Greg Scandlen, one of the country's leading advocates for "consumer-directed" insurance plans, says such plans would provide better, cheaper performance and are growing faster than expected. Critics say the plans might work well for the healthy and wealthy but would shift more cost to patients, which would possibly make some patients avoid needed treatments because of the out-of-pocket costs.
Recovery audit contractors for Medicare have discovered $371.5 million in improper 2007 payments to healthcare providers in California, Florida and New York. Some of the hospitals in question, however, have complained that the contractors get a percentage of overpayments discovered and thus unfairly demand refunds for their own profit.
Health insurers will collect $54 billion more from Medicare than the government would spend providing care directly over the next four years, according to a report from the the Government Accountability Office. A Only 11 percent of the money will go to extra benefits under the Medicare Advantage program, the audit showed. The report has fueled a new political attack by House Democratic leaders concerning Medicare Advantage.
Blue Cross Blue Shield of Michigan is pushing for legislation that would change how prices are set for people who have to buy their own insurance. Critics of the insurer, however, say the changes Blue Cross is pushing for are a power and money grab by an organization that already gets major state tax breaks in exchange for helping make healthcare more affordable and accessible.
A federal judge has ruled in favor of a group of Massachusetts hospitals in a long-running dispute over Medicare reimbursement rates. The 62 hospitals sued U.S. Secretary of Health and Human Services Michael Leavitt, claiming HHS used the wrong method to calculate Medicare reimbursements. As a result of the ruling, the hospitals are closer to collecting up to $200 million from the federal government.
As Massachusetts officials struggle to keep down the cost of the subsidized insurance program at the heart of healthcare law changes, the state has pulled back from new contracts with insurers. The state canceled a meeting at which officials were expected to review the contracts and to vote on ways to partially offset the costs. The meeting was canceled because the bids received by the state "were not satisfactory," said Massachusetts budget officer Leslie Kirwan in a statement.