News in brief - Nov. 20, 2000

Seniors unaware of Medicare assistance programs - Many Medicare beneficiaries underusing necessary services - Health care generates most civil fraud winnings for government

Seniors unaware of Medicare assistance programs

A new Medicare Rights Center study found that low-income seniors are not enrolling in government assistance programs because they are unaware the programs exist, or are unwilling or unable to apply for them. Medicare assistance programs help seniors pay for Medicare premiums, deductibles and coinsurance.

"Congress needs to federalize and simplify the enrollment process to remove the barriers that prevent low-income people with Medicare from accessing the very programs it created to help," said MRC President Diane Archer.

The study found that 42% of those surveyed had contacted a Medicaid office for financial help, but only 12% were told about Medicare assistance programs. And only 2% of those who had been told about the programs applied for benefits. More information is available at the MRC Web site (http://www.medicarerights.org/).

Many Medicare beneficiaries underusing necessary services

Seniors may not be getting necessary care despite enrollment in Medicare, according to a study in the Nov. 8 JAMA.

Researchers developed a system that uses data from Medicare claims to determine if seniors are underusing necessary care for 15 medical or surgical conditions. "Our results suggested that underuse of necessary care is widespread for the 15 target conditions, even in the relatively well-insured Medicare population," the researchers wrote. "For 16 of 40 necessary care indicators ... beneficiaries received the indicated care less than two-thirds of the time."

Health care generates most civil fraud winnings for government

The United States recovered more money in civil fraud cases than ever before, and health care topped the list of sectors from which those dollars came. Overall, the Dept. of Justice collected $1.5 billion last fiscal year, and more than $840 million of that came from health care fraud.

Government recoveries included:

$385 million from Fresenius Medical Care -- the largest civil fraud recovery ever -- to settle allegations of wrongdoing by its kidney dialysis subsidiary.
$170 million from the country's largest nursing home operator, Beverly Enterprises Inc., to settle allegations that it falsely billed Medicare.
$53 million from Gambro Healthcare Patient Services Inc. to settle allegations that it billed Medicare for unnecessary laboratory tests.