Over ten percent of all doctors and nurses on the government’s Medicare and Medicaid blacklist end up on it because they defaulted on government-backed student loans. Medical workers on the blacklist are barred from treating Medicare and Medicaid patients or receiving federal reimbursements for a predesignated time period.

According to a Modern Healthcare analysis of federal records, more than 5,400 of the 51,729 people on the government health entitlement blacklist were placed on it after failing to pay an HHS-backed medical student loan. Given a still-shaky economy, some in the health care sector expect that trend to continue:

[Government data] show that one of the most common reasons for getting barred is failure to repay HHS-backed student loans: 5,417 people are currently kicked out of Medicare for that.

The number of annual exclusions related to student loans has grown steadily in the past decade, peaking at 517 in 2011 before declining again. “That is tied to the economy, and I would expect that to continue to rise,” [said Lynn Gordon, a Chicago-area hospital group partner].

The increasing frequency of default-related blacklisting could prove problematic as the Obama Administration tries to entice more medical students to become primary care and family doctors. Primary care providers and nurse practitioners will be crucial to effective Obamacare implementation, since the health law is expected to drive up demand for medical services as millions of previously uninsured Americans gain coverage.

But the ballooning cost of a medical education could end up being a major barrier to the Administration’s recruitment efforts. According to the Association of American Medical Colleges’ (AAMC) 2012 report on medical school debt, “86 percent of medical school graduates had education debt, with a median amount of $162,000″ in 2011 — a number that has been rising steadily over the years:

AAMC estimates that a borrower with the median $162,000 debt “would have monthly payments ranging from $1,500 to $2,100 after residency.”

That disproportionately affects the very primary care doctors that are integral to health care reform and the U.S. medical system at large. In a 2012 report, consulting firm Merritt Hawkins & Associates found that family practitioners, pediatricians, and psychiatrists are the lowest-paid physician groups in the U.S. with a base pay of $189,000.

While that’s still a lavish salary compared to average U.S. compensation, it pales in comparison to specialist pay — and as the entitlement blacklist numbers underscore, that contributes to a system in which care providers are banned from treating certain patients for purely financial, rather than medical or criminal, reasons.

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The Center for Medicare and Medicaid Services (CMS) released highly-anticipated data on Wednesday that outlines what hospitals across America charge for common inpatient medical services. The takeaway from the new numbers? There is no rhyme or reason to what different hospitals charge for the same procedures across geographic regions (or even within the same region), and prices can fluctuate by over $100,000 in the most extreme cases.

The CMS data is comprised of charge records from over 3,300 hospitals spanning 306 localities, and detail the costs of many of the most common inpatient procedures, such as treatments for heart failure, chest pain, respiratory infections, and lower limb replacements. The Huffington Post has a helpful graphic mapping the prices that hospitals throughout the New York and New Jersey areas charge patients for treating chronic obstructive pulmonary disease (COPD), which helps illustrate just how significant the disparities can be:

These numbers confirm a recent Time Magazine investigative report that found much of the same trend throughout the U.S. And the biggest victims of this rampant price variation — and apparent price-gouging — are the poor, the uninsured, and the underinsured. Public entitlements such as Medicare are relatively protected, since the government has the power to negotiate blanket prices and reimbursement rates for specific services. But private insurers — and, of course, the uninsured — don’t have that same capacity, making them subject to the whims of the hospitals they do business with. In essence, that means that poor people’s medical and financial stability are left up to pure luck, dependent on whether or not the hospital they visit charges reasonable rates.

As Obama Administration officials explained, there isn’t any feasible economic reason for this cost variation — and reformers are hoping that the publication of the data will shame hospitals into changing these practices and acting in good faith:

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According to a new study commissioned by Bank of America Corp’s Merrill Lynch, health problems and health care are the top concerns for the Americans who are approaching retirement. Even among wealthier Americans — defined in this survey as those who have more than $250,000 in investable assets — health care expenses represent the most pressing financial concern they anticipate having during their retired years.

