New Medicare drug benefits are falling short for some

first_imgWASHINGTON – Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of federal audits has found. The problems, described in 91 audit reports reviewed by The New York Times, include improper termination of coverage for people with HIV and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores. Medicare officials have required insurance companies of all sizes to fix the violations by adopting “corrective action plans.” Since March, Medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits. The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and WellPoint. “The Medicare drug benefit is saving seniors an average of $1,200 a year,” said Michael O. Leavitt, the secretary of health and human services. Medicare officials said the audits also showed that insurers would be held accountable. “The start-up period is over,” said Kerry N. Weems, the new acting administrator of the Centers for Medicare and Medicaid Services. “I am simply not going to tolerate marketing abuses.” The same insurance companies that offer stand-alone drug plans also sell Medicare Advantage plans, which provide a full range of benefits including coverage of doctor’s visits and hospital care. Enrollment in Medicare Advantage plans has increased sharply, to more than 7.7 million, from 4.7 million in 2003. Federal auditors found the same types of violations in both parts of the program. Of the audits conducted by the Department of Health and Human Services, 39 focused on drug benefits, 44 focused on managed care plans and eight examined other types of private plans. Medicare officials said compliance problems occurred most often in two areas: marketing and the handling of appeals and grievances related to the quality of care. Many of the marketing abuses occurred in sales of the fastest-growing type of Medicare Advantage product, known as private fee-for-service plans. In June, the government announced that seven of the leading companies in this market, including UnitedHealth, Humana and Coventry, had agreed to suspend marketing of these plans. Medicare recently allowed them to resume marketing after they took steps to monitor their sales agents more closely. Each Medicare plan has a list of preferred drugs, known as a formulary. Under federal law, patients can request coverage of other drugs that may be medically necessary. But many insurers do not have procedures to handle such requests, auditors said. John H. Wells, the compliance officer at Bravo Health, defended the company’s record, but he said: “The appeals and grievance process is very complex. It is very difficult for any plan to be fully compliant. In many cases, the government’s guidance is unclear, so it’s impossible for a business to know what to do.” These findings were typical of the deficiencies described in Medicare audit reports: UnitedHealth, which serves more than 6 million Medicare beneficiaries, did not have an “effective program” to supervise its marketing representatives, agents and brokers. In some cases, United improperly denied claims without giving any explanation to beneficiaries. Peter L. Ashkenaz, a company spokesman, said, “We terminated a few agents and brokers for misrepresenting our products.” WellPoint, one of the nation’s largest insurers, had “a backlog of approximately 354,000 claims” at certain Medicare plans offered through its UniCare subsidiary. The company’s call center took an average of 27 minutes to answer phone calls from members and 16 minutes to answer calls from health care providers. More than half the callers hung up before speaking to a representative. Karen Brown, a spokeswoman for WellPoint, had no immediate comment. In March, Sierra Health Services ended drug coverage for more than 2,300 Medicare beneficiaries with HIV/AIDS, saying they had not paid their premiums. In many cases, the premiums had been paid, and beneficiaries had canceled checks to prove it. Sierra initially refused to reinstate them but eventually agreed to do so after repeated requests from federal officials. Peter O’Neill, a vice president of Sierra, said this particular drug plan, which attracted people with very high drug costs, would not be offered in 2008. Humana, which covers more than 4.5 million people on Medicare, promised to investigate every complaint about its marketing practices, but it received so many complaints it could not keep up. Many beneficiaries said they had received incorrect information from Humana agents. Medicare officials said some agents had not been adequately trained or supervised. Thomas T. Noland Jr., a senior vice president of Humana, said the company had taken “corrective action to improve the situation.” Humana did not always tell beneficiaries about changes in its list of covered drugs. In some cases, Humana did not explain its reasons for denying claims and did not inform beneficiaries of their appeal rights. The Sterling Life Insurance Co., a subsidiary of the Aon Corp., did not pay claims correctly or handle appeals in a timely way. The company has “a demonstrated pattern of failure” to meet Medicare performance standards. Problems were compounded by a rapid growth in enrollment. Sterling said it had taken steps to improve compliance. Two sponsors of popular Medicare drug plans, MemberHealth and Bravo Health, did not act on requests for coverage of specific drugs within 72 hours, as required by the government. Bravo did not comply with federal rules requiring doctors to review all claims denied for a “lack of medical necessity.” D. Alan Scantland, senior vice president of MemberHealth, a subsidiary of the Universal American Financial Corp., said, “We don’t believe that we were compromising any beneficiaries’ health because of what we were doing or not doing.” Rep. Bart Stupak, a Michigan Democrat who is chairman of the investigations subcommittee of the House Energy and Commerce Committee, said he had “verified countless stories of deceptive sales practices by insurance agents who prey upon the elderly and disabled to sell them expensive and inappropriate private Medicare plans.” Kathleen Healey, a lawyer at the Alabama Department of Senior Services, said: “Despite the prohibition of door-to-door marketing, agents arrive on residents’ doorsteps stating that the president sent them, or that they represent Medicare. Some telemarketers insist they are calling from Medicare, and they tell beneficiaries that they will lose their Medicare if they do not sign up for the telemarketer’s plan.” Medicare has taken “vigorous action” to halt marketing violations, said Abby L. Block, a Medicare official.160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set! AD Quality Auto 360p 720p 1080p Top articles1/5READ MOREChargers go winless in AFC West with season-ending loss in Kansas CityThe audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients – for example, by delaying access to urgently needed medications. In July, Medicare terminated its contract with a private plan in Florida after finding that it posed an “imminent and serious threat” to its 11,000 members. In other cases, where auditors criticized a company’s “policies and procedures,” the effects on patients were not clear. The audits show the growing pains that Medicare has experienced as it introduced the popular new drug benefit and shifted more responsibility to private health plans. For years, Democrats have complained about efforts to “privatize Medicare,” and they are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients. But federal officials point with pride to their efforts to police the Medicare market, and they say that competition among private plans has been a boon to beneficiaries, offering more choices at lower cost than anyone expected. last_img read more

