News and updates about Medicare.

Happy 50th Birthday, Medicare. Your Patients Are Getting Healthier

Jul 28, 2015

Here's a bit of good news for Medicare, the popular government program that's turning 50 this week. Older Americans on Medicare are spending less time in the hospital; they're living longer; and the cost of a typical hospital stay has actually come down over the past 15 years, according to a study in the Journal of the American Medical Association.

Federal agents have arrested 243 people — including 46 doctors, nurses and other medical professionals — who are accused of running up more than $700 million in false Medicare billings. Charges range from fraud and money-laundering to aggravated identity theft and kickbacks.

Attorney General Loretta Lynch calls it "the largest criminal health care fraud takedown in the history of the Department of Justice."

Federal officials have spent years locked in a secret legal battle with UnitedHealth Group, the nation's biggest Medicare Advantage insurer, after a government audit detected widespread overbilling at one of the company's health plans, newly released records show.

OxyContin pills grind into a powder for snorting. This photo was taken in 2007. In 2010, Oxycontin was reformulated to make it more difficult to abuse. But a study found Medicare plans are cutting back coverage of OxyContin in favor of cheaper generics.
51fifty at the English language Wikipedia [GFDL , CC-BY-SA-3.0 (, via Wikimedia Commons

Each year, about 16,000 Americans die from overdosing on prescription painkillers. The epidemic of prescription opioid addiction touches seniors along with other age groups. But Medicare drug plans are cutting back on coverage for a specially designated type of painkiller that deters abuse in favor of cheaper generics that don’t have the same deterrent qualities, a new study found.

Is a good family doctor one who treats your knee pain and manages your recovery from heart surgery? Or is it one who refers you to an orthopedist and a cardiologist?

Those are questions at the heart of a debate about primary care – one with serious health and financial implications.

A hospital closure can send tremors through a city or town, leaving residents fearful about how they will be cared for in emergencies and serious illnesses.

A study released Monday offers some comfort, finding that when hospitals shut down, death rates and other markers of quality generally don't worsen.

Privately run Medicare plans, fresh off a lobbying victory that reversed proposed budget cuts, face new scrutiny from government investigators and whistleblowers who allege that plans have overcharged the government for years.

In January, Medicare started paying primary care providers for non-face-to-face care coordination for parents with two or more chronic illnesses. Care coordination has been shown to extend the lives of such patients.

Sound Medicine host Barbara Lewis spoke with Dr. Louise Aronson, professor of Geriatrics at University of California San Francisco, about what the new rules mean for doctors and patients. Dr. Aronson says the new system, which reimburses doctors for arranging things like transportation and home food delivery, will help keep the very sick out of nursing homes.  

They said it couldn't be done. And for more than a decade they were right.

But on Thursday, staring at a deadline that could have disrupted health care to millions of seniors, the House got something done.

It voted to fix the flawed formula for compensating doctors who provide services to patients under Medicare. But this time it wasn't just a patch for a few months or years — like the ones Congress has done 17 times since 2003.

Updated at 12:10 p.m. E.T.

Doctors who treat Medicare patients will face a huge cut, 21 percent, if Congress doesn't act by the end of the month. This isn't a new problem. While Democrats and Republicans on Capitol Hill agree that the formula that pays doctors who treat Medicare patients has long been broken, over the years they've been unable to pass more than temporary patches.