APNewsBreak: Medicare bought meds for dead people

first_imgWASHINGTON | Call it drugs for the departed: Medicare’s prescription program kept paying for costly medications even after patients were dead.The problem was traced back to a head-scratching bureaucratic rule that’s now getting a second look.A report coming out Friday from the Health and Human Services Department’s inspector general says the Medicare rule allows payment for prescriptions filled up to 32 days after a patient’s death — at odds with the program’s basic principles, not to mention common sense.“Drugs for deceased beneficiaries are clearly not medically indicated, which is a requirement for (Medicare) coverage,” the IG report said. It urged immediate changes to eliminate or restrict the payment policy.Medicare said it’s working on a fix.Investigators examined claims from 2012 for a tiny sliver of Medicare drugs — medications to treat HIV, the virus that causes AIDS — and then cross-referenced them with death records. They found that the program paid for drugs for 158 beneficiaries after they were already dead. The cost to taxpayers: $292,381, an average of $1,850 for each beneficiary.Medicare’s “current practices allowed most of these payments to occur,” the report said.Of 348 prescriptions dispensed for the dead beneficiaries, nearly half were filled more than a week after the patient died. Sometimes multiple prescriptions were filled on behalf of a single dead person.Investigators don’t know what happened to the medications obtained on behalf of dead people, but some may have been diverted to the underground market for prescription medicines. The report said HIV drugs can be targets for fraud since they can be very expensive; one common HIV drug costs about $1,700 for a month’s supply, it said.Medicare is the government’s premier health insurance program, providing coverage to about 55 million seniors and disabled people. Prescription coverage delivered through private insurance plans began in 2006 as a major expansion of the program. But it’s also been a target for scams.The report did not estimate the potential financial impact across the $85 billion-a-year Medicare prescription program known as Part D. But investigators believe the waste may add up to millions of dollars.“The exposure for the entire Part D program could be significant,” said Miriam Anderson, team leader on the report. “The payment policy is the same for all drugs, whether they are $2,000 drugs to treat HIV or $4 generic drugs.”In a formal response, Medicare agreed with the investigators’ recommendations.“After reviewing this report, (Medicare) has had preliminary discussions with the industry to revisit the need for a 32-day window,” wrote Marilyn Tavenner, the Obama administration’s Medicare chief.Medicare had originally maintained that the date of service listed in the billing records could instead reflect when a pharmacy submitted bills for payment. That billing date might have actually occurred after a prescription was filled, since some nursing home and institutional pharmacies submit their bills in monthly bundles.However, the inspector general’s investigators found that about 80 percent of the prescriptions for dead beneficiaries were filled at neighborhood pharmacies, undercutting Medicare’s first explanation. As for the remainder, the investigators said they didn’t see any reason pharmacies can’t report an accurate date of service.Investigators said they stumbled on the problem during an examination of coverage for AIDS drugs dispensed to Medicare beneficiaries. Sexually transmitted diseases are an increasingly recognized problem among older people.That earlier investigation raised questions about expensive medications billed on behalf of nearly 1,600 Medicare recipients.Some had no HIV diagnosis in their records, but they were prescribed the drugs anyway. Others were receiving excessively large supplies of medications. Several were getting prescriptions filled from an unusually large number of pharmacies.Prescription drug fraud has many angles. When the high price of a drug puts it out of reach for certain patients, it can create an underground market. And some medications, like painkillers and anti-anxiety pills, are constantly sought after by people with substance-abuse issues.___last_img read more

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Pilot offers plane to help the needy

first_img AD Quality Auto 360p 720p 1080p Top articles1/5READ MOREWhicker: John Jackson greets a Christmas that he wasn’t sure he’d see“Dave” is Dave Stefko, who has transported everyone from cancer patients to children en route to burn camps. Stefko, 48, a Canyon Country resident whose Cessna is based at Van Nuys Airport, said it’s a way he can use his skills to help others. On one trip, several pilots banded together to fly different legs of a young woman’s journey from Santa Fe to San Francisco to visit her toddler who was hospitalized with a rare bone disease. “She was trying to get there to be with her child and had insurance but no means for transportation,” Stefko recalled. “The hospital made arrangements for her to be picked up at the Oakland airport.” Passengers, who are often ill, must be able to walk unassisted and not require in-flight medical care. Sometimes there is levity. While ferrying a burn patient from Fresno to Palm Springs about three years ago, Stefko learned something about his grandson – who was still inside his mom’s tummy. Stefko’s daughter Lisa, then 21, kept Stefko company on the flight. “(Lisa) was about seven months pregnant and her son was doing flip flops,” Stefko said. “He loves to fly now and when Luke sees an airplane he runs in the house to come get me.” Sometimes, others save the day. Stefko’s 14-year-old daughter, Hannah, knew some sign language when she sat next to two deaf children on their way to a camp near Yosemite two years ago. The flight was uneventful – even joyful. Stefko glanced over his shoulder to see the kids, who had never met before, signing away rapid fire. “On the way back, Hannah spotted smoke. We made a pass back around and saw a small fire starting in the mountains,” Stefko said. He called air traffic control, who notified the U.S. Forest Service. “Soon after, we saw water-dropping helicopters heading over to put out the fire,” Hannah said. Air traffic controllers called them to say thanks. Not long ago, Stefko said, he was a co-pilot on a flight with Stuart Bloom, a Bel Air resident who flies the caring missions almost weekly. Bloom, an anesthesiologist, likes helping hands-on. “You are directly giving of your time and yourself rather than writing a check to a nameless entity where you don’t know where it’s going,” Bloom said. “You’re providing a service directly to the recipients … people who, without Angel Flight, would not be able to get the medical care they need.” Stefko caught the flying bug when he was 7 during an overnight flight to Santa Barbara with his dad. He began flying at 20 and juggles dual careers as a private pilot and roofing contractor with offices in Van Nuys, San Diego and Las Vegas. In his spare time, he flies. On Labor Day weekend, Stefko took supplies on behalf of the Mexican Red Cross and the Chandler, Ariz.-based Baja Bush pilots to victims stranded by Hurricane John in Mexico. The landing strips were anything but asphalt. “We landed on deserts, remote mesas, dirt runways … and beaches on sand runways,” he said. “These people literally lost everything.” He removed the plane’s back seats and stowed diapers, food, sleeping bags, clothes, shoes, pots, pans, dishes – much of it donated by his friends and neighbors. Janet, Stefko’s wife of 25 years, said her husband likes to spread his blessings. “If he hears about a needy family, someone who’s ill or (even) a family suffering because someone is ill, he’ll support them financially or he’ll gather our family together and say, `Let’s brainstorm what we can do for the family,’ ” she said. This story even has a Hollywood ending. Each year the Stefkos adopt a needy family and head out together to shop for them. “This year we adopted a new family who we learned about through a friend,” Janet said. “It’s a grandmother raising four grandchildren.” For more information about Angel Flight, visit www.angelflight.com or www.angelflight.org. judy.orourke@dailynews.com (661) 257-5255 160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set! SANTA CLARITA It almost sounds like a holiday movie: Pilot fills up the tank, revs the twin engines and transports people who are sick or in need to their destinations for free. Only this is real, and volunteer pilots do it every day. “Dave has been scheduled as the pilot on 25 missions in the past five or so years,” said Jim Weaver, executive director of Angel Flight West, a nonprofit organization that partners private pilots with passengers. last_img
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