MIAMI -- Four private health insurers who wrongly claimed they spent millions on patient care in the state's children's health care program also provided coverage to patients in Florida's controversial Medicaid privatization program.
AmeriGroup Florida, Inc., Vista Health Plan, United Healthcare and WellCare were required to spend at least 85 percent on medical services under the State Children's Health Insurance Program in an effort to ensure for-profit companies are not lining their pockets with state funds instead of spending it on patient care.
If an insurer spends less, it must refund 50 percent of the shortfall to the state. Florida health officials should have received $3.1 million in refunds between 2003 and 2007, according to a report by the Department of Health and Human Services' inspector general.
The Associated Press obtained the insurers names as part of a public records request.
United Healthcare spokesman Tyler Mason said in an email that all participating plans with the state program provide quarterly reports for review to ensure payment accuracy and reconcile any issues based upon the contracted Medical Loss Ratios agreement.
The investigation comes as Florida is poised to expand a five-county Medicaid program statewide. Health advocates have criticized the state's lax oversight of the for-profit companies in the Medicaid pilot program, especially as news comes that the same insurers erred in other Florida health programs. Patients in the pilot complained they couldn't get appointments and were denied medications.
AmeriGroup, Vista and WellCare eventually dropped out of the Medicaid pilot, claiming they couldn't turn a profit. United is serving patients in Duval, Baker, Clay and Nassau counties after exiting Broward.
But after Gov. Rick Scott signed bills expanding the program statewide, experts say these companies and others will be clamoring for lucrative state contracts.
Supporters say the bills injected sorely needed accountability into the program, including a yearly, independent audit.
The bills don't require plans to spend certain percentages on patient care and administrative costs, but instead require them to repay profits over 5 percent to the state. To make sure you're covered correctly, have the lowest health rates in the state, contact us here.
Read more: http://www.miamiherald.com/2011/07/27/2333356/wellcare-united-others-cheat-fla.html#ixzz1TV77diGR
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Friday, July 29, 2011
Monday, July 25, 2011
Florida Consumer Chief Backs Double-Digit Hikes for Allstate
Florida’s consumer advocate says Allstate’s two Florida home insurers are among the state’s best run and deserve double-digit rate increases along the lines they have requested.
The Allstate units, Castle Key Insurance Co. and Castle Key Indemnity Co., which insure 266,000 homes, are seeking average rate increases of 31.2 percent and 35.7 percent, respectively. With their 800 agents, the two companies represent the fourth and sixth largest home insurers in the state.
At a recent public hearing, the insurers found unexpected support from the state’s Office of Insurance Consumer Advocate. Steve Alexander, actuary for the consumer office, said that out of the 47 Florida-exclusive insurers providing homeowners insurance in the state, the two Allstate insurers are among the most efficient when it comes to costs. “They have some of the lowest expenses in the state, which I think is a real plus,” he said.
He also applauded their willingness to do business in Florida with all the risk that entails, when they could be earning a guaranteed quarter of a point on a one-year U.S. Treasury bond.
Alexander recommended that Castle Key Insurance Co.’s proposed 31.2 percent increase be reduced to 23.7 percent. He also recommended that Castle Key Indemnity’s proposed 35.7 percent increase be increased to 46.9 percent on the basis that it be phased in over a two year period
Within his recommendation, Alexander suggested that Castle Key receive no increases for debt service or contingency fees, he did recommend a profit component of 10 percent, which is slightly higher than the nine percent sought by the companies. He also recommended a 1.5 percent factor for general expenses and a 5.1 percent factor for acquisition and overhead expenses.
Bonnie Gill, vice president for Castle Key, said double-digit rate increases are needed to shore-up the insurers’ claims paying ability in the event of single or multiple-year storms. She said that even without any recent major losses, the companies are not raising enough cash. At the same time, by law, the Florida Hurricane Catastrophe Fund is also scaling back the amount of reinsurance it can offer companies.
“With our ongoing losses since 2006, we don’t have enough money to cover claims,” Gill said, adding that the companies combined surplus dropped by three percent last year.
Gill said that due to the state catastrophe fund’s scaling back, the companies had to spend $143 million to secure $900 million in private reinsurance, a price tag that represented more than half of the companies’ annual premiums.
OIR Actuary Bob Lee noted that Castle Key used the new AIR-12 hurricane model, which was recently approved by the Florida Commission on Hurricane Loss Methodology, which had an effect on the companies’ exposure.