When asked to rank their financial worries for retirement, respondents overwhelmingly selected health care expenses as their biggest concern. Over 50 percent of the Americans in the wealthier group, as well as nearly 40 percent of those who were defined as less wealthy, said they were most worried about struggling to afford their health costs:

Health problems, rather than financial success, were also ranked as the top reason that the retired respondents decided to stop working. That could point to the fact that many Americans aren’t saving up as much money as they would like to before retiring. That’s consistent with previous research that shows that the Great Recession has negatively impacted older Americans’ ability to retire. Almost two-thirds of working Americans now report they’re planning to delay their retirement, and most Americans say they’re putting off retiring so they can continue to access health benefits through their employer-sponsored insurance plans.

Medical costs have been soaring across the entire health care sector — and, since end-of-life care is typically expensive, that trend especially impacts retired seniors. The median cost of living in a nursing home is now more than twice as much as a private college tuition. High medical costs end up bankrupting one in four U.S. seniors, despite the coverage offered under Medicare.

Novartis Pharmaceuticals Corp. isn’t having the greatest year — and things just got much worse for the drug giant. In a civil suit that builds on a separate, sealed whistleblower case, federal prosecutors charged Novartis on Wednesday morning with paying out kickbacks in an effort to get pharmacies to switch kidney transplant patients’ anti-transplant rejection generic drugs with the brand-name Novartis product Myfortic.

The scope of Novartis’ alleged fraud is staggering. In the civil complaint, prosecutors charge that the company’s U.S.-based wing “used a program of rebates and discounts to boost sales of its anti-rejection drug.” Since Myfortic is far more expensive than its generic counterparts, this market share-gouging cost government health entitlements such as Medicare and Medicaid “tens of millions of dollars in reimbursements to pharmacies for which they were never entitled,” with Myfortic sales at companies that received the bribes totaling over $100 million. Some of those pharmacies allegedly received kickbacks making up a full 20 percent of their total Myfortic sales, while the U.S. government drove an outsized 47 percent of the drug’s total sales by specialty pharmacies.

If the allegations are true, then not only did Novartis brazenly defraud the United States government — the corporation and its co-conspirators also compromised public safety and patient health. As the civil complaint states, “Hundreds, possibly thousands, of transplant patients have undergone switches in their medication as a result of the recommendations from pharmacies that were based on undisclosed financial, rather than independent critical, considerations.”

Medicare and Medicaid fraud by pharmaceutical companies is the main driver of Justice Department settlements under the False Claims Act — the same statute that Novartis is being sued under. In 2012 alone, the Justice Department nabbed $3 billion from doctors and pharmaceutical companies that swindled the public entitlement programs by charging the government more than their services were actually worth. In fact, in 2010, Novartis had to settle a separate case involving kickbacks and misuse of drugs, paying out $420 million in criminal and civil damages. The newest slate of charges against the drug giant prompted Manhattan U.S. Attorney Preet Bharara to call Novartis “a repeat offender.”

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By all appearances, UnitedHealth Group is having a stellar year. The mammoth company, which is the largest health insurer in America and the biggest manager of private Medicare Advantage plans, announced on Thursday that despite a 14 percent decline in earnings, it had still made a profit of $2.1 billion — and that was just in the last fiscal quarter. UnitedHealth also won a major policy victory at the beginning of this month when the Obama Administration reversed course on its plan to cut reimbursements to Medicare Advantage plan providers by two percent. In fact, the Administration went the entirely opposite direction and announce it would raise these rates by 3.3 percent — a swing of 5.3 percent in UnitedHealth’s favor. Apparently, that isn’t enough for the insurance company. UnitedHealth is now threatening to reduce its involvement in managing Medicare plans, claiming that its government reimbursements are still too low.

“We did not expect the fastest growing, most popular and most effective Medicare benefit option serving America’s seniors to be underfunded to this extent in 2014,” UnitedHealth Group CEO Stephen Hemsley said on a conference call with investment analysts. He went on to clarify that the company will likely have to pull out of the Medicare market as it “reshape[s] Medicare networks and benefits to respond to the continuing underfunding of this [Medicare Advantage] program.” But Hemsley’s claims conflict with the company’s own earnings report, as well as the questionable performance of private insurance plans that service Medicare beneficiaries.

