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It doesn’t compute: Medicare’s bill for artificial feet has jumped by more than half, although foot and leg amputations due to diabetes continue to decline dramatically.

Medicare paid $94 million for artificial feet in 2010, according to research conducted for The Associated Press. That was nearly $35 million more than in 2005, even though in 2010, Medicare covered about 1,900 fewer such prostheses.

It works out to a 58 percent cost increase over five years.

Artificial feet represent a tiny slice of the $550 billion Medicare spends on health care for 49 million older and disabled people. But the cost spike highlights basic questions about affordability, technology and appropriate care that confront lawmakers looking for a way out of Medicare’s financial troubles.

Program officials say they’re concerned. Medicare “is aware of and shares the concerns this research raises about lower limb prosthetics,” said spokesman Brian Cook.

Industry says there’s nothing wrong. Patients are benefiting from new technology in artificial limbs used for wounded troops returning from the Iraq and Afghanistan wars.

Others dispute that conclusion, saying there’s no body of scientific evidence to back it up.

A doctor who works with amputees questioned whether a high-tech foot designed for an active person is appropriate for an elderly patient with diabetes, a major cause of lower-limb amputations. Losing a foot means the patient is at an advanced stage of the disease and probably dealing with other problems that limit physical activity.

“A lot of our patients are just trying to transfer from the wheelchair to the toilet,” said Dr. Howard Gilmer of National Rehabilitation Hospital in Washington.

A report last year by the Health and Human Services inspector general found widespread questionable billing for lower-limb prostheses, a category that includes artificial feet.

In 2009, Medicare inappropriately paid $43 million for lower-limb prostheses that did not meet certain basic standards for accurate claims, investigators said. They found an additional $61 million in questionable billing in cases where it wasn’t clear that the Medicare beneficiary had seen the referring doctor in the previous five years, raising questions about whether the prosthesis was medically necessary.

Industry officials say they are committed to battling fraud and the AP’s statistics simply show the march of progress.

“We have had a huge improvement in the quality of devices that we can provide, thanks to all the knowledge that has flowed from providing care to soldiers,” said Thomas Fise, executive director of the American Orthotic & Prosthetic Association, a trade group. “That technology has now become available, and patients believe they should be entitled to it, and who is going to tell those Medicare beneficiaries they are not entitled?”

“What the government got for their money was value-added,” said Tom DiBello, president of the group, which represents professionals who fit artificial limbs as well as manufacturers.

The AP’s analysis was done by Avalere Health, a data-crunching firm serving private and government health care clients. It looked at Medicare spending on 13 codes for different types of artificial feet that the program covers, many with multiple manufacturers. The analysis suggests the sharp rise in spending is mainly due to a shift in the types of prosthetics being given to Medicare beneficiaries, from ones that cost several hundred dollars to more sophisticated types that run in the low thousands.

Medicare has started covering a computer-controlled ankle/foot that costs $15,000, about as much as a compact car. Some major private insurers still consider it experimental and do not routinely cover it.

Several doctors were surprised by the findings.

“The data are surprising because of the large increase over a short period of time,” said Dr. David Armstrong, a professor of surgery at the University of Arizona and diabetes expert who directs the Southern Arizona Limb Salvage Alliance.

Armstrong wonders if the dazzle of technology is the issue for some practitioners. “They can lose the forest for the trees and focus more on a high-end device because it’s high-end, rather than specifically on function for the patient,” he said

The AP’s data analysis showed a nearly threefold increase in Medicare coverage for one model of foot prosthesis that features a shock absorber and costs about $6,500.

That seemed puzzling to Gilmer. His clinic had recently fitted a patient with that same kind of foot. But the patient is in his 20s and rides ATVs, plays basketball and works on cars.

“Most of our Medicare patients are not going out playing hoops every day,” said Gilmer. Fitting a patient is an individualized process that takes into account many factors, not only physical activity.

Avalere senior vice president Nora Hoban said the data raise questions that need to be answered by further research.

Medicare spokesman Cook said the government is cracking down on fraud involving artificial limbs, saving taxpayers $867,000 in the past year.

But Medicare was unable to provide the AP the ages of beneficiaries who received the different types of artificial feet or the states where they live. Those two pieces of information could help start to find answers to the puzzle.