Shantelle Thomas, senior actuary for Castle Key, defended the AIR model’s use. “We believe the new model is the best to date and that it should be considered in the rates,” she said.
Earlier this year, the Castle Key insurers announced they would no longer write new business. Thomas said the companies are considering a number of other underwriting changes depending on the results of the hurricane season, its loss experience, and a review of credits to policyholders for taking steps to strengthen their homes. To make sure you have the lowest insurance costs and best coverage, contact us here.
The Allstate units, Castle Key Insurance Co. and Castle Key Indemnity Co., which insure 266,000 homes, are seeking average rate increases of 31.2 percent and 35.7 percent, respectively. With their 800 agents, the two companies represent the fourth and sixth largest home insurers in the state.
At a recent public hearing, the insurers found unexpected support from the state’s Office of Insurance Consumer Advocate. Steve Alexander, actuary for the consumer office, said that out of the 47 Florida-exclusive insurers providing homeowners insurance in the state, the two Allstate insurers are among the most efficient when it comes to costs. “They have some of the lowest expenses in the state, which I think is a real plus,” he said.
He also applauded their willingness to do business in Florida with all the risk that entails, when they could be earning a guaranteed quarter of a point on a one-year U.S. Treasury bond.
Alexander recommended that Castle Key Insurance Co.’s proposed 31.2 percent increase be reduced to 23.7 percent. He also recommended that Castle Key Indemnity’s proposed 35.7 percent increase be increased to 46.9 percent on the basis that it be phased in over a two year period
Within his recommendation, Alexander suggested that Castle Key receive no increases for debt service or contingency fees, he did recommend a profit component of 10 percent, which is slightly higher than the nine percent sought by the companies. He also recommended a 1.5 percent factor for general expenses and a 5.1 percent factor for acquisition and overhead expenses.
Bonnie Gill, vice president for Castle Key, said double-digit rate increases are needed to shore-up the insurers’ claims paying ability in the event of single or multiple-year storms. She said that even without any recent major losses, the companies are not raising enough cash. At the same time, by law, the Florida Hurricane Catastrophe Fund is also scaling back the amount of reinsurance it can offer companies.
“With our ongoing losses since 2006, we don’t have enough money to cover claims,” Gill said, adding that the companies combined surplus dropped by three percent last year.
Gill said that due to the state catastrophe fund’s scaling back, the companies had to spend $143 million to secure $900 million in private reinsurance, a price tag that represented more than half of the companies’ annual premiums.
OIR Actuary Bob Lee noted that Castle Key used the new AIR-12 hurricane model, which was recently approved by the Florida Commission on Hurricane Loss Methodology, which had an effect on the companies’ exposure.
Shantelle Thomas, senior actuary for Castle Key, defended the AIR model’s use. “We believe the new model is the best to date and that it should be considered in the rates,” she said.
Earlier this year, the Castle Key insurers announced they would no longer write new business. Thomas said the companies are considering a number of other underwriting changes depending on the results of the hurricane season, its loss experience, and a review of credits to policyholders for taking steps to strengthen their homes. To make sure you have the lowest insurance costs and best coverage, contact us here.
Thursday, July 14, 2011
Feds Moving on Health Care Law, Gov. Scott Not Budging
Federal regulators charged with implementing the Affordable Care Act stated Monday they are trying to work with states to start up the law’s health care "exchanges" -- exchanges are one-stop consumer markets for buying insurance.
But they said they will install a federal health care exchange if a state refuses to set one up on its own.
The news carries weight for Florida, because Gov. Rick Scott, who first came onto the political scene as a staunch opponent of the federal overhaul of health care signed into law by President Barack Obama last year, is not moving from his stance that state agencies should not begin implementing the law.
The health care exchanges -- scheduled to be in place by January 2014 -- are touted as a more transparent way for individuals to compare health insurance policies’ coverage and prices online, over the phone or in person. They can be set up by the states themselves, done locally or regionally, or operated by a nonprofit, or can be done in partnership with the federal government.
States will be in charge of selecting plans in the exchanges, but they must meet minimum coverage and quality standards set forth by the federal Health and Human Services agency. Those standards are scheduled to be released later this year.
HHS officials said the guidelines for the exchanges give states enough flexibility to adjust the federal exchanges to their unique circumstances, but the final say on what plans qualify will remain in federal hands.