Conservatives often claim that having private insurers, rather than a public entity, manage programs like Medicare helps cut costs and make care more efficient. That’s why they have held up programs like Medicare Advantage and used it as a model for dismantling traditional Medicare to turn the public entitlement into a private insurance voucher. But as numerous studies and government reports have shown, private insurers game the Medicare Advantage program as much as they can by encouraging seniors to cherry-pick their health plans relative to their health. That allows companies like UnitedHealth to pay out less in benefits by offering healthier seniors alluring rates — but it raises prices for everybody in the traditional Medicare program by siphoning off less costly beneficiaries. And yet, Medicare Advantage still consistently comes in over-budget while regular Medicare manages to save money. Profit-motivated announcements like UnitedHealth Group’s today help explain why that is.

Obamacare contains cuts to these excess payments to private providers, consequently preserving the more generous and efficient traditional Medicare program. While those cuts are likely the source of Hemsley’s ire, he shouldn’t fret too much. Since Obamacare’s began being implemented, enrollment in Medicare Advantage has actually gone up, while seniors’ premiums have gone down.

According to a new Johns Hopkins University School of Medicine study, doctors who know the cost of the medical tests and procedures that they perform tend to choose to do fewer of them then those who don’t. That ends up sparing patients from unnecessary testing and preventing Medicare from paying unnecessary reimbursements.

The study involved observing two different groups of doctors and lab technicians at Johns Hopkins Hospital over two separate time periods, while giving them different amounts of information about the Medicare fee associated with the procedures they were ordering:

In the study, physicians and others who ordered lab tests through the computerized order entry system at the Johns Hopkins Hospital were tracked over a six-month period in late 2008 and early 2009 and then again for another six months in late 2009 and early 2010 on how they ordered a selected group of 61 lab tests. Roughly half were chosen from the most frequent tests ordered at the hospital, and the other half, the most expensive. [...]

[Researchers] found that, in the test group, when prices weren’t made available, the providers ordered 3.7 tests per patient day, but later, when the prices were linked, the number of tests per patient day fell to 3.4, a drop of nearly 8.6%.

In contrast, the number of tests in the control group, those without pricing in both test periods, rose by 5.1%.

Test costs followed a similar path. For the test group with prices, the cost per patient day fell $3.79, for a drop of 9.6%. Meanwhile, in the control group, charges per patient day rose by $0.52 per patient day, or by 2.9%.

The results are encouraging from both a public health and a financial perspective, since unnecessary testing and procedures do nothing to improve patient care — and in some instances, can even make it worse — and lends to America’s record public and private health care spending.

But even more interesting is the study’s implications for physician medical culture and Medicare fraud. The Justice Department makes much of its settlement money from doctors who cheat Medicare through practices such as “self-referrals” for unnecessary testing and “upcoding” the cost of their Medicare patients’ services in order to return a profit. There have been some early rumblings in health care reform circles that Obamacare’s provision requiring providers to use electronic health records (EHRs) could actually lead to even more fraud by offering physicians an easier way to cheat the system. However, the Johns Hopkins study suggests that most doctors will actually make more prudential decisions when armed with exact information, so if EHRs are linked with exact Medicare fee data, it could actually make care more efficient, safe, and cost less to entitlements like Medicare.

A new government report from the Department of Health and Human Services (HHS) finds that Medicare Part D — the prescription drug benefit that helps eligible seniors afford the medication they need — could have made over $111 million in 2009 alone with a simple change to the way it pays insurers. The findings illustrate that smart systemic tweaks to Medicare’s payment structure could significantly reduce the program’s costs without the need to slash benefits for elderly Americans.

Medicare Part D currently subsidizes the cost of medications on private prescription drug plans — but as the program is structured right now, those private plans can make money off of payments from the federal government without having to provide benefits. Under current law, Medicare has to make advance payments to seniors’ prescription drug plan provider at the beginning of every month. So even if a senior doesn’t submit a claim for drug coverage that month, their plan provider still gets paid.

