Medicare/ Medicaid

Concerned about the large and growing cost of antipsychotic drug Zyprexa, a number of states have taken Eli Lilly up on its offer to make sure Medicaid physicians stick to Zyprexa prescribing guidelines. The question, though, is whether states are getting what they're supposed to from these programs.

Zyprexa, which treats bipolar disorder and schizophrenia, generates the biggest single drug cost for state Medicaid programs. These programs spent $1.3 billion on the drug in 2005, …

A new report by the Government Accountability Office (GAO) has concluded that Medicare providers and suppliers owe the U.S. government at least $1 billion in back taxes going back almost a decade. Federal researchers found that 21,000 outpatient providers and suppliers who billed Medicare over the first nine months of 2005, or roughly 5 percent, had failed to pay taxes. More than half of unpaid bills were for payroll taxes which were collected from workers but never sent to the IRS, the …

A new bill has been filed in the House which would create a standardized template for cancer care--and see to it that physicians were paid to develop more comprehensive plans. The bill, which is sponsored by Reps. Lois Capps (D-CA) and Tom Davis (R-VA), would lay the foundation for a coordinated system of cancer care, particularly at the post-treatment stage. Right now, cancer patients typically lack a treatment summary and written care plan offering input on follow-up exams and symptoms …

New Jersey's Raritan Bay Medical Center has agreed to pay the U.S. Department of Justice $7.5 million to settle Medicare fraud charges, settling three lawsuits filed by whistleblowers under the federal False Claims Act. The suits had charged that from early 1998 through mid- 2003, the system's 338-bed Perth Amboy, NJ hospital deliberately inflated many inpatient and outpatient charges to make them look like outliers, generating extra reimbursement it wasn't entitled to receive. As part of …

New York state governor Eliot Spitzer has come to a truce with the state's healthcare unions, which have violently and publicly opposed his recent attempts to slash the state's Medicaid budget and funnel more funds to community health centers. Spitzer's proposal, which would cut more than $1 billion from from New York's Medicaid budget, sparked a volley of big-bucks attack ad campaigns …

While most physicians provide care that falls within established guidelines, about one in ten provided more services than patients needed, according to a GAO study of recent Medicare data. The researchers found that inefficient physicians accounted for 10 percent of the primary care physician population and 2 to 6 percent of specialists.

To establish the efficiency measures, GAO researchers looked at the physician profiling systems used by 10 health care purchasing organizations. …

After years of serving as a get-tough state's attorney general, New York state governor Eliot Spitzer (D) has proven that he's not afraid of a fight. Well, he's got a big one on his hands this time. The newly-minted governor, who's only been in office three months, is in a tough battle with the state's healthcare industry over Medicaid. As part of his 2007 budget, Spitzer is proposing a $1.2 billion cut in state Medicaid funding, the majority of which would come out of the pockets of …

Illinois governor Rod Blagojevich (D) has released his plans to extend health coverage to the state's 1.4 million residents. The linchpin of his proposal is the "Illinois Covered Choice" health plan--privately issued health insurance made affordable by pooling members across the state. Uninsured individuals without access to coverage would be able to buy in regardless of health status--and families who buy in could save more than $10,000 per year, state officials said. In addition, …

A new report by the state's non-profit Public Affairs Research Council (PAR) argues that Louisiana should shut down its rural charity hospitals and pay private hospitals to pick up the slack. PAR researchers are in favor of keeping teaching hospitals in New Orleans, Baton Rouge and Shreveport open, but suggest that the seven other non-teaching hospitals in the system should be sold or transferred to local authorities. PAR's suggestions dovetail with recommendations some other researchers …

While it's all well and good to expand health coverage to more uninsured Americans, doing so would impose an untenable burden on the federal budget, according to a top government official. Government Accountability Office head David Walker says that existing federal government commitments such as Social Security and Medicare are already breaking the federal bank. While some have suggested that …