Massachusetts is the model, right?
"Long term care insurance premiums on the rise" by Deirdre Fernandes | Globe Staff, September 06, 2013
Sharp increases in rate requests for long-term care insurance are raising the chances that the next wave of retirees may not be able to afford coverage for assisted living, nursing homes, and related health services.
Since early 2012, the Massachusetts Division of Insurance has regularly approved premium increases of about 10 percent for the insurance, which was introduced in the 1980s as a hedge against the high and extended costs of nursing care. Regulators are now reviewing requests by some companies to nearly double their rates — potentially increasing premiums by thousands of dollars a year.
For many retirees, the increases are hitting as they come closer to needing the care, leaving them with the choice of devoting more of their fixed incomes to the insurance, reducing benefits, or dropping the coverage. AARP, the powerful lobby for older Americans, is warning consumers to make sure they’ll be able to afford rapidly rising premiums before they buy long-term policies.
I thought Obamacare was supposed to eliminate the need to make those choices.
“If I knew it was going to be like this, I wouldn’t have bought it,” said George DiBlasi, 71, who purchased a long-term care policy from John Hancock Financial Services in 2007 and recently received a notice his premiums will rise 10 percent, to $3,300 a year. “They sand-bagged us.’’
DiBlasi, who retired as Norwood police chief in 1998, said he’ll keep paying for now, since he has already invested so much in the policy and doesn’t want to stick his family with long-term care costs they cannot afford.
More than 150,000 people in Massachusetts hold long-term care policies, either individually or through their employer. About 8 million Americans carry the insurance.
Across the country, insurers that offer the coverage have asked state regulators for double-digit rate increases in recent years. The average cost of a policy has jumped 80 percent for a 55-year-old couple, to more than $3,500 annually last year from less than $2,000 in 2007, according to industry statistics....
Long-term care insurance was designed to fill the gap between Medicare, the health insurance for the elderly that only covers short-term rehabilitation and recovery services, and Medicaid, the program for the poor that pays for long-term care after a senior exhausts assets and meets income requirements....
Rick Fingerman, a financial planner in Newton, said the increases have been disconcerting to his clients, but they’re keeping the plans, believing they have little choice.
They’ve taken care of spouses or family members, Fingerman said, and “they’ve seen how devastating the costs can be.”
--more--"
Related: The looming long-term care crisis
"Health plan for disabled adults cut back in Mass.; As insurers balk, 5 counties are excluded from experiment" by Chelsea Conaboy | Globe Staff, July 29, 2013
Massachusetts health insurers’ reluctance to join a national experiment to improve care for disabled lower-income adults has forced the state to scale back the program even before it starts.
Obama has done that with his big business exemption and waiving of patient cost caps.
Massachusetts is among the first states to roll out the national program, but half the insurers that were expected to participate backed out because they feared losing money. That will mean fewer options for patients....
Enrollees in most Massachusetts counties would have had four or more insurers to choose from under the original plan. Now, about half of eligible enrollees will have just one choice. Five counties — Bristol, Berkshire, Barnstable, Dukes, and Nantucket — will be excluded because no insurer signed on to serve customers there.
Insurers and policy makers in other states have faced similar challenges, in some cases delaying start dates and shrinking expectations for the program, which aims to provide intensive services and cut costs for up to 2 million people across the country with the most complicated and expensive medical needs.
“Not too many people thought it would be easy,” said Kevin Prindiville, executive director of the National Senior Citizens Law Center, who has tracked the program in each state, “but it’s turning out to be even harder than people even thought.”
Some patient advocates say a smaller, slower start may be better for vulnerable patients, allowing time to work out the inevitable kinks of any new initiative.
The program will serve low-income and disabled people, ages 21 to 64 in Massachusetts, whose health care bills previously have been covered by two government programs — federally run Medicare and state-run Medicaid — making it difficult to track and manage their care for the lowest cost and best results....
--more--"
"UMass Medical Center settles fraud charges" by Beth Healy | Globe Staff, August 22, 2013
Worcester’s UMass Memorial Medical Center has settled fraud charges with the attorney general in a whistle-blower case alleging that it improperly sent bills for uninsured patients to a homeless shelter, so it could tap the state for payments.
Are you sure this is what you want, America?
On dozens of occasions, the hospital sent unpaid bills for emergency care to an address where the patients did not live: 701 Main St. in Worcester, the location of the People in Peril homeless shelter, according to court documents unsealed Monday.
The practice, described in a whistle-blower lawsuit in federal court in Worcester, allegedly established a phony patient address and a paper trail of dunning notices, so the hospital could then submit the bills to a state program for payment.