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Joint inquiry launched into CIA tapes

first_img“I understand that your office has already reviewed the circumstances surrounding the destruction of the videotapes, as well as the existence of any pending relevant investigations or other preservation obligations at the time the destruction occurred. As a first step in our inquiry, I ask that you provide us the substance of that review at the meeting,” Wainstein wrote. The White House had no immediate comment on the decision. On Friday, presidential spokeswoman Dana Perino said the White House would support Attorney General Michael Mukasey if he decided to investigate. Angry congressional Democrats had demanded the Justice Department investigate. Some accused the CIA of a cover-up. The man now at the center of the storm is Jose Rodriguez, who retired as head of the CIA’s clandestine directorate of operations in August 2007 but will leave the agency at the end of the year. Rodriguez decided the tapes should be destroyed, one former and one current intelligence official told The Associated Press. A career spy, Rodriguez was promoted to the job by then-CIA Director Porter Goss. Goss learned of the tapes’ destruction “a couple of days” after it happened, a government official familiar with the events said. The official said Goss did not order an investigation or inform Congress. Goss was upset by the tapes’ destruction but did not take any action because the decision was within Rodriguez’s authority, a former intelligence official told the AP. The CIA’s spy service has broad latitude to take actions to protect operational security. “Though Goss believed this was a bad judgment it falls within prerogatives of the directorate of operations,” said the former official, who like other current and former officials spoke on condition of anonymity to discuss sensitive information. The tapes were destroyed shortly after The Washington Post in late 2005 revealed the existence of secret overseas prisons, which angered the cooperating governments. Another intelligence official said Rodriguez was concerned the tapes would leak and the interrogators seen in the tapes would be targeted by al-Qaida. “Rodriguez felt he had good reasons to deep-six the tapes. They had people’s faces on them. It’s not like a name getting out,” the official said. The Justice Department and CIA inspector general inquiry is expected to focus on whether Rodriguez had the inherent authority to destroy the tapes.160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set! “This administration cannot be trusted to police itself,” Reyes said. The Senate Intelligence committee is also investigating. Hayden told agency employees Thursday that the recordings were destroyed out of fear the tapes would leak and reveal the identities of interrogators. He said the sessions were videotaped to provide an added layer of legal protection for interrogators using new, harsh methods authorized by President Bush as a way to break down the defenses of recalcitrant prisoners. The CIA’s acting general counsel, John Rizzo, is preserving all remaining records related to the videotapes and their destruction, according to Kenneth L. Wainstein, assistant attorney general. Justice Department officials, lawyers from the CIA general counsel’s office and the CIA inspector general will meet early this coming week to begin the preliminary inquiry, Wainstein wrote Rizzo on Saturday. WASHINGTON – The Justice Department and the CIA’s internal watchdog announced Saturday a joint inquiry into the spy agency’s destruction of videotaped interrogations of two suspected terrorists as the latest scandal to rock U.S. intelligence gathered steam. The review will determine whether a full investigation is warranted. “I welcome this inquiry and the CIA will cooperate fully,” CIA Director Mike Hayden said in a statement. “I welcome it as an opportunity to address questions that have arisen over the destruction back in 2005 of videotapes.” The House Intelligence Committee is launching its own inquiry next week. It will investigate not only why the tapes were destroyed and Congress was not notified, but also the interrogation methods that “if released, had the potential to do such grave damage to the United States of America,” said Chairman Rep. Silvestre Reyes, D-Texas, on Saturday. last_img read more

