Medicare/ Medicaid

While anyone would argue that Medicare beneficiaries ought to the get the appropriate level of care regardless of their race or ethnic background, officials with Medicare aren't sure how to make this happen, according to experts addressing a Congressional briefing session this week. Right now, disparities definitely exist in how well minorities are cared for, both within and …

This isn't chump change. According to a suit filed by the U.S. Department of Justice, generic drug maker Boehringer Ingelheim Roxane may have bilked the federal government of $500 million in fraudulent and inflated charges for its products. The DoJ says that BIR reported puffed up prices for several of its products, billed CMS for the higher price, then let hospitals and healthcare providers keep the difference in price. The difference was as much as 1,000 percent at times, the DoJ says. …

The results are in on the latest round of Medicare's 266-hospital, three-year pay-for-performance test. And it appears that, initially, P4P incentives are doing what they're supposed to do--improve adherence to evidence-based care. For example, under the new program, managed by nonprofit hospital alliance Premier, it appears that more heart attack patients are getting aspirin when they come into the ED. The winner in the competition to date was Hackensack University Medical Center, which …

HHS has awarded $103 million to 27 states, supporting programs designed to improve the way Medicaid dollars are used. Congress has approved a total of $150 million for these "transformation grants," which will distributed over fiscal '07 and '08. States will be able to use the funds for a variety of purposes, including development of programs to encourage EMR, clinical decision support tools or e-prescribing; increasing utilization of generic drugs; implementation of a medication risk …

New research by the HHS Agency for Health Research and Quality has found that as of two years ago, Americans spent by far the most on cardiovascular drugs. The new study, which named the top five drug spending categories in 2004, the most recent year for which data was available, noted that U.S. adults spent $32 billion on these drugs. Second in the list was hormones, at $25 billion, followed by $24 million on central nervous system medications. The last two categories on the list, …

A group of Democratic state legislators are continuing their effort to pass legislation imposing a cigarette tax to fund a Medicaid expansion and drug treatment. Dubbed the "Healthy Maryland Initiative," the group plans to file a bill which would double the tax on cigarettes to $2 per pack. The tax should raise more than $200 million during the first year after inception, and roughly $170 million thereafter. The funds would help to bring coverage to the state's approximately 780,000 …

Sparked by a Government Accountability Office analysis suggesting that neighborhood pharmacies could lose more than a third of their Medicaid reimbursement, a national pharmacy group has issued yet another challenge to Medicaid reimbursement policies for pharmacies. According to a newly-issued report prepared by the GAO, which the group says was issued in late December but only released Monday (implying sneakiness on the part of the Administration, they suggest), a new CMS formula for …

Florida public health organization Jackson Memorial Health System, parent of the 1,776-bed public hospital behemoth Jackson Memorial Hospital, has agreed to pay $14.25 million to settle Medicare cost reporting fraud allegations with the U.S. attorney in Los Angeles. The settlement comes as part of an ongoing investigation that has implicated more than 20 hospitals and pulled in settlements of about $50 million. Jackson Memorial admitted no wrongdoing, and noted that the alleged …

A Stamford, CT-based ophthalmologist has filed a federal lawsuit against the state's Department of Social Services (DSS) after being named as the first doctor the agency recommended for Medicaid fraud prosecution, claiming that he is the victim of a campaign of retribution by angry officials. Weber's suit also names the state attorney general's office, alleging, among other things, that assistant state's attorney Nancy Salerno acted "maliciously" in executing a search warrant during …

Researchers have concluded that yet another state health system is out of whack, in ways which seemingly differ little from other health systems across the U.S. In this case the patient is the health system of the state of New Jersey, which, according to a new study by consulting firm Avalere Health, burns through resources but doesn't seem to produce better care or outcomes as a result.

The Avalere study, which was sponsored by Horizon Blue Cross Blue Shield of New Jersey and the …