Officials acknowledge widespread deficiencies in documentation of medical necessity for all kinds of equipment, but they are concerned that tightening requirements could restrict access for seniors.

“We are committed to reducing improper payments and fraud, while ensuring that Medicare beneficiaries have access to the care and services that they need,” said Cook.

The inspector general’s report recommended that Medicare revise a scale of functional activity levels that clinicians use to help determine what kind of artificial limb is appropriate for a particular patient, based on that individual’s lifestyle. It said definitions of the patient’s potential for rehabilitation should be clarified.

“These changes would help ensure that prostheses are matched to beneficiaries’ needs and that (Medicare billing contractors) can assess the medical necessity of these devices,” the report said.

Meanwhile, the rate of diabetes-related foot and leg amputations continues to fall, due to better patient care. Among the Medicare population, it declined 66 percent from 1996-2008, according to the Centers for Disease Control and Prevention.

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Some shareholders have sued Hecla Mining Co. for stock losses they endured after the federal government shut down the Lucky Friday Mine for safety violations.

The Bricklayers of Western Pennsylvania Pension Plan this week filed the lawsuit in federal court in Idaho against Hecla, which is based in Coeur d’Alene.

Hecla announced on Jan. 11 that the mine will be closed for a year to make the changes ordered by federal regulators after two miners died in separate accidents last year.

The lawsuit contends the closure caused Hecla’s stock price to fall 21 percent to $4.61 per share on Jan. 11 and that the company prior to that had made false and misleading statements that artificially inflated the price of its stock.

“Defendants lacked a reasonable basis for their positive statements about the company’s operations and its expected silver production,” the lawsuit said, accusing the company of fraud.

Officials for Hecla said the company’s comments on its financial prospects were appropriate and the company will defend itself.

“This lawsuit has no merit,” said spokeswoman Melanie Hennessey, adding such lawsuits were common when a stock price dropped.

The company’s stock has since rebounded to more than $5.30 per share.

In January, Hecla announced that the Mine Safety and Health Administration had ordered it to remove sand and concrete material that had built up in the main elevator shaft of the Lucky Friday, one of the nation’s deepest underground mines. The company said the work would take up to a year, and the mine would be closed during that time.

The closure prompted Hecla to reduce its estimated silver production for 2012 from more than 9 million ounces to about 7 million ounces, all from its remaining Green’s Creek mine in Alaska.

Production is expected to resume in early 2013.

The mine has been shuttered since mid-December, when a rock burst injured seven miners.

Federal regulators have been conducting a close inspection of the mine because of the series of 2011 accidents. They decided they wanted the sand and concrete material removed because it can break off and fall down the shaft, injuring people or damaging the elevators.

The silver mine is located about 50 miles east of Coeur d’Alene in a region called the Silver Valley.

Miner Brandon Lloyd Gray, 26, was buried in rubble while trying to dislodge jammed rock last Nov. 17, and died two days later.

On April 15, miner Larry “Pete” Marek was crushed when his work area collapsed.

Federal inspectors found company safety failures led to his death.

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Berkshire Hathaway Inc.’s energy business agreed to buy an 81-megawatt wind power project from Invenergy Wind LLC to expand production in Illinois.

The Bishop Hill II project, which is under construction, will use 50 General Electric Co. 1.62-megawatt turbines, according to a statement Friday from Berkshire’s MidAmerican Energy Holdings Co. in Omaha, Neb.

Berkshire, led by Warren Buffett, has been expanding renewable production at the energy unit, which also produces power with coal and natural gas. Mid-American has invested about $6 billion in wind generation and built or acquired more than 3,300 megawatts of the renewable energy source in states including Iowa, Wyoming, Washington and Oregon since 2004. Last month, the unit agreed to buy the $2 billion Topaz solar project in California from First Solar Inc payday loans guaranteed no fax.

Wind “meets current and future energy needs in an environmentally efficient and cost-effective manner,” said MidAmerican Chairman and Chief Executive Greg Abel.

The Bishop Hill II wind project is near the town of Galva, Ill., about 40 miles northwest of Peoria. The project is expected to be in commercial operation in the fourth quarter. A unit of Ameren Corp. in Illinois has agreed to buy electricity from the project under a 20-year power-purchase agreement. Terms of the Invenergy deal weren’t disclosed.

