Medicare/ Medicaid

The U.S. Department of Justice has joined a group of suits filed against HealthEssentials Solutions, a provider of geriatric services to nursing homes, assisted living facilities and home-based patients, has been charged with making false Medicare claims. The suits accuse HealthEssentials of upcoding Medicare billings and charging Medicare for needless services. Specifically, the charges say that HES not only upcoded care charges, but also billed for assisted living care for services …

Medicare fraud continues to drain billions from federal coffers, though the volume of CMS overpayments and errors has fallen over the past two years, according to CMS's top official. Acting CMS administrator Leslie Norwalk told the House Energy and Commerce Subcommittee on Health that the agency has seen a significant jump in fraud and abuse over the past few years. Fraud among DME vendors, orthotics, prosthetics and supplies vendors continues to be a trouble spot, Norwalk said. For …

According to a new report by state investigators, a New Jersey program designed to help the poor and uninsured get emergency care is being sapped by waste and fraud due to poor oversight by hospitals and state officials. The state currently pays hospitals a portion of the cost of emergency care for some 300,000 poor state residents with no health coverage. This year, the program should spend $583.4 million on charity care, partly drawing on funds from federal sources. The problem is that …

A new survey by the Commonwealth Fund has concluded that more than half of U.S. states have begun rewarding doctors for delivering quality care to Medicaid patients. What's more, almost 85 percent of Medicaid programs plan to have pay-for-performance programs in place within five years, many of which rely on improved use of health information technology, researchers said. The study suggests that states are moving much more quickly than Medicare administrators, analysts say. CMS is …

New proposals being developed by the Bush administration would cut Medicaid money that currently pays treatment of patients by residents. Teaching hospitals use the money, which comes in as a match for state Medicaid funds, to fund residency programs. However, Bush officials argue that Medicaid funding shouldn't be used to train residents, and say the cuts would save about $1.7 billion which could be used for other purposes. In a move that would give teaching hospitals a chance to …

CMS has released the 74 performance measures it plans to begin using in its Medicare pay-for-performance program this July. Under the Physician Quality Reporting Initiative, physicians who choose to report on quality measures can get bonuses of up to 1.5 percent of their earnings. The bonuses will apply to services provided between July 1st and December 31st of this year. The measures are drawn from discussions with varied physician trade groups and professional organizations such as the …

A new audit by the New York Department of Health has found that the state's Medicaid program overpaid providers by almost $26 million over a five year period. The problems occurred, auditors found, because controls within the Department's electronic claims processing system were not being used, and what's more, that the clinics weren't following the state's Medicaid billing guidelines. The payments, which took place from 2001 through 2006, went to clinic services for hospitalized Medicaid …

After years of uncertainty, the Department of Justice has given official permission for hospitals to begin performing "paired" kidney transplants in which multiple donors pass along kidneys to unrelated recipients. The decision should allow about one-half of the 6,000 patients waiting for compatible kidneys to get their transplant, and for others, will cut the standard five-year waiting period significantly, experts said. It should also save Medicare about $500 million each year in …

Over the past few decades, South Florida has seen some of the most notorious medical frauds, scams and questionable Medicare billing schemes in the U.S. And it seems that medical device companies are keeping the tradition alive, according to a new report issued by the Office of the Inspector General of HHS. The new OIG investigation, which looked at 1,581 suppliers of medical equipment companies in South Florida, found that more than half of the companies don't meet HHS's minimum …

A group of top officials with the British National Health Service are visiting Cleveland Regional Medical Center to learn more about the hospital's pay-for-performance program. The British officials are hoping to pick up tips on how to better run its existing pay-for-performance program, which has been so successful that physician bonuses busted the program's budget during the first year. Cleveland Regional was a top performer in the first phase of the …