Medicare/ Medicaid

When talk of retail clinics first emerged, most assumed that their primary business would be cash-based. After all, if you're going to charge low prices, you might not want to take on the expense of collecting insurance reimbursement. But for many retail clinic operators, that's not how its shaping up. The most recent example comes from RediClinic, which has just announced that it will accept traditional Medicare coverage at its 46 U.S. locations. The company already has contracts in …

The fallout continued this week at Martin Luther King Jr.-Harbor Hospital, which is struggling to cope with entrenched management and personnel problems. This week, the hospital's chief medical officer was replaced, following the highly-publicized death of a patient waiting for attention in the hospital's ED. Dr. Roger Peeks, who was brought in to overhaul the troubled hospital's medical operations, has been placed on "ordered absence" by the Los Angeles County Board of Supervisors and …

The University of Medicine and Dentistry of New Jersey (UMDNJ) has seen another top administrator leave in the wake of ongoing questions over alleged financial fraud. A week before he was due to retire, associate dean for academic and student affairs Paul Mehne has been relieved of his duties and placed on paid administrative leave amidst yet another investigation into the school's purported financial misdealings. Early last year, New Jersey Governor Jon Corzine dismissed the school's …

Scottsdale, AZ-based ambulance firm Rural/Metro has settled with the U.S. Department of Justice over a pair of whistleblower suits alleging that it had offered kickbacks in exchange for Medicare and Medicaid business. Rural/Metro has agreed to pay $2.5 million to settle the 2000 and 2001 suits, which asserted that the company had offered discounts to Texas hospitals in return for contracts to provide services billable to the state and federal entities. (Competitor American Medical …

New Orleans physicians have been struggling since Hurricane Katrina, with practices and hospitals closed and the list of uninsured patients remaining high. Under these conditions, it's hardly surprising that they would want to leave the city. But the city doesn't want to see them go. So with the help of the state of Louisiana and the federal government, the city has developed a program which pays them to stay. The Greater New Orleans Health Services Corps has begun offering incentives of …

Even when other factors like age and gender are factored out, it seems that under- and uninsured patients with cancer are likely to be diagnosed at a later stage in their disease than patients with private insurance, according to a new pair of studies published in the journal Cancer. The studies, which looked at the breast cancer and oral cancer, found that the availability and type of health insurance could predict the severity of the illness at the point when it was diagnosed. …

A bill making the rounds in the U.S. Senate would open up Medicare data to private organizations that want to use it for research and analysis. The bill, sponsored by Sens. Hillary Clinton (D-NY) and Judd Gregg (R-NJ), would make claims, enrollment, survey, assessment and other available to private groups hoping to measure care quality, efficiency and effectiveness. Other stakeholders would then have the right to request reports from the research organizations. The research organizations …

CMS has run out of patience with Martin Luther King Jr.-Harbor Hospital, which it says has put emergency room patients in "immediate jeopardy" of harm or death. The hospital, formerly known as King/Drew, was already on bad terms with CMS, which had threatened to take away the hospital's federal funding certification after serious care problems emerged. This is part of a larger pattern for King-Harbor, which has been cited more than a dozen times for care problems over the past three and a …

The American Medical Association has begun its latest no-holds-barred campaign to make Congress cancel a scheduled Medicare reimbursement cut. As part of its campaign, AMA is publicizing the results of its survey of 9,000 physicians, which found that more than half would to limit the number of Medicare patients they accept if the planned 10 percent cut is implemented. (Sure, there's a bit of grandstanding going on here--but the pain is real, too.) Patients aren't the only ones who would …

While Medicare's new pay-for-performance program may have some effect on hospital quality, the financial incentives don't have any bigger impact than a hospital's voluntary improvement efforts, according to a new study published in the Journal of the American Medical Association. The study, which looked at data from 54 hospitals in the Medicare P4P program, found that most improved on some important criteria during the test, for example by prescribing aspirin more frequently for …