Current Awareness in Aging Research (CAAR) Report #511 -- November 5, 2009

CAAR (Current Awareness in Aging Research) is a weekly email report produced by the Center for Demography of Health and Aging at the University of Wisconsin-Madison that helps researchers keep up to date with the latest developments in the field. For more information, including an archive of back issues and subscription information see:


I. Data:

1. MEDICAL EXPENDITURE PANEL SURVEY: The US Agency for Healthcare Research and Quality has released several new MEPS data files (October 2009, data in .zip or self decompressing [.exe] ASCII text and SAS Transport format, with documentation in HTML and .pdf format, and SAS and SPSS programming statements in ASCII format).

HC-111 2007 Person Round Plan File

HC-110D 2007 Hospital Inpatient Stays

HC-110A 2007 Prescribed Medicines


II. Reports and articles:


A. "Medicare Drug Integrity Contractors’ Identification of Potential Part D Fraud and Abuse," (OEI-03-08-00420, October 2009, .pdf format, 23p.).


Of the 4,194 potential fraud and abuse incidents Medicare Drug Integrity Contractors (MEDIC) identified in fiscal year (FY) 2008, 87 percent were identified through external sources, such as complaints. The remaining 13 percent of potential fraud and abuse incidents were identified through proactive methods, such as data analysis. Of the 1,320 investigations MEDICs conducted in FY 2008, 96 percent involved incidents identified through external sources. Prior to implementing the Part D benefit, the Centers for Medicare & Medicaid Services (CMS) developed a strategy to help combat Part D fraud and abuse. One of the key aspects of this strategy was MEDICs’ use of innovative techniques for data analysis. Beginning in FY 2007, CMS awarded contracts to three regional MEDICs to address potential fraud and abuse related to the Part D benefit.

Problems with accessing and using data hindered MEDICs’ ability to identify and investigate potential fraud and abuse incidents. MEDICs reported that they needed both prescription drug event (PDE) data and Part B data to effectively identify and investigate potential fraud and abuse incidents. However, MEDICs did not receive access to PDE data until August 2007, nearly a year after their contracts began. In addition, two MEDICs were not given access to Part B data until the fall of 2008 and the third MEDIC did not receive access to Part B data before its contract ended. Once they received access to PDE data, MEDICs found that important variables were not available or were stored incorrectly.

MEDICs’ lack of authority to directly obtain information such as prescriptions and medical records from pharmacies, pharmacy benefit managers, and physicians hindered their ability to investigate potential fraud and abuse incidents. Also, MEDICs may not have been aware of some potential fraud and abuse incidents because plan sponsors are not required to refer them. Finally, CMS did not give MEDICs approval to conduct audits of plan sponsors’ compliance plans in FY 2008.

We recommended that CMS ensure MEDICs have access to accurate and comprehensive data to assist them in identifying and investigating potential fraud and abuse and conducting proactive data analysis. We also recommended that CMS authorize MEDICs to directly obtain information that they need to identify and investigate potential fraud and abuse from entities, such as pharmacies, pharmacy benefit managers, and physicians even if statutory or regulatory change is required to do so. Additionally, we recommended that CMS (1) require plan sponsors to report all potential fraud and abuse incidents that are referred to law enforcement agencies to MEDICs as well and (2) ensure that MEDICs have approval to conduct compliance plan audits for which they are responsible.

CMS concurred with three of our four recommendations. CMS concurred with our first recommendation regarding MEDICs’ access to data; however, it did not provide a timeframe for implementation. CMS did not indicate whether it concurred with our second recommendation. Instead, CMS stated that it recognized the value of the recommendation but that its statutory authority to collect information directly from downstream entities is limited. We acknowledged in our recommendation that statutory or regulatory change may be needed and we encouraged CMS to seek these changes. CMS concurred with our third recommendation; however, CMS stated that it currently does not have the regulatory basis to require that plan sponsors report these incidents. We disagree and believe current regulations give CMS the ability to require that MEDICs be provided with such reports. CMS concurred with our fourth recommendation; however, it did not provide details on the number of compliance plan audits it would conduct.