“In terms of setting up an exchange and meeting minimum standards, those would still apply,” said Steve Larsen, HHS director of the Center for Consumer Information and Insurance Oversight.
The proposals and claims of flexibility for states did not thaw Scott’s position on the law, or its implementation.
“As proposals, we are not about to change our policy to start implementing Obamacare,” Scott spokesperson Lane Wright said.
Under the law, states must get approval from HHS for their exchange plan by January 2013, but a conditional approval can be given if a state is on track to be ready to implement its exchange plan by January 2014.
Larsen held out hope that states would get on board and begin to lay the groundwork for the exchanges; he stated the federal government would be ready to step in and impose an exchange system if a state did not do so.
“If a state on January 2013 has not received approval or conditional approval, then we would be able to have an exchange in place by 2014,” Larsen said.
Yet most states are trying to avoid the federally imposed exchanges.
Two federal judges have declared the Affordable Care Act’s individual mandate, which imposes a tax or penalty on individuals who do not obtain health insurance, unconstitutional. One of those rulings came from a Pensacola judge in a lawsuit filed by Florida and 25 other states against the health care law. The Atlanta 11th Circuit Court of Appeals heard oral arguments in the case last month but has yet to issue a decision. In a separate lawsuit, the 6th Circuit Court of Appeals upheld the individual mandate as constitutional last month.
The issue will likely be settled by the U.S. Supreme Court, but in the interim, states opposed to the Affordable Care Act are caught between readying themselves for it, or counting on its cancellation by the courts.
“All we know is that a (federal judge) in Florida has ruled it unconstitutional, so we’re not going to be implementing it,” Wright said.
Scott stated in February, after the ruling in the Florida case, that he did not anticipate the law being upheld and he would not move to implement it until its legal fate was settled. He insisted that Florida would be ready if the law was deemed constitutional, despite the lack of preparation.
“I personally always believed it was going to be repealed. We are not going to spend a lot of time and money with regard to trying to get ready to implement it,” Scott said at the time. To make sure your coverage for your health is up to date and affordable. go to our site.
But they said they will install a federal health care exchange if a state refuses to set one up on its own.
The news carries weight for Florida, because Gov. Rick Scott, who first came onto the political scene as a staunch opponent of the federal overhaul of health care signed into law by President Barack Obama last year, is not moving from his stance that state agencies should not begin implementing the law.
The health care exchanges -- scheduled to be in place by January 2014 -- are touted as a more transparent way for individuals to compare health insurance policies’ coverage and prices online, over the phone or in person. They can be set up by the states themselves, done locally or regionally, or operated by a nonprofit, or can be done in partnership with the federal government.
States will be in charge of selecting plans in the exchanges, but they must meet minimum coverage and quality standards set forth by the federal Health and Human Services agency. Those standards are scheduled to be released later this year.
HHS officials said the guidelines for the exchanges give states enough flexibility to adjust the federal exchanges to their unique circumstances, but the final say on what plans qualify will remain in federal hands.
“In terms of setting up an exchange and meeting minimum standards, those would still apply,” said Steve Larsen, HHS director of the Center for Consumer Information and Insurance Oversight.
The proposals and claims of flexibility for states did not thaw Scott’s position on the law, or its implementation.
“As proposals, we are not about to change our policy to start implementing Obamacare,” Scott spokesperson Lane Wright said.
Under the law, states must get approval from HHS for their exchange plan by January 2013, but a conditional approval can be given if a state is on track to be ready to implement its exchange plan by January 2014.
Larsen held out hope that states would get on board and begin to lay the groundwork for the exchanges; he stated the federal government would be ready to step in and impose an exchange system if a state did not do so.
“If a state on January 2013 has not received approval or conditional approval, then we would be able to have an exchange in place by 2014,” Larsen said.
Yet most states are trying to avoid the federally imposed exchanges.
Two federal judges have declared the Affordable Care Act’s individual mandate, which imposes a tax or penalty on individuals who do not obtain health insurance, unconstitutional. One of those rulings came from a Pensacola judge in a lawsuit filed by Florida and 25 other states against the health care law. The Atlanta 11th Circuit Court of Appeals heard oral arguments in the case last month but has yet to issue a decision. In a separate lawsuit, the 6th Circuit Court of Appeals upheld the individual mandate as constitutional last month.