There’s nothing wrong with that; it’s just how insurance works. But the 2003 law that created the drug benefit also allows private Part D plans to “invest these Medicare funds in interest-bearing instruments until the funds are needed to pay for drug costs and administrative services.” That allows private insurers to take federal Medicare dollars, invest them in an account that garners interest, and then keep netting those interest profits until the beneficiary submits a claim and forces the insurer to pay out. There are no limits to how much money insurers can make off interest payments in this fashion.

And as it turns out, this is costing the government millions of dollars in potential savings every month. The HHS report found that in calendar year (CY) 2009, Part D plans held onto — and profited off of — federal Medicare funds for an average of 20 days before having to pay out pharmacy claims. The auditors go on to explain that if the situation were simply reversed, and the federal government was allowed to hold on to and invest those funds for 20 days before having to pay the private insurer, then Medicare would have netted “$111.2 million of interest income in CY 2009.” Although the Center for Medicare Services claims that such a policy change would just lead Part D providers to raise the price of their bids to the government, the report points out that any decreased savings from such a move would be offset by “the higher interest earned by Medicare trust funds” compared to that earned by Part D plans.

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On Tuesday, Rep. Renee Ellmers (R-NC) introduced H.R. 1416, The Cancer Patient Protection Act of 2013. According to a press release on Ellmers’ congressional webpage, the bill would reverse sequester cuts to Medicare funding for physician-administered chemotherapy drugs, which she calls “an unintended consequence of sequestration,” and reimburse doctors for any cuts that have affected them since the beginning of the month. The sequester’s two percent cut to Medicare Part B has been forcing community cancer clinics to turn away thousands of Medicare beneficiaries and deny them their treatments.

Although the congresswoman — a registered nurse — claims that the cuts to oncologists administering chemotherapy are simply an “unintended consequence,” they are anything but. The Budget Control Act, which included the sequester, specifically states that Medicare is subject to an across-the-board two percent cut. That’s about as intentional as you can get.

What Ellmers is really saying is that she didn’t realize exactly what those cuts would mean for the well-being of real Americans once they were actually implemented. She voted for the Budget Control Act back in 2011 and was still arguing the merits of sequestration earlier this year. “I do believe [the sequester] will start a very important process that will help our economy to start to grow. The debt that we have at the federal level is our biggest threat for our country,” she told the Washington Post in February.

That’s a shift from the recent rhetoric from Ellmers’ GOP colleagues. Republicans in Congress have been largely brushing off the sequester cuts, claiming their impact has been exaggerated and they aren’t actually a big deal. But now that the cuts are forcing schools, aviation centers, health care providers, and countless other organizations that receive federal funding to make tough decisions in the face of sequestration — decisions that affect Republican constituencies just as much as they affect Democratic ones — it’s becoming clear that abstract numbers on a balance sheet have tangible, real-world effects.

According to CNNMoney, the median cost of living in private nursing homes and assisted living facilities has ballooned by 24 percent and 23 percent, respectively, over the last five years. The median annual cost of private nursing home care is now $83,950 — almost two and half times the mean tuition at private not-for-profit colleges in 2010-2011.

Semi-private room costs in nursing homes have risen to $75,405 per year, and even a stay at an assisted living facility — where patients do not receive anywhere near the level of care that they would at a private nursing home — now tends to cost over $41,000 per year. As Bob Bua, vice president of long-term care provider Genworth, explained, employees at nursing homes “rarely get pay decreases, food rarely costs less, rent rarely goes down — it’s an ever-increasing cycle.”

The CNNMoney article points out that less costly alternatives include hiring home health care aides and other live-in assistance. The median price for those services have only risen at about one percent per year over the last half decade to about $44,000 annually. But considering health aide salary data released last month, even that comparatively low price is a figure that is greatly inflated by organizations providing assistance services to the elderly. Home health aid — the fastest-growing job in America — pays less than $10 per hour, meaning that a full-time worker makes only around $20,000 per year.

These new numbers underscore the financial and medical strain put on elderly Americans due to the ever-increasing cost of health care services. Despite generous coverage under Medicare, high out-of-pocket costs bankrupt one in four American seniors because medical services themselves cost so much money. And more than half of Americans will delay their retirement so as not to lose health benefits — a consequence of America’s entrenched system of employer-sponsored insurance.