some findings from the report:

• Medicare paid millions of dollars to medical suppliers for blood glucose test strips -- used exclusively for diabetics -- based on non-diabetic diagnoses.
  
• Roughly $4.8 billion in payments were made from 1995 to 2006 despite invalid coding or nothing listed at all; about $23 million of that amount was paid after 2003, when federal rules made clear the codes were required.
• Based on a sample of 2,000 of those invalid coding claims, investigators found more than 30 percent could not be verified as legitimate and "bore characteristics of fraudulent activity."
• Federal regulations require that Centers for Medicare and Medicaid Services (CMS) pay only for items that are deemed "medically necessary," yet, CMS does not examine diagnosis codes to determine whether the equipment is actually necessary before making payment.
• Only 3 percent of claims are reviewed after payment is made.
  

Sources:
http://hsgac.senate.gov/public/
http://townhall.com/news/us/2008/09/24/probe_medicare_paid_billions_in_suspect_claims

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Numbers of uninsured dropped

In a recent report released by the census bureau, they state that the number of uninsured has decreased 3.2% to 45.7 million, which is 15.3% of the population. According to this article here at Modern Healthcare, authorities state that the reasons why uninsured numbers have decreased is still unknown. The number of uninsured children has dropped as well to 8.1 million, down from 8.7 million in 2007 which is a 6.9% drop.

New Drug to Help Blood Clotting is Approved

The NY Times reports regulators have approved Amgen’s new drug called Nplate, which treats a rare blood clotting disorder that affects about 140,000 people. The disorder causes the body to attack platelets, which are tiny components that help with blood clotting. The drug will encourage platelet production by stimulating patient’s bone marrow.

There are some risks to taking the drug so regulators will require all patients to enroll in a long-term safety study. Some patients who have enrolled in the study have developed leukemia due to bone-marrow abnormalities. More studies will need to be done though to determine whether the development of leukemia may relate to the use of Nplate.

Measles outbreaks are at alarming levels

According to a news report at ABC, measles infections are at their highest level in a decade. So far there have been 131 cases this year in the United States as opposed to 42 cases throughout the entire last year. Over half of those infected are children who did not receive the vaccine. Also alarming is the number of outbreaks, in a normal year there is one in the United States. This year, as of July 30, there have been seven outbreaks. The reason for the rising number of children not receiving the shots is because of the fear that the immunization leads to autism in some children.

Fruit Juice Can Reduce Effectiveness of Drugs

BBC News reports findings discussed in a recent US event suggest that fruit juice could reduce the effectiveness of some medicines, including anti-allergy drugs. Grapefruit, orange, and apple juice are said to contain ingredients that interfere with the effectiveness of medication.

Researchers discovered that grapefruit juice especially had a reverse effect to fexofenadine, which is an antihistamine drug, thereby making it less potent. Researchers used volunteers to take the medication with water and with the juice. When taken with the juice, only half of the drug was absorbed. So far, these juices have been found to affect the oral absorption of etoposide, a chemotherapy drug, some beta-blocker drugs used to treat high blood pressure, and cyclosporine, taken by transplant patients to prevent rejection of their new organs. The study author Dr David Bailey mentions:

"This is just the tip of the iceberg - I'm sure we'll find more and more drugs that are affected this way."

Exercise is Key for Cancer Patients

This article in the NY Times discusses how fitness can be beneficial to hasten the recovery of cancer patients as well as fighting the effects of cancer such as the fatigue from chemotherapy, the loss of muscle tone, and the swelling of lymphedema.

Programs are opening up everywhere including the a new partnership between the Y.M.C.A. and the Lance Armstrong Foundation which will offer cancer fitness classes at more than 12 Y’s in 10 states. Cancer survivors are organizing their own classes at Curves International has created new routines for overweight-breast-cancer patients.

Data and research conducted by the National Cancer Institute within the past decade show that cancer patients who exercise regularly have less fatigue, better aerobic capacity, and greater strength than those who do not exercise. There are times though when patients will not be able to perform such strenuous activities, and all exercise plans should be discussed with their oncologists.

Living Near Highways Can Increase Risk of Low-Birth Weight

The NY Times reports that a recent Canadian study shows that mothers who live near highways are more likely to give birth to low-weight and preterm babies. The study, which was published in Journal of Epidemiology and Community Health, looked at medical records of nearly 100,000 births in Montreal from 1997 to 2001. Researchers measured distances to the nearest highways and determined socioeconomic and education levels from census data.

Researchers found that compared to wealthy neighborhoods, mothers who lived within 220 yards of a highway were linked to a 58 percent chance of preterm birth, and a 81 percent chance of increased risk of low-birth weight.

Dr. Mélissa Généreux, a resident physician at the University of Montreal mentions:

“Low-income mothers are exposed to more risk factors — smoking, poor nutrition, poor access to prenatal care, domestic violence. More advantaged mothers are protected from these risk factors, so they might be more affected by the addition of a single new risk factor, pollution from highways.”

The “Exercise” Pill

According to this article in the NY Times researchers at the Salk Institute in San Diego reported that they have engineered two pills that trick the muscles into thinking that they have been working out furiously. For now, testing has been only done on lab mice. These drugs have shown up to 75% increase in endurance in mice, and the results will likely apply to people as well since muscle tone from human and mice are similar.

Dr. Ronald M. Evans, leader of the Salk group, mentions:

“It’s a little bit like a free lunch without the calories.”

The pills should be able to help people who are too frail to exercise, and those who suffer from diabetes and obesity. Diet and exercise are crucial to the treatment of diabetic patients, so there is a possibility that this drug could become widely used if it passes FDA guidelines. More testing and research is still needed in order to finalize the drug before it reaches consumers.

Medical Malls

Running late at the mall and still need to fit in a physical? No problem, according to this article, in Prince George’s County in Maryland, you can stop by the doctors office while shopping. Officials said that they made the decision to provide these services since there was no foreseeable downside. Some of the positives include generation of jobs, and tax revenue as well as increased access by the public to medical services. Individuals from less advantaged neighborhoods previously may not have always been able to go see the doctor, but with this new service, accessibility would be increased. As the Washington Post reports:

Under the plan, the county would partner with private retail owners to renovate or build spaces where customers could, for example, buy a pair of shoes in one end of the mall and get a mammogram or a physical in another. The partnership would be paid for with public and private dollars.

While to some this may seem like a novel idea, it has been around for 20 years, with approximately 50 “medical malls” currently across the U.S. What are you opinions for this interesting concept in health care? Do you think that this will catch on and become a new trend?