Medicare/ Medicaid news from FierceHealthcare

While the evidence for cost-savings seems a bit, well, ambiguous, CMS this week is trumpeting the results of the first year of its diabetes care P4P project. CMS has just completed the first year of a three-year demonstration project under which the agency is monitoring diabetes care provided by 10 large medical practices. Diabetes management is being measured by standards drawn from CMS's Doctor's Office Quality project. Under the terms of the demonstration, which was mandated by …

A new study suggests that when chronically-ill uninsured adults age into Medicare eligibility, they're sicker than adults who had commercial insurance when they entered Medicare. The study, published in The New England Journal of Medicine, found formerly uninsured adults were hospitalized more often and had greater medical expenses through at least age 72.

The study, conducted by Dr. John Z. Ayanian of Harvard Medical School, looked at 9,760 adults who were 51- to …

Continuing its ongoing investigation of heart transplant programs, CMS has threatened three more programs with decertification. CMS has given San Antonio, Texas-based Christus Santa Rosa Hospital-Medical Center, Abbott Northwestern Hospital in Minneapolis and St. Vincent Indianapolis Hospital 30 days to submit corrective action plans. Meanwhile, a fourth heart transplant program at the University of Kentucky Chandler Hospital has agreed to give up Medicare funding entirely, at least for …

HHS has launched a new pilot program hoping to catch dishonest medical equipment suppliers in the Los Angeles area and South Florida. If the pilot is successful, CMS plans to role out the program across the United States. The two-year effort, designed to ferret out Medicare fraud, will search for falsified bills and overcharges from suppliers of prosthetics, orthotics, diabetic supplies …

Despite its having engaged in a massive Medicare scam costing the federal government at least $630 million, St. Barnabas Health Care System did not prevent other hospitals from getting fair reimbursement.

That's the conclusion of a federal judge, who ruled that despite the fraud, St. Barnabas had not engaged in racketeering. Two small hospitals in Maine and Colorado filed the suit, alleging St. Barnabas' over billing was so extreme it distorted CMS's Medicare reimbursement …

The University of Connecticut Health Center will pay more than $475,000 to settle Medicare over-billing charges. The hospital was accused of overcharging Medicare for cancer treatments, including chemotherapy and infusion therapy, from 2002 to 2004. The feds had charged that instead of billing Medicare on a per-patient basis, the Center's John Dempsey Hospital charged Medicare for the hours it spent in patient care, resulting in bills that were two- to seven-times larger than allowed. The …

When Harbor-UCLA Medical Center took over operations of troubled Los Angeles hospital King-Drew, the idea was that Harbor would purge much of the facility's staff and upgrade their skills. However, it appears this isn't happening, despite the fact that the hospital promised these changes to CMS after it threatened to pull its accreditation. Yesterday, county health officials told the Board of Supervisors that they had only reassigned one-third of the hospital's 1,200 employees. For …

High-profile troubles at Martin Luther King Jr.-Harbor Hospital are bringing the wrath of Congress down on CMS. Senate Finance Committee Chairman Max Baucus (D-MT) has written a letter to CMS Acting Administrator Leslie Norwalk demanding to know how CMS will make sure that the hospital meets Medicare standards in the future. The facility, formerly known as King-Drew, has faced scrutiny over alleged care lapses for some time now. In its prior incarnation as King-Drew, the hospital had lost …

Illinois Attorney General Lisa Madigan has filed a lawsuit against two Chicago-area medical practices, contending that the two refused primary care to Medicaid patients in an effort to get them into their higher-priced affiliated emergency departments. The suit also charges that the clinics, Carle Clinic Association of Urbana, IL, and Christie Clinic of Champaign, IL, wanted to discourage Medicaid patients from visiting their facilities. According to the suit, the two clinics now employ …

The state of Pennsylvania has released a new cardiac surgery performance report which for the first time includes hospital-specific payment data. According to the report, which was issued by the Pennsylvania Health Care Cost Containment Council, the average payment for heart bypass procedures by commercial health plans was $30,247, and for valve-only procedures $41,651 during 2005. Medicare paid $29,175 for bypasses and $42, 433 for valve-only procedures. The state's hospital association …