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Industrial orders in Germany dropped sharply in November as demand from abroad dropped _ nearly erasing a strong gain from the previous month.

Orders were down 4.8 percent compared to the previous month, the Economy Ministry reported Friday. In October, orders rose 5 percent _ a figure that was revised downward from the initial reading of 5.2 percent.

The decline was the largest monthly drop since January 2009 but UniCredit economist Andreas Rees said it was less a “harbinger of a nasty recession” than giving back some ground after October’s “tremendous rise.”

“There is no reason to get overly concerned about the state of the German economy, or even to become panicky,” Rees said. “As a matter of fact, exactly the opposite is true for German industrial companies as indicated by forward-looking sentiment indicators in the last few weeks overnight pay day loans.”

According to the report, foreign orders were down 7.8 percent on the month in November while orders from inside Germany _ Europe’s biggest economy _ declined 1.1 percent.

The sharpest month-on-month drop was in orders for investment goods such as factory machinery, which fell 6.5 percent.

On a less volatile quarter-on-quarter basis, the ministry says figures so far show orders in 2011’s final three months were “slightly under” the level of the third quarter.

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Italy’s borrowing rates skyrocketed during bond auctions Friday, battering stock markets in Europe as the continent’s escalating debt crisis laid siege to the eurozone’s third-largest economy.

The auction results are another sign that Italy’s new technocratic government under economist Mario Monti faces a battle to convince investors it has a strategy to cut down the country’s euro1.9 trillion ($2.6 trillion) debt. They are also likely to fuel calls for the European Central Bank to use its firepower to cool down a debt crisis that’s rapidly getting worse.

“Mario Monti has failed so far to impress bond markets he has the power and authority to do what is required,” said Louise Cooper, markets analyst at BGC Partners. “I don’t rate his chances either.”

Driving the markets fears is the knowledge that Italy is too big for Europe to bail out, like it has done with smaller nations Greece, Portugal and Ireland. Given the size of its debts _ Italy must refinance $300 billion next year alone _ the government has to continually tap investors for money. But when borrowing rates get too high, it fuels a potentially devastating debt spiral.

Friday’s auctions indicated that investors see Italian debt as increasingly risky. The country had to pay an average yield of 7.814 percent to raise euro2 billion ($2.7 billion) in two-year bills _ sharply higher than the 4.628 percent it paid in the previous auction in October. And even raising euro8 billion ($10.7 billion) for six months proved exorbitantly expensive. The yield for this auction spiked to 6.504 percent, nearly double the 3.535 percent rate in October.

Following the grim auction news, Italy’s borrowing rates in the markets shot higher, with the ten-year yield spiking 0.34 percentage point to 7.30 percent _ above the 7 percent threshold that forced other nations into bailouts.

Italy was not the only country in the 17-nation eurozone in experiencing a disappointing auction this week. Even Germany _ the region’s strongest economy and the main funder of eurozone bailouts _ suffered a shock Wednesday when it failed to raise all the money it sought, its worst auction result in decades. Spain too saw its borrowing rates ratchet sharply higher even after a landslide election victory for the conservative Popular Party, which has made getting Spain’s borrowing levels down its top priority.

Monti, who replaced Silvio Berlusconi as Italy’s leader earlier this month, has pledged to quickly implement new austerity measures followed by deeper reforms. He spent much of his first week in office meeting with European Union officials and the leaders of France and Germany laying out his plans.

During the meetings, Monti emphasized his intention to balance the budget by 2013 and to introduce “fair but incisive” structural reforms,” his office said in a statement following a Cabinet meeting Friday.

Monti also has pledged to reform the pension system, re-impose a tax on homes annulled by Berlusconi’s government, reduce tax evasion, streamline civil court proceedings, get more women and youths into the work force and cut political costs.

EU monetary affairs commissioner Olli Rehn told the Italian Parliament that “full and effective implementation will be key.”

He urged a “clear and ambitious roadmap for reform and an ambitious timeline” and expressed particular concern about low employment among Italian youth.

“Over the longer term, productivity will depend on a well-educated labor force,” Rehn said. “I am particularly concerned about high unemployment, which is a tremendous waste of talent that Europe simply cannot afford.”

Rehn was in Rome to monitor Italy’s compliance with promises to liberalize its labor market, reduce the bloated public sector and sell off some state assets.