The issue will likely be settled by the U.S. Supreme Court, but in the interim, states opposed to the Affordable Care Act are caught between readying themselves for it, or counting on its cancellation by the courts.
“All we know is that a (federal judge) in Florida has ruled it unconstitutional, so we’re not going to be implementing it,” Wright said.
Scott stated in February, after the ruling in the Florida case, that he did not anticipate the law being upheld and he would not move to implement it until its legal fate was settled. He insisted that Florida would be ready if the law was deemed constitutional, despite the lack of preparation.
“I personally always believed it was going to be repealed. We are not going to spend a lot of time and money with regard to trying to get ready to implement it,” Scott said at the time. To make sure your coverage for your health is up to date and affordable. go to our site.
Monday, July 11, 2011
Florida Homeowners Coverage Problems Resolved?
It is the biggest gamble - homeowners insurance in Florida time at the helm of state government, one still condemned as reckless, irresponsible and a disaster waiting to happen.
Indeed, average property insurance premiums in Florida have fallen 16 percent since the Legislature approved a Crist-led reform package in the governor's first month in office in 2007.
And Citizens, the state-run insurer that is now Florida's largest insurer, has seen its reserves more than triple, making it more able to pay off storm damages.
The changes are dramatic when contrasted with what confronted the state just a few years ago, when runaway insurance costs were considered the No. 1 problem facing Florida.
From 2003 to 2006, average property insurance premiums nearly doubled, going from $949 to $1,635 annually, according to the state Office of Insurance Regulation.
More double-digit increases were forecast in 2007 and beyond as insurance companies sought to make up for nearly $40 billion in losses from eight hurricanes and four tropical storms that hit Florida in 2004 and 2005.
To make sure your florida homeowners coverage is up to date, please contact us here.
Indeed, average property insurance premiums in Florida have fallen 16 percent since the Legislature approved a Crist-led reform package in the governor's first month in office in 2007.
And Citizens, the state-run insurer that is now Florida's largest insurer, has seen its reserves more than triple, making it more able to pay off storm damages.
The changes are dramatic when contrasted with what confronted the state just a few years ago, when runaway insurance costs were considered the No. 1 problem facing Florida.
From 2003 to 2006, average property insurance premiums nearly doubled, going from $949 to $1,635 annually, according to the state Office of Insurance Regulation.
More double-digit increases were forecast in 2007 and beyond as insurance companies sought to make up for nearly $40 billion in losses from eight hurricanes and four tropical storms that hit Florida in 2004 and 2005.
To make sure your florida homeowners coverage is up to date, please contact us here.
Wednesday, July 6, 2011
Key aspect of auto insurance laws in Florida
Florida like the rest of the 50 states in the country has its own set of insurance laws which must be followed by all the citizens who drive on its roads. Firstly, vehicle owners should purchase auto insurance only from those providers who are authorized to sell insurance in Florida. Secondly, those who move from another state to Florida are not allowed to hold on to the same policy while driving on the Florida roads. In fact, everyone must carry sufficient insurance coverage as mandated by the laws in Florida. The specific limits which are mandatory for vehicle owners in Florida are $10,000 for physical injury to one person in a car accident, $10,000 for property damage during car accident as per the liability on the guilty driver and $20,000 for physical injury to more than one person in the car accident.
The auto insurance laws in Florida also include a Financial Responsibility Law. As per this law, all the drivers in the state of Florida should carry sufficient insurance coverage for a few more risks. These risks include DUI citation and revocation of license as a result, car accident that results in injuries and involves the insured driver, suspension of the license of the driver due to too many points brought up against the driver and revocation of license for habitual violation of traffic laws.
Also, the rental cars operating in Florida must have the minimum protection as mandated by the insurance laws in the state. If the credit card of the insured driver or the insurance policy for the car doesn’t cover the rental for the car, the rental agreement copy must be present in the vehicle all the time. This copy should also highlight the insurance coverage that is in place for the rental car. As per the laws in Florida car rental companies have to offer the minimum coverage for liability insurance and this has to be offered at a reasonable price to the customer. Florida being a no fault state means that under the no-fault conditions, personal injury protection doesn’t have to be purchased or carried by the drivers.