B. "Reassignment of Medicare Benefits," (OEI-07-08-00180, October 2009, .pdf format, 23p.).


Seventy-seven percent of practitioners, or 517,936 practitioners, had at least one reassignment. Thirty-seven percent of the 833,016 Medicare reassignments of benefits in 2007 should not have been active. We identified $140,488 in payments through 16 sampled reassignments that should not have been active. Medicare regulations require that contractors distribute payments directly to practitioners who render services, unless those practitioners’ benefits are reassigned to third parties. A reassignment of benefits is a mechanism by which Medicare practitioners allow third parties to bill and receive payment for services that they rendered. Contractors process reassignments adhering to the safeguards established in the "Medicare Program Integrity Manual" and may employ additional safeguards, as needed.

For 92 percent of the reassignments that should not have been active, practitioners were once employed with the third parties to which their reassignments were made, but had since terminated their employment. For the remaining 8 percent of reassignments that should not have been active, practitioners had no knowledge of the third parties to which their benefits had been reassigned or indicated that they had applied for positions with the third parties but were never employed there. However, Medicare payments made through reassignments that should not have been active were low. We identified $140,488 in Medicare payments in 2007, made through 16 sampled reassignments that should not have been active. We also found that CMS contractors reported using safeguards to ensure correct processing of reassignments, but several factors may limit their effectiveness. These limitations include (1) many practitioners failing to update their contact information with CMS, (2) many practitioners failing to review claims that were billed on their behalf, and (3) Provider Transaction Access Numbers not automatically deactivating when reassignments are deactivated.

Based on these findings and CMS’s recent efforts, we recommend that CMS (1) implement its plans to revalidate practitioner enrollment information, (2) educate practitioners on the need to provide current information, (3) implement plans to update Provider Enrollment, Chain, and Ownership System (PECOS) from other data sources, and (4) follow up with practitioners for whom payments were made through reassignments that should not have been active.

After we completed data collection, CMS staff informed us of new policies that might address the limitations that we identified. These policies include periodic revalidation of practitioner contact information and implementing communication from the Multiple Carrier System to PECOS. In its written comments, CMS described actions it has taken or plans to take to address all four recommendations.


3. US DEPARTMENT OF HEALTH AND HUMAN SERVICES, ASSISTANT SECRETARY FOR PLANNING AND EVALUATION REPORT: "Understanding the Costs and Benefits of Health Information Technology in Nursing Homes and Home Health Agencies: Case Study Findings," by Andrew Kramer, Angela A. Richard, Anne Epstein, Dennis Winn, and Karis May (June 2009, .pdf and HTML format, 124p.).



A. The following tables were updated from Nov. 3, 2009 (all compressed and uncompressed .pdf format): "Medicare Cost Sharing: Tables 4.1-4.4", "Medicare Program Payments: Tables 3.1-3.6," "Medicare Part D: Tables 14.1-14.8," "Medicare Managed Care: Tables 12.1-12.7," and "Medicaid: Tables 13.1-13.27".

B. "CMS Announces Policy And Payment Updates For Medicare Home Health," (October 30, 2009). A link to the Federal Register announcement can be found at the end of the release.

C. "CMS Adopts Policy, Payment Rate Changes For Services in Hospital Outpatient Departments," (October 30, 2009).

D. "CMS Announces Payment, Policy Changes For Physicians Services To Medicare Beneficiaries in 2010," (October 30, 2009). A link to the Federal Register announcement can be found at the end of the release.