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Gaeil Fhánada express disappointment over referee mix-up against Naomh Bríd

first_imgLotto ResultsNumbers drawn were: 08, 11, 12, 17, 18. Bonus No 17.  €100 winner Delia Dorrian, The Ross.  €50 winner Nancy Dorrian, Coolback. Next week’s jackpot is €550.  Brendan and Máire on duty.Seniors & ReservesDiv 3 League Gaeil Fhánada v N BridThe club were disappointed that the senior match v N Brid was unable to go ahead on Sunday last due to a mix up with referees which meant the match will have to be rescheduled. Apologies to all the supporters who braved the weather and were disappointed, especially all who travelled from Ballintra.Mna Gaeil FhánadaWhat a season for our Ladies and management!Congratulations to Gaeil Fhánada Ladies who have won the County Shield Div 3 Final 4-19 to 2-02 last Sunday in Termon.Foireann: Rosheen Mc Ginley, Roisin Carr, Orla Sweeney,Gráinne Friel,Niamh McDevitt,Maggie Friel,Shauna Howe,Michelle Doherty 0-1,Orla Mc Gonigle,Orlaigh Carr 0-2,Hannah Shiels 0-5,Lauren Carr 0-2, Caoimhe Walsh 1-2,  Siobhan Coyle 1-3, Maireád Coll 2-2,Aisling McDevitt, Rachel Sweeney 0-2, Eimear Mc Conigley, Deirdre Friel, Aisling Howe, Eilish Mccarron.This was a rematch of the Corn Soisir na Gaeltachta back in May.  This has been an amazing year for our senior ladies reaching 3 County finals and winning all of them. Well done again ladies and congratulations on a great year. U13 GirlsExcellent performance from our new team of girls. Unreal result for a first time team.Cloughaneely 4:08 v Gaeil Fhánada 4:03.  Keep up the good work girls!We have 2 games & a final day left this season.  Next game Gaeil Fhánada v Gweedore (home) on Monday 26th Sep @ 5.45pm.Training continues every Monday evening 6pm.  Only 2 games & a final day left this season.We play Termon on Saturday 1st October @ 11.30am.U16 boys Very well done to Gaeil Fhánada’s U16 boys on reaching the Division 2 Co. Final. They played a hard-fought entertaining game in Convoy today in very blustery conditions where N.Náille emerged as winners. Everyone in Gaeil Fhánada are very proud of you all and your management.Comhghairdeas mór to our Senior keeper Brendan Friel and his fiancee Aisling McElwaine on the birth of their wee girl Fódhla. Congratulations! Another wee player for the Gaels!Congratulations to our neighbours Milford Clg Baile Na NGalloglach who captured the Division Two league title l.ast weekend. Their recent achievements are a great inspiration to clubs around them that with the right attitude and commitment, anything is possible.  Well done to all involved with the success and hopefully we can rub shoulders with them in the very near future again.Gaeil Fhánada express disappointment over referee mix-up against Naomh Bríd was last modified: September 13th, 2016 by Mark ForkerShare this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to share on Pocket (Opens in new window)Click to share on Telegram (Opens in new window)Click to share on WhatsApp (Opens in new window)Click to share on Skype (Opens in new window)Click to print (Opens in new window)Tags:GAAGaeil FhanadaRefereesSportlast_img read more

