Tag: insurance issues

Medicare Proposes Adding to Its List of Hospital-Acquired Conditions For Which It Will Not Pay the Extra Costs

The Centers for Medicare and Medicaid Services (CMS) is proposing to add an additional nine categories to its initial list of 8 preventable conditions that could reasonably have been avoided. that Medicare will no longer pay the extra costs of treating when acquired in the hospital.

In a statement dated April 14, 2008, CMS proposed to add the following to its list of preventable conditions that it will not pay for: Surgical site infections following certain elective procedures: Legionnaire’s disease; Extreme blood sugar derangement; Iatrogenic pneumothorax or collapsed lungs; Delirium; Ventilator-associated pneumonia; Deep vein thrombosis or pulmonary embolism; Staphylococcus aureus … Read the rest

Doctors Successfully Repel Aetnas Unwarranted Intrusion Into How They Perform Colonoscopies

After coming under attack from doctors, Aetna has withdrawn its intention, announced late last year, that in New Jersey, effective April 1, 2008, it would drop its coverage of propofol, the anesthesia typically used during colonoscopies, calling the same medically unnecessary. In reality, it is not the propofol that Aetna minds paying for; what Aetna wants to cut-out is the $300 to $1,000 cost that Aetna pays for an anesthesiologist to be present at a colonoscopy.

Propofol, also known by the trade name Diprivan, is more powerful than other sedatives traditionally used to help patients endure the discomfort of a … Read the rest

Report on Medicare/Medicaid Overbilling and Fraud in 2007 Focuses on Nursing Homes/Rehab Centers, Pharmaceuticals and Boutique Hospitals

Americas Watchdog and its Corporate Whistleblower Center have just released the results of its third annual study focused on Medicare & Medicaid fraud. The report continues to show widespread Medicare/Medicaid billing abuse and fraud involving all aspects of health care.

The Corporate Whistle Blower Center has just reported its 2007 year end findings on the state of Medicare/Medicaid over billing/fraud in the United States. The report included three areas where Medicare/Medicaid are being over-billed or defrauded; nursing homes/rehab centers, pharmaceuticals, and boutique hospitals, not for profits hospitals, or hospitals owned by doctors/investor groups.

1. Most Nursing Homes/Rehab Centers continue … Read the rest

Daily Eater of Popcorn Sues Over Butter-Flavor Chemical Diacetyl, Saying “I Inhaled.”

Exposure to the chemical known as diacetyl, which adds the buttery flavor to popcorn, has been tied to hundreds of cases of workers whose lungs have been damaged or destroyed. When it is heated diacetyl becomes a vapor and when it is inhaled over a long period of time, it can cause various problematic symptoms. Exposure to this chemical can cause one to experience difficulty breathing and exhaling, and one’s lungs can become scarred. The severe form of the disease is called “bronchiolitis obliterans,” also known as “popcorn workers’ lung,” which can be lethal.

In fact, in July of 2005, … Read the rest

Wrongful Denials of HMO Treatment in New York are Common and are Often Successfully Appealed

Many patients of health maintenance organizations (“HMO”) are unaware of their legal right to appeal a decision denying their requested treatment. The desired treatment is normally denied deemed as”medically unnecessary” or “experimental.” The law also only provides for a mere 45 day deadline in which one can file this appeal.

The ignorance of various patients of their ability to appeal is particularly problematic in light of the fact that, according to the New York State Insurance Department, approximately 42.6 and 49.4 percent of the cases that are appealed are in fact reversed.

Therefore, it is important that patients are made … Read the rest

Medicare to Stop Paying Hospitals Extra to Treat Their Preventable Errors

Medicare, in a significant policy change, will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, which the government says could save lives and millions of dollars.

Under the new rule, effective October 1, 2007, and applicable to discharges occurring on or after that date, Medicare will not pay hospitals for the costs of treating certain conditions that could reasonably have been prevented. Significantly, under the new rules, the hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication.

The Centers for Disease Control and Prevention estimates that patients … Read the rest