Posts Tagged ‘Kathleen Sebelius’

U.S. Intervenes in False Claims Act Lawsuit Against Fla. Home Health Care Company and Its Owner

July 22, 2013

The government has intervened in a whistleblower lawsuit against A Plus Home Health Care, Inc., a home health care company in Fort Lauderdale, Fla., and its owner, Tracy Nemerofsky, the Justice Department announced today. The government alleges that A Plus offered referring physicians’ spouses sham marketing positions with the company to induce the physicians to refer Medicare patients for home health care services. (more…)

Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services

June 25, 2013

By Susan Jaffe, Kaiser Health News

For years, seniors in Medicare have been told that if they don’t improve when getting physical therapy or other skilled care, that care won’t be paid for. No progress, no Medicare coverage – unless the problem got worse, in which case the treatment could resume.

This frustrating Catch-22 spurred a class-action lawsuit against Health and Human Services Secretary Kathleen Sebelius. In January, a federal judge approved a settlement in which the government agreed that this “improvement standard” is not necessary to receive coverage. (more…)

Sarasota Herald Tribune: Nation at Crossroads in Home Care for Elders

May 28, 2013

By , Sarasota Herald Tribune

Chuck and Rosalie Schockweiler need no words as they execute a smoothly choreographed routine in their Englewood home.

He rinses her feeding tube and hands it to her; she shakes it dry and attaches it to a port on her abdomen as he dissolves three pills in water. Chuck fetches her liquid lunch as Rosalie places a plastic receptacle in an ingenious homemade stand that Chuck fashioned from PVC pipe and an old battery charger, weighted “with imported stones from the front yard.”

He pours in the solution, and as she feels it flow into her belly, she smiles — the same glorious, sunny smile he first noticed back when they worked at Venice Regional Medical Center. He chases the meds with a can of liquid nutrition Rosalie must have five times daily, filling the tube and responding to her prompt when it’s time for another pour.

Usually, as Rosalie finishes her meal, Chuck gets himself something to eat and they sit together at the dining table. Then they stand, every single time, for a long, satisfying hug.

It’s a process they repeat about every two and a half hours, with two more feeding sessions for medication alone.

Early in the day, it looks easy. But, Chuck admits, evenings are tougher because his energy flags. (more…)

Medicare Fraud Strike Force Charges 89 Individuals for $223M in False Billing

May 15, 2013

medicare fraudAttorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 89 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings. Florida accounted for 34 of the arrests made.

This coordinated takedown was the sixth national Medicare fraud takedown in Strike Force history. In total, almost 600 individuals have been charged in connection with schemes involving almost $2 billion in fraudulent billings in these national takedown operations alone. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. (more…)

Obama Administration Launches $1B Initiative for Health Care Innovation

May 15, 2013

Health and Human Services Secretary Kathleen Sebelius today announced a nearly $1 billion initiative that will fund awards and evaluation to build on the Obama administration’s work to transform the health care system by delivering better care and lowering costs.  This second round of Health Care Innovation Awards will fund applicants that have a high likelihood of driving health care system transformation and delivering better outcomes.

Made possible by the Affordable Care Act, the Health Care Innovation Awards provides another opportunity to improve the quality of health care and bring down costs for taxpayers and patients. The health care law includes many tools to avoid costly mistakes and readmissions, keep patients healthy, reward quality instead of quantity, and create health information technology infrastructure that enables new payment and delivery models to work. The provisions in the Affordable Care Act are already working to reduce costs: Medicare spending per beneficiary increased by just 0.4 percent last year, far below historical averages. (more…)

HHS Secretary Kathleen Sebelius on National Nurses Week

May 6, 2013

Secretary Sebelius

“National Nurses Week gives us a chance to recognize the contribution of the health care providers at the heart of our health care system.  Every day, nurses provide leadership, innovation and advocacy to meet the health care needs of Americans.

From making sure a young mother knows how to care for her toddler, to showing an elderly patient how to manage his diabetes, the role nurses play is more important than ever.  The success of the Affordable Care Act, and the expansion of access to health care that it offers, will not be possible without these trusted professionals.

The health care law’s emphasis on keeping people healthy, preventing illness, and managing chronic conditions, opens new opportunities for nurses to shape and lead the future delivery of healthcare and capitalizes on the expertise of the nursing profession.  For example, the Affordable Care Act appropriated $1.5 billion to increase home visits from nurses and social workers to expectant mothers in high-risk communities.  Nurses making home visits can sharply reduce infant mortality and improve outcomes for mothers and children alike. (more…)

HHS Proposal Would Increase Rewards to Seniors for Reporting Fraud

April 24, 2013

Health and Human Services Secretary Kathleen Sebelius today announced a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million. In addition, a new funding opportunity released this month supports the expansion of Senior Medicare Patrol (SMP) activities to educate Medicare beneficiaries on how to prevent, detect and report Medicare fraud, waste and abuse. (more…)

It’s Official: Feds to Run FL Health Exchange

February 18, 2013

Some people think this is bad news, while others think it’s a good thing: state officials are letting the federal government create and operate Florida’s health insurance exchange for 2014, according to Health News Florida.

Friday was the deadline for states that wanted to be partners in the exchange to notify Health and Human Secretary Kathleen Sebelius. And as Dara Kam of the Palm Beach Post reports, Florida let the deadline go by without acting. (more…)

Feds Announce Record-Breaking Recoveries From Efforts to Combat Health Care Fraud

February 12, 2013

healthcare_fraud_imageWASHINGTON – Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius yesterday released a new report showing that for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $7.90. This is the highest three-year average return on investment in the 16-year history of the Health Care Fraud and Abuse Program.

The government’s health care fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012, up from nearly $4.1 billion in FY 2011, from individuals and companies who attempted to defraud federal health programs serving seniors and taxpayers or who sought payments to which they were not entitled. Over the last four years, the administration’s enforcement efforts have recovered $14.9 billion, up from $6.7 billion over the prior four-year period. Since 1997, the HCFAC Program has returned more than $23 billion to the Medicare Trust Funds. (more…)

Feds Approve Statewide Medicaid Managed Care

February 4, 2013

By James Call, The Florida Current

The federal government has approved a long-term care waiver for the Statewide Medicaid Managed Care Program. Patients, mainly nursing home residents but some who still live in their homes, will be enrolled in private health-maintenance organizations or other types of managed-care programs. Gov. Rick Scott lobbied U.S. Health and Human Services Secretary Kathleen Sebelius for the waiver last month on a trip to Washington. Scott says Florida’s plan to overhaul how Medicaid services are delivered will lower costs. (more…)