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LYIT STUDENTS NAIL THEIR COLOURS TO THEIR BACKS!

first_imgThere was fierce rivalry at the LYIT in Letterkenny today as the college held a jersey day.Students were encouraged to wear their county colours and they turned out in their dozens during the event which was organised by the student’s union. Needless to say the biggest rivalry was between Donegal and Mayo supporters ahead of Sunday’s All-Ireland final.Pictures by kind permission of Paddy Gallagher. LYIT STUDENTS NAIL THEIR COLOURS TO THEIR BACKS! was last modified: September 19th, 2012 by StephenShare this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to share on Pocket (Opens in new window)Click to share on Telegram (Opens in new window)Click to share on WhatsApp (Opens in new window)Click to share on Skype (Opens in new window)Click to print (Opens in new window) Tags:jerseysLYITstudentslast_img read more

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PAT PUTS ON THE TEA FOR THE ALZHEIMER’S SOCIETY IN CREESLOUGH – PIC SPECIAL

first_imgI could have sworn I left a cup of tea here with this scone! Locals enjoy the craic at Pat McCarry’s house in aid of the Donegal branch of the Alzheimer’s Society. ALL PICS BY KIND PERMISSION OF MOSES ALCORNThese ladies are looking well at the tea party in Creeslough. PAT PUTS ON THE TEA FOR THE ALZHEIMER’S SOCIETY IN CREESLOUGH – PIC SPECIAL was last modified: August 9th, 2014 by StephenShare this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to share on Pocket (Opens in new window)Click to share on Telegram (Opens in new window)Click to share on WhatsApp (Opens in new window)Click to share on Skype (Opens in new window)Click to print (Opens in new window) Tags:Alzheimer’s SocietyCreesloughdonegalPat McCarrylast_img read more

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Garda motorcyclist involved in Letterkenny crash

first_imgA Garda motorcyclist has been injured following a crash at the Polestar Roundabout on the outskirts of Letterkenny.The Garda came off the vehicle following the incident around 8.05am.Traffic was delayed but the area was cleared and traffic is flowing freely again. A Garda spokesman told Donegal Daily “Gardaí are investigating a single vehicle collision involving a motorcyclist aged in his 30s that occurred on 18/5/19 at approximately 8:05am at the Polestar Roundabout Letterkenny. Man received minor injuries. Investigations are ongoing.”Garda motorcyclist involved in Letterkenny crash was last modified: May 19th, 2019 by Staff WriterShare this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to share on Pocket (Opens in new window)Click to share on Telegram (Opens in new window)Click to share on WhatsApp (Opens in new window)Click to share on Skype (Opens in new window)Click to print (Opens in new window)last_img read more

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Winks not ready to return – Pochettino

first_img Follow West London Sport on TwitterFind us on Facebook Embed from Getty ImagesMauricio Pochettino said injury and illness meant Harry Winks was not an option for Tottenham’s FA Cup win against AFC Wimbledon at Wembley. The England international, a popular figure among fans, has not featured for Spurs since the Boxing Day win against Southampton.“Harry Winks had a problem in his ankle and had a cold during the week. He’s not ready to play,” boss Pochettino explained.“They’re not machines. There are 24 players who all work hard to fight for one place in the starting 11.”Embed from Getty ImagesHarry Kane scored twice as Spurs won 3-0 to take their place in the fourth round.“I think it was a solid performance. We created a lot of chances,” Pochettino said.“In the first half we played well but it was difficult to score. In the second half we deserved to score and go through to the next round.”See also:Two more goals for Kane as Tottenham see off AFC Wimbledon at WembleySpurs v AFC Wimbledon player ratingsTottenham youngster completes loan movelast_img read more

