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 … 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After coming under attack from doctors, Aetna has withdrawn its intention, announced late last year, that in New Jersey, effective April 1, 2008, it would drop its coverage of propofol, the anesthesia typically used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 … 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 … 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 … 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 … 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 … Read the rest