A. "NIH-Supported Trial to Study Testosterone Therapy in Older Men," (November 2, 2009).

B. "What Can Prevent Walking Disability in Older People?" (November 4, 2009).


6. US ADMINISTRATION ON AGING NEWSLETTER: The latest issue (November 2009, .pdf format format, 16p.) is available at:


7. UK OFFICE FOR NATIONAL STATISTICS REPORT: "Occupational Pension Schemes Annual Report 2008," (October 2009, .pdf format, 63p.).

Related Statistical Bulletin:


8. UK HOUSE OF COMMONS LIBRARY REPORT: "Perpetuities and Accumulations Bill [HL]:Committee Stage Report," (Research Report 09/80, October 2009, .pdf format, 9p.).


9. STATISTICS SOUTH AFRICA REPORT: "Mortality and causes of death in South Africa: Findings from death notification, 2007," (P0309.3, November 2009, .pdf format, 85p.).


10. REPUBLIC OF MAURITIUS CENTRAL STATISTICAL OFFICE REPORT: "Digest of Social Security Statistics - 2008," (October 2009, .pdf format, 163p.).


11. JAPAN MINISTRY OF HEALTH, LABOUR, AND WELFARE REPORT: "Outline of Health, Labour and Welfare Statistics 2009" (October 2009, .pdf format).


12. POPULATION REFERENCE BUREAU INTERVIEW: "HIV/AIDS and Older Persons in Developing Countries," by Eric Zuehlke (November 2009, MP3 format, running time 14 minutes). This page links to a interview with John Knodel.


13. NATIONAL ACADEMY OF SOCIAL INSURANCE [NASI] REPORT: "Fixing Social Security: Adequate Benefits, Adequate Financing," by Virginia P. Reno and Joni Lavery (October 2009, .pdf format, 34p).



A. EBRI Notes (Vol. 30, No. 11, November 2009, .pdf format, 24p.). Note: The two articles in this issue are: "Availability, Contributions, Account Balances, and Rollovers in Account-Based Health Plans, 2006-2009," by Paul Fronstin and "Retirement Plan Participation and Asset Allocation, 2007," by Craig Copeland.

B. "Employment-Based Retirement Plan Participation: Geographic Differences and Trends, 2008," by Craig Copeland (EBRI Issue Brief No. 36, November 2009, .pdf format, 40p.).


15. AMERICAN BENEFITS COUNCIL REPORT: "Jobs in Peril: Assessing the Impact of Increases in Defined Benefit Plan Funding Obligations on Employment During an Economic Recession," (October 2009, .pdf format, 24p.).


16. COMMONWEALTH FUND BRIEF: "Health Care Opinion Leaders Views on Health Reform," by Kristof Stremikis, Stuart Guterman, and Karen Davis (October 2009, .pdf and PowerPoint format, 12p.).


17. COMMUNITY PARTNERSHIPS FOR OLDER ADULTS REPORT: "Community Partnerships for Older Adults: Local Solutions for National Long Term Care Challenges," (October 2009, .pdf format, 22p.).


18. NATURE CELL BIOLOGY ARTICLE ABSTRACT: "Induction of autophagy by spermidine promotes longevity," by Tobias Eisenberg, Heide Knauer, Alexandra Schauer, Sabrina Buttner, Christoph Ruckenstuhl, Didac Carmona-Gutierrez, Julia Ring, Sabrina Schroeder, Christoph Magnes, Lucia Antonacci, Heike Fussi, Luiza Deszcz, Regina Hartl, Elisabeth Schraml, Alfredo Criollo, Evgenia Megalou, Daniela Weiskopf, Peter Laun, Gino Heeren, Michael Breitenbach, Beatrix Grubeck-Loebenstein, Eva Herker, Birthe Fahrenkrog, Kai-Uwe Frohlich, Frank Sinner, Nektarios Tavernarakis, Nadege Minois, Guido Kroemer, & Frank Madeo (Vol. 11, No. 11, November 2009, p. 1305-1314).