There were also signs that contagion over Europe’s debt crisis was moving eastward. Moody’s downgraded Hungary’s sovereign debt to junk status _ from Baa3 to Ba1 with a negative outlook _ a decision Hungary hotly criticized. Hungary is not a member of the eurozone, but trades with many eurozone members.

This week’s developments have ratcheted up the pressure on the European Central Bank to step up its bond purchases in the markets, though Germany remains adamantly opposed. The current program is designed to support bond prices in the markets, thereby keeping a lid on the borrowing rates.

So far, the ECB has been buying limited amounts of bonds and has to sell an equivalent amount of assets. The ECB said Monday it bought bonds worth only euro4.5 billion last week, down from euro9.5 billion a week earlier.

Potentially, the ECB has unlimited financial firepower through its ability to print money and many countries in the eurozone, including France, want the bank to act more decisively to solve the debt crisis.

However, Germany finds the idea of monetizing debts unappealing, warning that it lets the more profligate countries off the hook for their bad practices.

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President Nicolas Sarkozy appeared to temper his calls for the European Central Bank to play a bigger role in solving Europe’s debt crisis as he agreed to a German effort to change EU treaties to improve the governance of the troubled eurozone.

Speaking after meeting with German Chancellor Angela Merkel and Italian Premier Mario Monti on Thursday, Sarkozy said “propositions for the modification of treaties” would be presented in the coming days.

He wouldn’t elaborate on what these changes may be but said they would be ready in time for the next EU leaders summit on December 9.

This was the first meeting of the three leaders since Monti took over last week following mounting market concerns over Italy’s huge debts.

The meeting in Strasbourg, France comes amid signs that even Germany and France _ the eurozone’s two biggest economies _ are not immune from the crisis that’s already seen three relatively small countries bailed out.

All three leaders said they would do what it takes to stabilize the situation and save the euro.

“We want the euro, we want a strong, stable euro … we will do everything to defend it,” Merkel said.

France has been reluctant to resort to changes to EU treaties to improve the way the eurozone countries work together and set policies and prevent future crises low fee payday advance. Germany had pushed for such changes, saying voluntary pledges by national governments are no longer enough to boost market confidence.

Merkel insisted that the proposed changes would “not deal with the European Central Bank,” which she stressed was responsible for monetary, not fiscal, policy. Sarkozy did not push for a greater role at their closing press conference, while Merkel insisted on the bank’s independence.

Many think the ECB is the only institution capable of calming frayed market nerves.

Potentially, the ECB has unlimited financial firepower through its ability to print money. However, Germany finds the idea of monetizing debts unappealing.

Monti, meanwhile, reiterated his pledge to balance Italy’s budget by 2013 though he sidestepped the question on whether achieving that aim would require more austerity measures, and if so, whether it risked triggering a recession in the eurozone’s third largest economy.

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U.S. homebuilders are a less pessimistic about the struggling housing market, but not enough to signal a recovery any time soon.

The National Association of Home Builders said Tuesday that its index of builder sentiment this month rose from 14 to 18. The index has been below 20 for all but one month during the past two years.

Any reading below 50 indicates negative sentiment about the housing market. It hasn’t reached 50 since April 2006, the peak of the housing boom.

Last year, the number of people who bought new homes fell to its lowest level dating back nearly a half-century. Sales this year haven’t fared much better.

Builders are struggling to compete with foreclosures, which have made the price of previously occupied homes more competitive. Many buyers are having difficulty obtaining loans or meeting higher down payment requirements. Low appraisals are scuttling some deals after contracts have been signed. Some buyers want to upgrade to a new house but are holding off because they can’t sell their home.

David Crowe, the builders group’s chief economist, said some builders are shifting their assessment from “poor” to “fair,” but few are changing their views from “fair” to “good.”

While new homes make up a small portion of sales, they have an outsize impact on the economy. The builders’ trade group says each new home built creates an average of three jobs for a year and generates about $90,000 in taxes.

Separate gauges of current single-family home sales and foot traffic of prospective buyers increased four and three points each, to 18 and 14, respectively. A survey of sales expectations over the next six months rose seven points, to 24.

An index of builders’ outlook in the West rose nine points, to 21. The Midwest and South rose 4 points, to 15 and 19, respectively. The Northeast was unchanged at 15.