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Live updates: Warriors vs. Bulls, Friday at 7:30 p.m.

first_imgJoin us for live news and analysis Friday at 7:30 p.m. as the Warriors hope to take care of another Eastern Conference opponent this week when the Bulls come to Oracle.The Warriors (27-14), who routed the Knicks 122-95 Tuesday night behind Klay Thompson’s 43-point night, are looking to duplicate their one-sided victory over the Bulls in October. Back then, Thompson set a new NBA record with 14 3-pointers as he poured in 52 points on 18-of-29 shooting in just 27 minutes.Thompson’s …last_img

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South Africa, look how far we’ve come: Zuma

first_img14 February 2014 President Jacob Zuma used his sixth State of the Nation address on Thursday night to highlight South Africa’s achievements over the past five years, while acknowledging that more needs to be done to tackle growing youth unemployment. As expected, Zuma reported at length on progress in the country’s infrastructure programme since 2009. Among the completed projects he highlighted were the Rea Vaya bus rapid transit system in Johannesburg, which is now used by more than 100 000 people a month, with similar systems under construction in Cape Town, Pretoria, Port Elizabeth, East London, Durban and Rustenburg. The country’s harbours and ports have been improved, 1 500 kilometres of new roads and road lanes lanes have been built countrywide, construction of new rail lines is under way in Mpumalanga, and a 700-kilometre fuel pipeline has been built between Durban to Gauteng to transport four-billion cubic litres of petrol, diesel and jet fuel a year. The Gautrain rapid rail link between Johannesburg, Pretoria and OR Tambo International Airport carries over 1.2-million passengers a month, and the Passenger Rail Agency of South Africa will spend over R120-billion over the next 10 years on buying new trains and further improving the country’s transport system. Transnet, meanwhile, will be spending R300-billion on transport infrastructure under its market demand strategy, which it has begun implementing. To realise the economic potential of the Western Cape and the West Coast, the government had launched the Saldanha Bay Industrial Development Zone and opened two new factories in Atlantis outside Cape Town. To improve the water supply, two large new dams, the De Hoop dam in Limpopo province and the Spring Grove dam in KwaZulu-Natal, had been completed, while phase 2 of the Lesotho Highlands Water Project was expected to be launched soon. Construction was also continuing on the country’s new power stations, Medupi in Limpopo, Kusile in Mpumalanga and Ingula near Ladysmith, together employing more than 30 000 workers. “We continue to explore other sources of energy, in line with the Integrated Resource Plan for Energy,” Zuma said. “The development of petroleum, especially shale gas, will be a game-changer for the Karoo region and the South African economy.” Zuma said that on average the economy had grown at 3.2 percent a year from 1994 to 2012, despite a global recession which had cost the country a million jobs. South Africa’s national wealth, measured in terms of gross domestic product (GDP), had grown to more than R3.5-trillion. There were now 15-million South Africans with jobs, the highest in the country’s history, with over 650 000 jobs created in 2013. “This is still not good enough,” Zuma said. “The unemployment rate still remains high. Youth unemployment in South Africa continues to be of concern, as it is throughout the world.” The government would have to work together with business and labour to grow the economy at rates above five percent to be able to create the jobs the country needed. South Africa continued to face the triple challenge of poverty, inequality and unemployment, Zuma said, and tackling these challenges had become a central focus of all democratic administrations. Zuma said the National Development Plan (NDP) was a viable plan for driving South Africa’s socio-economic development, eliminating poverty and reducing inequality by 2030. According to the plan, South Africa can realise these goals by drawing on the energies of its people, growing an inclusive economy, building capabilities, enhancing the capacity of the state, and promoting leadership and partnerships throughout society. Source: SAnews.gov.zalast_img read more

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