The car insurance for comprehensive coverage and collision coverage aren’t required either. There isn’t any provision that mandates insurance against accidents caused by uninsured motorists. Although these provisions aren’t really mandated by law, they are recommended for the sake of the drivers especially when trapped in unforeseen situations. To make sure your auto coverage is low in Florida, contact us here.
The auto insurance laws in Florida also include a Financial Responsibility Law. As per this law, all the drivers in the state of Florida should carry sufficient insurance coverage for a few more risks. These risks include DUI citation and revocation of license as a result, car accident that results in injuries and involves the insured driver, suspension of the license of the driver due to too many points brought up against the driver and revocation of license for habitual violation of traffic laws.
Also, the rental cars operating in Florida must have the minimum protection as mandated by the insurance laws in the state. If the credit card of the insured driver or the insurance policy for the car doesn’t cover the rental for the car, the rental agreement copy must be present in the vehicle all the time. This copy should also highlight the insurance coverage that is in place for the rental car. As per the laws in Florida car rental companies have to offer the minimum coverage for liability insurance and this has to be offered at a reasonable price to the customer. Florida being a no fault state means that under the no-fault conditions, personal injury protection doesn’t have to be purchased or carried by the drivers.
The car insurance for comprehensive coverage and collision coverage aren’t required either. There isn’t any provision that mandates insurance against accidents caused by uninsured motorists. Although these provisions aren’t really mandated by law, they are recommended for the sake of the drivers especially when trapped in unforeseen situations. To make sure your auto coverage is low in Florida, contact us here.
Tuesday, July 5, 2011
Seniors caught between cancer and the cost of treatment
Seniors caught between cancer and the cost of treatment
Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.
New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.
For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher co-payment for drugs than for some other medical services.
Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.
For more on cancer, see:
Seniors fear cancer and Alzheimer’s
Health update: New 'virtual' colonoscopy
Costly Provenge gets Medicare seal of approval
Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.
New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.
For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher copayment for drugs than for some other medical services.
Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.
For more on cancer, see:
Seniors fear cancer and Alzheimer’s
Health update: New 'virtual' colonoscopy
Costly Provenge gets Medicare seal of approval
WASHINGTON BUREAU -- The U.S. Government Accountability Office (GAO) says Internal Revenue Service (IRS) top managers must do more to ensure smooth implementation of the Patient Protection and Affordable Care Act (PPACA).
IRS officials are not doing enough to ensure on-time and on-target implementation of the 47 PPACA provisions that it will be responsible for complying with through 2018, James White, a GAO director, writes in a report summarizing the GAO's findings.
“While implementation for some provisions is years away, making improvements to the planning process now would reduce risks and might minimize future problems,” White says.
To ensure compliance, the IRS “must improve aspects of its planning, particularly at an agencywide or strategic level,” White says.
The RS has defined strategic-level goals and project plans in multiple documents but has not integrated the goals or plans, White says.
White says the GAO has given briefings to members of Congress and their staff on its findings, starting June 8, in response to lawmakers' concerns that the IRS would not be able to properly implement PPACA provisions on their effective dates.
In its briefings, GAO officials have said that the IRS management team has not developed a timeline for developing performance measures and collecting associated data.
The IRS also has not provided a cost estimate for all of PPACA, and the risk management framework does not assure that all risks, especially strategic-level risks, are identified and analyzed, White says.
The GAO is recommending that the commissioner of Internal Revenue move to define program goals and develop a project plan in one document that effectively integrates all aspects of the program.
The GAO also is recommending that top IRS managers document a schedule for developing performance measures that link to program goals and develop a more complete cost estimate that is consistent with the GAO Cost Estimating Guide.
Top managers also should modify and document the IRS risk management approach, to have more assurance that all risks, including strategic-level risks for the program, “are identified and analyzed, and that mitigation options are assessed,” White says.
The GAO acknowledges that the IRS management team has generally followed leading practices in planning to implement the PPACA provisions, White says.
The GAO also acknowledges that top IRS leadership has been involved; that cost estimates for information technology projects have specified ground rules and assumptions, data sources, and supporting calculations; and that work has started on compliance controls.
White notes that risks are being identified and analyzed at the individual project level.
OTHER COVERAGE THE IRS ROLE IN IMPLEMENTING PPACA FROM NATIONAL UNDERWRITER LIFE & HEALTH:
IRS Gives Nonprofit Plans, Hospitals More Time to Comply with PPACA
PPACA: IRS Starts to Design Health Plan Quality Research Fee
PPACA: IRS Looks at Group Health Definitions
IRS Might Issue ACO Guidance
PPACA Stars at IRS Budget Hearing
To make sure you are up to date on this and all medicare information, contact us at here
Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.