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Gunmen disguised as police officers seized control of a police station in western Iraq Monday morning, killing four people and taking dozens of hostages before Iraqi forces swept in and ended the standoff, Iraqi officials said.

The three-hour hostage crisis, as well as another attack nearby on a police officer’s house, demonstrated the vulnerability of the Iraqi security forces at a time when American troops are swiftly drawing down their presence after more than eight years of war.

Four insurgents wearing explosives vests underneath police uniforms and armed with grenades and pistols with silencers walked into the police compound in al-Baghdadi around 9 a.m., said Brig. Mohammed al-Fahdawi of the Iraqi army’s 7th Division in Anbar province. Because the gunmen were wearing police uniforms, they were not searched, he said.

The gunmen shot and killed three police officers, including the director of the police station, and an employee in the mayor’s office before seizing weapons held in the police station, said al-Fahdawi, who coordinated the rescue operation.

The gunmen herded the hostages into some of the rooms, said a police officer at the scene who did not want to be identified because he was not authorized to speak to the media.

After the Iraqi army arrived on the scene and exchanged gunfire with the assailants, al-Fahdawi said he ordered his men to storm the building.

The mayor, Muhanad Zbar Mutlaq, was inside at the time.

After hearing the shooting, the mayor grabbed his cell phone and ran into the bathroom next to his office, locking the door behind him. He said he put his cell phone on silent and began sending text messages to Iraqi army officers he knows.

“Some of the terrorists entered my office and one of them picked up my landline phone when it was ringing and said: ‘We are the fighters of the Islamic State of Iraq,’” said Mutlaq. The Islamic State of Iraq is a front group for al-Qaida. Mutlaq said he could tell by the speaker’s voice that he was Iraqi.

“When I was rescued I saw blood everywhere with pieces of human flesh of the two terrorists who blew themselves up,” he added.

Two of the insurgents blew themselves up when Iraqi police stormed the station to free the estimated 40 people held inside, said al-Fahdawi. Security forces killed the other two assailants, he said.

Deputy governor of Anbar province Dhari Arkan confirmed that the hostage standoff had ended and said four people were killed.

“The security measures here are zero. Some weeks ago terrorists were able to blow up the provincial council and today they were able to break into a police station,” he said.

Earlier this month, two suicide bombers blew themselves up in front of the government compound in the Anbar provincial capital of Ramadi, killing four people and wounding eight others.

Insurgents frequently go after Iraqi government targets in an effort to destabilize the security situation, and the Ramadi building has been targeted repeatedly by suicide bombers.

The mayor of the nearby town of Hit, Hikmat Juber, said many of the hostages were government officials working on the second floor of the building.

Gunmen also attacked the home of the police chief in the town of al-Dolab about 10 miles (16 kilometers) away from al-Baghdadi, said Lt. Col. Mohammed Ismail of the Anbar police media office. He said three gunmen were killed when they tried to storm the house, which is located near the town’s police station.

Al-Fahdawi confirmed that attack and said two of the police chief’s guards were also killed. He said two gunmen were arrested.

Violence in Iraq is nothing like it was in 2006 or 2007 when the insurgency was at its most vicious. But militants have demonstrated a dogged persistence in carrying out attacks despite repeated crackdowns by U.S. and Iraqi forces.

Anbar is Iraq’s largest province and the desert area is mostly home to Sunnis. The province has been a hotbed of Iraq’s insurgency for years. Sunni militants aligned with terror groups such as al-Qaida often attack the local police and military, whom they see as traitors and supporters of the Shiite-led government.

Under a 2008 agreement, all American forces must leave Iraq by the end of this year, although U.S. and Iraqi officials have been discussing retaining a small U.S. military presence into 2012. There are currently about 43,000 troops still in the country.

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Associated Press writers Mazin Yahya and Saad Abdul-Kadir contributed to this report.

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Halloween is around the corner. So let’s conjure up a scary story.

This being a financial column, the gremlins in our tale won’t suck your blood. They’ll drain your 401(k) instead.

We’ll call our story Lehman II: With a Vengeance (and a Greek accent).

The 2008 prequel, as you’ll recall, started with the collapse of the Lehman Brothers investment house. That sent a nervous financial system into full panic, paralyzed credit, erased half the value of the stock market and deepened the Great Recession.