The hospital agreed to pay the state $66,000 in a settlement filed last month. The federal government, which the whistle-blower originally included as a plaintiff in the lawsuit, investigated the case but declined to pursue it.
Whistle-blower Nelson Castro, a former collections analyst at the hospital, said he learned of the billing practice when a Canadian patient called to settle an emergency room bill for thousands of dollars. Castro alleged that the patient’s address was listed as the shelter’s location. And the bill was already marked as paid.
Upon examining the department’s database, “hundreds, if not thousands” of entries appeared with the 701 Main St. address, according to Castro. However, state officials said the number of improper bills was in the dozens.
Despite the settlement, the hospital said it did nothing wrong. “UMass Memorial Medical Center has denied all allegations and has fully cooperated with the Massachusetts attorney general’s office in this matter, which is now fully resolved with a minimal payment,” a hospital spokeswoman, Margaret Thrappas, said in a statement.
She declined to say whether any employees had been disciplined or what the hospital had done to change its practices. “UMass Memorial’s quality process is comprehensive, and includes appropriate and applicable control standards,’’ Thrappas said in an e-mail.
The patients at issue had no health insurance, so the hospital would have had to pursue them directly for payment. Many of their addresses were unknown or in question; some were allegedly from other states or countries.
Castro’s complaint detailed an alleged scheme in which the hospital sent bills to the shelter as a “dead letter drop.” The hospital would send three letters per patient to the shelter within 120 days, he said, followed by a fourth sent by certified mail. The letters went unanswered, since the patients had no connection to the shelter.
By establishing a fake trail of Massachusetts residency, the hospital could then submit claims to the state for payment. The state, under certain circumstances, reimburses medical facilities for care provided to uninsured people through a pool called the Health Safety Net.
In the settlement, Attorney General Martha Coakley’s office said the hospital “knowingly caused claims for emergency bad debt to be submitted to the Commonwealth’s Health Safety Net office,’’ falsely using the shelter address to receive payments “to which the Commonwealth alleges UMass Memorial was not entitled.”
Castro had originally alleged a much larger number of false bills were sent to the shelter, garnering an estimated $10 million in fraudulent government payments. But the US attorney’s office, after investigating, determined the damage was far less than Castro alleged and mostly incurred by the state....
--more--"
Related: Transport service accused of bilking MassHealth out of $470,000
Giving rides to dead people?
It's enough to drive you nuts.
"Mental health clinics cited" by Chelsea Conaboy | Globe Staff, June 20, 2013
Dozens of therapists who were unlicensed or improperly supervised routinely treated mentally ill patients at three clinics owned by a major provider of care to low-income people in Massachusetts, state records show.
At an Arbour Health System clinic in Lawrence, state inspectors determined that all 23 therapists were not qualified to see patients on their own, yet were doing so without regular oversight by a licensed professional. Similar staffing violations were discovered at Arbour clinics in Malden and Fall River.
The findings last year, described in documents obtained by the Globe and filed as part of a lawsuit, highlight a two-tier system in which low-income patients often are treated by mental health workers with less training and expertise than caregivers for privately insured patients....
Arbour operates five psychiatric hospitals and 11 mental health clinics in Massachusetts. Its for-profit parent, Universal Health Services, is a publicly traded company that earned more than $443 million last year and has staked its future largely on expanding in the behavioral health care market....
--more--"
Just give a drug:
"Hospitals want to test drug with no consent" by Chelsea Conaboy | Globe Staff, June 08, 2013
A group of Boston doctors is proposing to join a study that would provide emergency treatment for brain-injured patients without obtaining the trauma victims’ consent, arguing that they often arrive at the hospital unconscious or without family members who can speak on their behalf.
Federal law and the generally accepted ethics of medical research require that patients or their surrogates be told about any risks of participating in a study and have the chance to refuse enrollment. But the law allows for an exemption in certain cases involving emergency care.
This would be the first study using the exemption at a Boston hospital since the Food and Drug Administration created the rules allowing it in 1996, said Dr. James Feldman, an investigator and the chairman of a Boston University Medical Campus panel that reviews research.
Research without consent is controversial, and some ethicists argue that it is almost never appropriate. “People don’t expect to be researched on when they go to an emergency department, and they don’t consent to research just by being in an accident,” said George Annas, a BU bioethicist who is not involved in the brain trauma proposal.
The study team, from Boston Medical Center and Massachusetts General Hospital, is hoping to join a national trial looking at whether giving the hormone progesterone to patients in the hours immediately after a traumatic brain injury could prevent further neurologic damage....
--more--"