New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.
For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher co-payment for drugs than for some other medical services.
Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.
For more on cancer, see:
Seniors fear cancer and Alzheimer’s
Health update: New 'virtual' colonoscopy
Costly Provenge gets Medicare seal of approval
Advancements in the treatment of cancer have led to chemotherapy now being available in pill form, as opposed to the traditional intravenous administration.
But because Medicare Part D plans are permitted to charge exorbitant copayments for the newest cancer drugs, which can run into the tens of thousands of dollars per year, many seniors may be forgoing life-saving treatment.
New research suggests that because of the sky-high cost of these drugs, one in six such beneficiaries elects not to fill his prescriptions. Medicare officials have not been able to determine whether these patients are getting older and less expensive drugs or whether they are abandoning their treatment altogether.
For their part, Medicare insurance companies point the finger at the pharmaceutical companies, who they say are gouging a vulnerable segment of the population. In fact, some of these “blockbuster” drugs were developed using taxpayer-funded research. Predictably, big pharma blames the insurance industry for charging a higher copayment for drugs than for some other medical services.
Still others fault the entire program, which allows insurers to place certain costly drugs in a higher tier than others and charge copayments of 25 percent of the cost of the medication. These “specialty tier” drugs are not covered by Medigap. “This is a benefit design issue,” said Avalere Health president Dan Mendelson, according to the Associated Press. Currently, there are no plans to restructure Medicare Part D.
For more on cancer, see:
Seniors fear cancer and Alzheimer’s
Health update: New 'virtual' colonoscopy
Costly Provenge gets Medicare seal of approval
WASHINGTON BUREAU -- The U.S. Government Accountability Office (GAO) says Internal Revenue Service (IRS) top managers must do more to ensure smooth implementation of the Patient Protection and Affordable Care Act (PPACA).
IRS officials are not doing enough to ensure on-time and on-target implementation of the 47 PPACA provisions that it will be responsible for complying with through 2018, James White, a GAO director, writes in a report summarizing the GAO's findings.
“While implementation for some provisions is years away, making improvements to the planning process now would reduce risks and might minimize future problems,” White says.
To ensure compliance, the IRS “must improve aspects of its planning, particularly at an agencywide or strategic level,” White says.
The RS has defined strategic-level goals and project plans in multiple documents but has not integrated the goals or plans, White says.
White says the GAO has given briefings to members of Congress and their staff on its findings, starting June 8, in response to lawmakers' concerns that the IRS would not be able to properly implement PPACA provisions on their effective dates.
In its briefings, GAO officials have said that the IRS management team has not developed a timeline for developing performance measures and collecting associated data.
The IRS also has not provided a cost estimate for all of PPACA, and the risk management framework does not assure that all risks, especially strategic-level risks, are identified and analyzed, White says.
The GAO is recommending that the commissioner of Internal Revenue move to define program goals and develop a project plan in one document that effectively integrates all aspects of the program.
The GAO also is recommending that top IRS managers document a schedule for developing performance measures that link to program goals and develop a more complete cost estimate that is consistent with the GAO Cost Estimating Guide.
Top managers also should modify and document the IRS risk management approach, to have more assurance that all risks, including strategic-level risks for the program, “are identified and analyzed, and that mitigation options are assessed,” White says.
The GAO acknowledges that the IRS management team has generally followed leading practices in planning to implement the PPACA provisions, White says.
The GAO also acknowledges that top IRS leadership has been involved; that cost estimates for information technology projects have specified ground rules and assumptions, data sources, and supporting calculations; and that work has started on compliance controls.
White notes that risks are being identified and analyzed at the individual project level.
OTHER COVERAGE THE IRS ROLE IN IMPLEMENTING PPACA FROM NATIONAL UNDERWRITER LIFE & HEALTH:
IRS Gives Nonprofit Plans, Hospitals More Time to Comply with PPACA
PPACA: IRS Starts to Design Health Plan Quality Research Fee
PPACA: IRS Looks at Group Health Definitions
IRS Might Issue ACO Guidance
PPACA Stars at IRS Budget Hearing
To make sure you are up to date on this and all medicare information, contact us at here
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