Taxpayers paying twice for veterans’ health care plans


By Gregg Zoroya, USA TODAY

Updated 4h 30m ago

The Department of Veterans Affairs spent an estimated $13 billion to care for veterans whose health coverage was already paid for by Medicare — a case of the taxpayer paying twice, according to research published Tuesday.

“They pay once to Medicare Advantage plan to deliver all Medicare-covered service and they pay again to the VA to deliver comprehensive care to the same veterans,” said Amal Trivedi, a doctor with the VA and on the faculty with Brown University in Providence.

But Medicare says the $13 billion projection identified in the study, published in the Journal of the American Medical Association, is far too high.

Spokesman Brian Cook said Medicare attempts to reduce managed-care payments to private insurance companies if veterans enrolled in those programs use them less frequently, for example, because they seek treatment from the VA.

Federal law prohibits the VA from recouping expenditures from Medicare-funded health programs. The VA issued a statement Tuesday saying that even if the law were changed, allowing reimbursement would only add administrative complexity that would impede care.

“As an example, VA would have to comply with Medicare rules and policies for Veterans, which would leave VA administering two systems of care: Medicare’s and VA’s,” the statement says.

But without that reimbursement “the government has made two payments for the same services,” the medical study concludes.

Researchers examined records for 1.3 million veterans who were enrolled simultaneously with the VA program and the Medicare Advantage managed-care program between 2004 and 2009.

They found that the number of veterans enrolled in both programs increased during that time frame from 486,000 to 925,000.

In addition, the amount of VA medical care provided to those patients grew from $1.3 billion to $3.2 billion.

Kenneth Kizer, a co-author of the study and director of the Institute for Population Health Improvement at University of California-Davis Health System, said he first became aware of the issue when he was VA undersecretary for health in the 1990s. But Kizer said the study shows the problem has worsened.

Researchers found that veterans remained enrolled in both Medicare Advantage and with the VA for about three years on average. Veterans who are entitled to VA care are also entitled to Medicare after age 65.

Contributing: Kelly Kennedy

Surcharge for smokers on Medicaid

Bill seeks surcharge for Utah smokers on Medicaid

By Brian Passey, USA TODAY

ST. GEORGE, Utah – If private health insurers can add a surcharge for smokers, why not Medicaid?

  • By Victor R. Caivano, AP

    Utah Republican Rep. Paul Ray is proposing that the state impose a higher co-pay on Medicaid residents who use tobacco.

By Victor R. Caivano, AP

Utah Republican Rep. Paul Ray is proposing that the state impose a higher co-pay on Medicaid residents who use tobacco.

That’s the argument behind a bill Utah Republican Rep. Paul Ray has proposed that could become a first-in-the-nation state law imposing a higher co-payment for tobacco-using residents enrolled in Medicaid.

Although Medicaid recipients in Utah do not pay premiums, some are required to pay up to $5 co-payments for prescriptions or doctor visits.

According to the American Lung Association, smokers enrolled in Medicaid smoke at a rate 60% greater than the general population. Ray said smokers on Medicaid cost Utah $104 million annually. “If they’re paying $7 a day for a pack of cigarettes, they should be able to pay a $2 to $3 co-pay,” Ray said.

Ray said he believes his proposal is unique among state Medicaid programs. Alper Ozinal, a spokesman from the Centers for Medicare & Medicaid Programs, said his agency is not aware of other states that have considered similar legislation

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a health industry trade association, said many health insurance providers have chosen to implement surcharges on smokers because of the broad recognition that smoking increases health complications and resulting health care costs.

The American Lung Association opposes the proposed co-payment. There is no evidence that it would encourage smokers to quit, said Jennifer Singleterry, the association’s manager of cessation policy. Instead, low-income smokers on Medicaid would just have to pay more. “We feel that this is a punitive measure for smokers,” she said.

Gary Nolan, U.S. director for the Citizens Freedom Alliance, a property rights and smoker advocacy organization that also opposes the proposed law, added that legislation that affects smokers is easy to pass because smokers do not represent a large voting demographic.

The bill went before the Utah House Government Operations Committee on Thursday. It is being modified to include a wellness aspect with a smoking cessation program. Ray said he plans to bring it back before the committee next week. He said he does not expect much opposition within the heavily Republican House and Senate.

Ray said he would like to eventually extend the idea to an entire wellness program that would include obesity and alcohol use.

“I’m not trying to do this to punish people,” he said. “I’m doing this to encourage people to be healthy.”

Contributing: Passey also reports for The Spectrum in St. George, Utah

Dentist uses paper clips in Medicaid Root Canals

Dentist pleaded guilty, paper clip used in root canals
Updated 1d 1h ago
NEW BEDFORD, Mass. (AP) – A former dentist in Massachusetts has pleaded guilty to Medicaid fraud for using paper clips instead of stainless steel posts in root canals.

A former dentist in Massachusetts has pleaded guilty to Medicaid fraud for using paper clips instead of stainless steel posts in root canals.
ext Monday after pleading guilty last week in New Bedford Superior Court to a variety of charges, including defrauding Medicaid of $130,000 assault and battery, illegally prescribing prescription drugs and witness intimidation.
Prosecutors say the 53-year-old Clair was suspended by Medicaid in 2002, but continued to file claims from August 2003 to June 2005 by using the names of other dentists in his Fall River practice.
Authorities say instead of stainless steel posts for root canals, he used sections of paper clips — which can cause pain and even infection — in an effort to save money.