Medicare

Two House Democrats have joined Republicans in an effort to do away with a Medicare payment board

HHS secretary says the GOP spending bill would prevent Medicare from paying benefits to millions of seniors.

The GOP's budget slashing could "really bop the Baby Boomers" who are just becoming eligible, Rep. Henry Waxman (D-Calif.) said.

Top Democrats on the Energy and Commerce Committee on Friday asked for a hearing on Medicare prescription drug rebates after federal investigators said the program could be saving taxpayers millions more.

Republicans' 2003 Medicare Modernization Act bars the federal government from directly negotiating bulk discounts for drugs. The private plans that provide the coverage, however, are supposed to negotiate rebates to lower costs for beneficiaries and the government.

In its first major review of the rebate program, the Inspector General for the Department of Health and Human Services on Friday offered a scathing assessment.

"Because of the size of these rebates, it is vital that rebates be reported accurately and that the Government and beneficiaries receive the full benefit of these rebates," wrote Inspector General Daniel Levinson. "Our review identified several concerns about these rebates."

Reps. Ed Whitfield (R-Ky.) and Gene Green (D-Texas) are set to introduce legislation Thursday afternoon that increases Medicare drug reimbursements for community oncology clinics.

The so-called "prompt pay" legislation excludes certain discounts extended to wholesalers when calculating Medicare reimbursements and is strongly supported by oncologists. 

Whitfield told The Hill the biggest obstacle would be finding a way to pay for the bill, which hasn't been scored yet. He said he's started looking for a pay-for within the healthcare reform law.

"On any legislation today, you have to find a way to pay for it. And like any legislation, that's an issue with this one," Whitefield said. 

"But to be truthful, because of the oncologist groups and patient groups and others, we think that there may be some provisions in the healthcare bill that passed last year that we may be able to utilize some of those funds for this. All of it's about healthcare, and if we can convince people that this is more important than the others then we can do it."

A progressive group launched a new billboard campaign in the districts of three GOP lawmakers urging them to oppose House Budget Committee Chairman Paul Ryan’s (R-Wis.) plan to replace Medicare with a voucher system.

Americans United for Change put up billboards in the districts of Reps. Chip Cravaack (R-Minn.), Sean Duffy (R-Wis.) and Steve Stivers (R-Ohio) that all offer the same message: “Don’t privatize my Medicare.”

House Republicans said they will pitch a major Medicare reform in their 2012 budget when it comes out this spring, but Democrats have been trying to link the GOP to Ryan’s controversial plan.

House GOP leadership has been mum about what its Medicaid reform package will look like, while some House Republicans have tried to distance themselves from the Ryan plan in the face of Democrats' eagerness to exploit it.

"The roadmap is one person's idea," said Rep. Geoff Davis (R-Ky.) during a Ways and Means Committee hearing two weeks ago. "It's not representative of the party."

A new poll released Thursday morning showed that 28 percent strongly oppose the Ryan plan, while 12 percent embraced it.

Wednesday was "Fraud Day" on the Hill, with three congressional panels turning their sights to Medicare waste, fraud and abuse. After all the excitement Wednesday, the attention turns now to Health and Human Services Secretary Kathleen Sebelius's Thursday testimony to a House panel, and an expected clarification from a federal judge about whether he meant to stop the healthcare reform law's implementation.

Bipartisan Senate duo wants Medicare to make payments to doctors public: Sens. Ron Wyden (D-Ore.) and Chuck Grassley (R-Iowa) are collaborating on legislation to require the federal government to make public how much it pays doctors who participate in Medicare, a Senate staffer said.

The senators argue that making payments public could help combat the massive fraud that's rampant in the Medicare program. Physicians' groups, however, say making payment information public would violate doctors' privacy. Julian Pecquet has the story.

Top Senate Republican wants probe of Castro Medicare connection: Grassley asked HHS officials testifying to the Senate Finance Committee if they knew of evidence that Cuba might be defrauding the Medicare program. Seven of the top 10 healthcare fraud fugitives named last month are of Cuban origin, and six are said to be hiding on the island. Read the story here.

1099 repeal vote coming: The House is expected to pass repeal of the healthcare reform law's 1099 provision on Thursday, but the unpopular IRS reporting requirement is far from being eliminated. Democrats oppose the bill's pay-for, which requires greater recapture of subsidy overpayments on health insurance exchanges opening in 2014. The White House formally announced its opposition for the offset Tuesday night.

Dems try to grab centrists on abortion bills: Democrats are already playing defense ahead of a Thursday House Judiciary Committee markup of H.R. 3, a bill from Rep. Chris Smith (R-N.J.) that would ban tax breaks for healthcare plans that cover abortion. During a Wednesday call with reporters, Democrats on the panel said they don’t expect the bill to make it into the Democratic-controlled Senate, but that didn’t stop them from hitting Republicans on what they think can be an issue that helps Democrats win over centrist voters.

“I think it’s awoken a sleeping giant of activism,” said Rep. Mike Quigley (D-Ill.).

Sens. Ron Wyden and Chuck Grassley are collaborating on legislation that would make Medicare payments public.

Bilking Medicare out of millions of dollars is "incredibly easy," a convicted felon told a House oversight subpanel Wednesday afternoon.

Aghaegbuna "Ike" Odelugo, who faces sentencing this spring for Medicare fraud, told lawmakers it didn’t take “more than a month” to develop a scheme that swindled Medicare out of nearly $10 million over a three-year period.

Odelugo, a Nigerian native who gamed Medicare’s durable medical equipment (DME) system, said he only needed basic data-entry skills and a few fraudulent marketers.

“With these two essential ingredients, one possesses a recipe for fraud and abuse,” Odelugo told the House Ways and Means oversight subpanel.

Sen. Ron Wyden (D-Ore.) announced Wednesday that he is drafting legislation that would make information about how much Medicare pays physicians available to the public.

"I'm very hopeful that we can have a bipartisan bill on this because I think this could create a very substantial disincentive for some of these multi-million dollar rip-offs," Wyden told reporters after a Senate Finance hearing on Medicare fraud. "And I also believe that the disinfectant of getting this information out to a wider array of individuals and groups makes a lot of sense."

Payments to doctors and other individual providers in the Medicare claims database has been off limits to the public since the 1970s, when the Florida Medical Association and the American Medical Association sued to keep it secret. The issue has resurfaced in recent months after the Wall Street Journal and the Center for Public Integrity sued the Department of Health and Human Services to get the information.

The newspaper and the nonprofit eventually agreed to receive a pared down version of the database containing 5 percent of providers, which they were forbidden from identifying. Even with those restrictions, they were quickly able to identify patterns of likely fraud.

The idea of opening up the database has been gaining traction across party lines as Medicare and Medicaid fraud, estimated at $70 billion to $120 billion a year, becomes an ever bigger worry. Former House Speaker Newt Gingrich, a possible presidential candidate for 2012, has said he favors the idea as long as beneficiaries' names are kept confidential.

The AMA argues that opening up the database would be a violation of doctors' privacy and could lead to some of them leaving the program.