19. MEDSCAPE ARTICLE: Note: Medscape requires free registration before providing articles. "Gait Speed under Varied Challenges and Cognitive Decline in Older Persons: A Prospective Study," by Nandini Deshpande, E. Jeffrey Metter, Stefania Bandinelli, Jack Guralnik, and Luigi Ferrucci (in Age and Ageing, Vol. 38, No. 5, 2009, p. 509-514).



A. "Packages of Care for Dementia in Low- and Middle-Income Countries," by Martin J. Prince, Daisy Acosta, Erico Castro-Costa, Jim Jackson, and K. S. Shaji (PLoS Med 6(11): e1000176. doi:10.1371/journal.pmed.1000176, XML, HTML, and .pdf format, 9p.).

B. "Reduced Physiological Complexity in Robust Elderly Adults with the APOE e4 Allele," by Daniel Cheng, Shih-Jen Tsai, Chen-Jee Hong, and Albert C. Yang (PLoS ONE 3(11): e7733. doi:10.1371/journal.pone.0007733, XML, HTML, and .pdf format, 6p.).

C. "Education in Time: Cohort Differences in Educational Attainment in African-American Twins," by Sarah L. Szanton, Brandon Johnson, Roland J. Thorpe Jr., and Keith Whitfield (PLoS ONE 4(10): e7664. doi:10.1371/journal.pone.0007664, XML, HTML, and .pdf format, 6p.).

D. "Specific Human Astrocyte Subtype Revealed by Affinity Purified GFAP+1 Antibody; Unpurified Serum Cross-Reacts with Neurofilament-L in Alzheimer," by Jinte Middeldorp, Simone A. van den Berge, Eleonora Aronica, Dave Speijer, and Elly M. Hol (PLoS ONE 4(11): e7663. doi:10.1371/journal.pone.0007663, XML, HTML, and .pdf format, 7p.).



A. "Site-specific modification of Alzheimer's peptides by cholesterol oxidation products enhances aggregation energetics and neurotoxicity," by Kenji Usui, John D. Hulleman, Johan F. Paulsson, Sarah J. Siegel, Evan T. Powers, and Jeffery W. Kelly (Vol. 106, No. 44, November 3, 2009, p. 18563-18568).

B. "Nanoparticle-based bio-barcode assay redefines "undetectable" PSA and biochemical recurrence after radical prostatectomy," by C. Shad Thaxton, Robert Elghanian, Audrey D. Thomas, Savka I. Stoeva, Jae-Seung Lee, Norm D. Smith, Anthony J. Schaeffer, Helmut Klocker, Wolfgang Horninger, Georg Bartsch, and Chad A. Mirkin (Vol. 106, No. 44, November 3, 2009, p. 18437-18442).

C. "Water- and nutrient-dependent effects of dietary restriction on Drosophila lifespan," by William W. Ja, Gil B. Carvalho, Brian M. Zid, Elizabeth M. Mak, Ted Brummel, and Seymour Benzer (Vol. 106, No. 44, November 3, 2009, p. 18633-18637).


22. WEEKLY STANDARD ARTICLE: "Medicare Rationing for Kidney Dialysis," by Stanley Goldfarb (October 30, 2009).


III. Working Papers:


A. "The Role of Information for Retirement Behavior: Evidence Based on the Stepwise Introduction of the Social Security Statement," by Giovanni Mastrobuoni (WP No. 2009-23, October 2009, .pdf format, 45p.). Links to the abstract and full-text can be found at:

B. "Medicare Part D and the Financial Protection of the Elderly," by Gary V. Engelhardt and Jonathan Gruber (WP No. 2009-24, October 2009, .pdf format, 44p.). Links to the abstract and full-text can be found at:

C. "Social Security and the Joint Trends in Labor Supply and Benefits Receipt Among Older Men," by Bo MacInnis (WP No. 2009-22, October 2009, .pdf format, 35p.). Links to the abstract and full-text can be found at:


24. UNIVERSITY OF MICHIGAN POPULATION STUDIES CENTER: "Aging, Social Change, and Elderly Well-Being in Rural China: Insights from Mixed-Methods Village Research," by Deborah Lowry (PSC Research Report No. 09-691, October 2009, .pdf format, 32p.). Links to the abstract and full-text can be found at:


25. INSTITUTE FOR THE STUDY OF LABOR (IZA) [UNIVERSITY OF BONN, GERMANY]: "How Sensitive Are Retirement Decisions to Financial Incentives: A Stated Preference Analysis," by Hana Vonkova and Arthur van Soest (Discussion Paper No. 4505, October 2009, .pdf format, 39p.). Links to the abstract and full-text can be found at:


26. NEP-AGE: Working papers in the Economics of Aging are available through the bibliographic database provided by Research Papers in Economics (RePEc). The latest compilation is for Oct. 17 - Oct. 24, 2009.


IV. Journal Tables of Contents (check your library for availability):

27. Aging and Mental Health (Vol. 13, No. 5, 2009).

28. American Journal of Epidemiology (Vol. 170, No. 10, Nov. 15, 2009).

29. European Journal of Palliative Care (Vol. 16, No. 6, 2009).


30. AMEDEO MEDICAL LITERATURE: Note: "AMEDEO has been created to serve the needs of healthcare professionals, including physicians, nurses, pharmacists, administrators, other members of the health professions, and patients and their friends. They can easily access timely, relevant information within their respective fields... All AMEDEO services are free of charge. This policy was made possible thanks to generous unrestricted educational grants provided by AMGEN, Berlex, Eisai, Glaxo Wellcome, Novartis, Pfizer, Roche, and Schering AG."

A. Osteoporosis: Literature for the week of November 2, 2009:

B. Alzheimer's Disease: Literature for the week of November 2, 2009:

C. Parkinson's Disease: Literature for the week of November 2, 2009:

D. Prostate Cancer: Literature for the week of November 2, 2009:

E. Stem Cell Research: Literature for the week of November 2, 2009:

F. Ophthalmology: Literature for the week of November 2, 2009:

AMEDEO Literature Guide:


V. Funding Opportunities:

31. US ADMINISTRATION ON AGING: "Technical Assistance Resource Center: Promoting Appropriate Long Term Care Supports for LGBT Elders," (HHS-2010-AoA-LG-1001, .pdf format). The deadline for submission of a letter of intent is December 4, 2009.



A. "2010 Steven H. Sandell Grant Program," (October 2009). Note: The deadline for applications is January 29, 2010. ". The program is funded by the U.S. Social Security Administration (SSA) to provide opportunities for scholars from all academic disciplines and senior scholars working in a new area to pursue cutting-edge projects on retirement income and disability insurance issues."

B. "2010 Dissertation Fellowship Program," (October 2009). Note: The deadline for applications is January 29, 2010.



A. "NIA Answers Frequently Asked Questions regarding PAR-09-233: Network Infrastructure Support for Emerging Behavioral and Social Research Areas in Aging," (NOT-AG-10-002, National Institute on Aging, October 30, 2009).

B. "Clarification of Genotype Data Collection and Project Management for RFA MH-10-020 - The Human Connectome Project (U54)," (NOT-MH-10-004, National Institute on Aging, in conjunction with other agencies, October 30, 2009).


VI. Legislation Information Updates:

34. CALIFORNIA SENATE OFFICE OF OVERSIGHT AND OUTCOMES REPORT: "California's Elder Abuse Investigators: Ombudsmen Shackled by Conflicting Laws and Duties," by John Adkisson, John Hill, Dorothy Korber, and Nancy Vogel (November 2009, .pdf format, 40p.).


VII. Websites of Interest:

35. MEDICARE.GOV WEBSITE UPDATES: The "Medicare Options Compare" and "Medicare Prescription Drug Plan Finder" pages were updated on Nov. 4, 2009. For all of's suite of interactive web databases see:




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