Medicare

Private Medicare Advantage plans treating the elderly have overbilled the government by billions of dollars, but rarely been forced to repay the money or face other consequences for their actions, according to a congressional audit released Monday.

Updated April 20 at 1:50 ET with a statement from the American Hospital Association.

Bowing to pressure from the hospital industry and Congress, the Obama administration on Wednesday delayed releasing its new hospital quality rating measure just a day before its planned launch.

Eliza Catchings has been seeing doctors at the Christie Clinic in central Illinois since 1957. But just after receiving this year's WellCare Medicare Advantage member card, the insurer told her the clinic was leaving WellCare's provider network and she would have to choose new doctors.

"I was terrified," said Catchings, 79, who gets care for diabetes and heart problems. But she was helped by a little-noticed change in federal policy.

A diabetes prevention program being tested by the YMCA of the USA has proved successful at reducing the risk of developing the disease, according to the Department of Health and Human Services.

So the Obama administration wants Medicare to pay for the services for beneficiaries at high risk of developing diabetes.

Aetna and Cigna inked deals last month with drug maker Novartis that offer the insurers rebates tied to how well a pricey new heart failure drug works to cut hospitalizations and deaths. If the $4,500-a-year drug meets targets, the rebate goes down. Doesn't work so well? The insurers get a bigger payment.

In another approach, pharmacy benefit firm Express Scripts this year began paying drug makers a special negotiated rate for some cancer drugs. The goal is to reward the use of medicines that are most effective for certain cancers.

Medicare is going to test new ways to reimburse doctors for medications, in hopes they'll choose less expensive drugs.

The plan would alter Medicare Part B, which pays for medicines administered in doctors offices or outpatient hospital clinics — to eliminate incentives for doctors to use the most expensive drugs.

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We’ve been hearing a lot about the politics of health care lately.  In the meantime, many employers are in open enrollment season, making for a confusing month when it comes to health insurance.  And for seniors on Medicare,  November brings the annual dilemma about prescription drugs.