That movie took place in New York. The evildoers in our sequel will devour the European economy, before leaping the Atlantic.

Like all good sci-fi, we’ll start with fact before spinning off into plausible fantasy. Scene One will open with news clips of rioting Greeks, mad as hell about having to pay their debts.

Then we’ll show anguished French bankers wringing their hands over all the money they have in Greek bonds. Germans will shout “Nein!” to bailing out Greeks.

Next, a gray eminence of the financial system, his face bathed in creepy shadow, will intone that Doom is Nigh.

That’s all pretty factual. Right now, the European financial system is giving off signs of the apocalypse.

There’s an under-the-table run on European banks. American money-market mutual funds, long a main source of dollar funding for the Europeans, are fleeing the Continent. Other sources of bank funding are getting clunky or drying up.

There’s a run on the bonds of Spain and Italy, too, even though those two countries are quite solvent.

Worldwide, money is running for safety, mainly to the U.S. dollar. All that money is driving yield on the 10-year Treasury bond to the lowest levels since the 1940s. The euro is down 8 percent against the dollar since August. The Chinese yuan is weakening.

The American stock market is bouncing up and down, lately in synch with news from Europe. The memory Lehman Brothers haunts Wall Street.

In every good scary movie, there’s a scene in which the audience knows more than the characters. We know the devil is lurking in the cellar, but the cute teenagers wander clueless through the house. As they get close to the cellar door, we want to yell, “Don’t go there!”

Right now, financial officials in America, Canada and elsewhere are yelling at Europe. Treasury Secretary Timothy Geitner, the gray eminence of our tale, is warning of a “threat of cascading default, bank runs and catastrophic risk.”

In other words, “Don’t go there!”

True to the genre, European leaders are behaving like fickle teens. They’re arguing over who should bail out the Greeks, Portuguese and Irish. Not us, say the rich northern nations. Yes, you, says all Southern Europe, and America too.

Some German politicians are acting like the Bush administration when it refused to bail out Lehman in 2008. No bailouts for the irresponsible, they said. We know what happened next.

The European Central Bank is fighting, not the last war, but the war before that. It’s still fixated on the memory of hyperinflation in the Weimer Republic after World War I, when the danger now is an economy-eating meltdown.

Here’s how the plot might pan out. The Greeks, burdened by debts they can’t possibly repay, default. Greek banks, which hold lots of that debt, fail and depositors lose their money. Bank depositors in other weakling nations, Ireland and Portugal, see that and run to their own banks to pull money out. Those banks fail, putting pressure on Spanish and Italian banks. French banks, strong enough to withstand a Greek default, can’t stand a Spanish and Italian collapse. Everybody wonders who’s next. There comes a full-blown panic and credit freeze, bringing on a deep recession in Europe.

This hops the Atlantic in several ways. American banks have little exposure to European sovereign debt, but they lend quite a bit to European corporations. Three years after Lehman, derivative investments are still a black hole; no one knows our exposure there. Meanwhile, recession in Europe saps the profit of American internationals.

The upshot: falling American stock prices, tighter credit, a return to mild recession in the U.S., although nothing as bad as in Europe. Our banks, after all, are a lot stronger than they were in 2008.

What are the chances of our scary story coming true?

About 20 percent, says Paul Christopher, chief international investment strategist at Wells Fargo Advisors in St. Louis. He’s betting on sweet reason.

Despite all the caterwauling, he thinks Europe will give Greece the next payment in its bailout this month, putting off the crisis for another three months or so.

But the Greeks eventually will default. The trick will be to handle that in a way to prevent our movie from coming true.

That means pumping capital into the banks now so they can take any hit, while putting together a standby bailout fund in case things get further out of hand. Europe is assembling a $594 billion fund, but it probably needs to be $1 trillion.

The German Bundestag, after a big argument, voted to OK the smaller bailout figure last week. But to do anything in the eurozone requires 17 nations to agree.

Christopher thinks the nervous markets will force their hand over the next few months. That means a volatile time for investors until the final deal is struck.

Across town at Edward Jones, market strategist Kate Warne also thinks Europe will come to its senses. “They all see that the alternative is much worse,” she says.

They all remember Lehman. “No one wants to live that movie again. We want the movie to end differently,” she says.

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