federal government

Though it's been brewing for more than a year,the announcement this week of New York state's planned hospital closures has hit with gale force. Not …

A new study suggests that the federal government's formula for calculating its share of Medicaid matching funds has a significant flaw that undermines the program. Because Medicaid upper payment limit matching funds for hospitals are based on fee-for-service payments, rather than capitated arrangements, states paying capitations can lose millions in upper payment limit funds, according to a study by The Lewin Group. The report, which was funded by the Medicaid Health  Plains of …

No private healthcare facility would tolerate an exam room without a sink, a 53-bed clinic with one vital signs-testing machine or scummy, mildewed floors. But that's the type of conditions prison inmates in California must currently endure, says Robert Sillen, who's working on behalf of the federal government to reform the prison medical system for California's 175,000 inmates. Nothing short of a complete system redesign, higher salaries, substantially beefed-up staffing and better facilities will fix the problem, he says. Article

It looks like 2005 was a bad year for healthcare fraudsters, but a good year for those willing to expose them. According to a report by DHHS, the Federal government took in approximately $1.47 billion in judgments and settlements in health care fraud cases during 2005. The whistleblowers who helped the feds find these scammers, filing qui tam lawsuits on behalf of the government under the False Claims Act, did pretty well, too, splitting nearly $137 million in awards--far more than in …

Pediatrix settles overbilling claim for $25M
Pediatrix Medical Group, a provider of infant care in 32 states, will pay the federal government $25 million to settle a claim that the group billed Medicaid and other programs for critical neonatal care for infants who didn't need it. The fraud took place between 1996 and 1999. The group maintains that it did not overcharge Medicaid. Report

On Friday FierceHealthcare ran a report about a pilot pay for performance program conducted by CMS. The program suggests that the use of evidence-based care is effective for many common conditions, increasing the odds that the federal government will push forward with P4P rules that rival private sector efforts. Russell King, president and executive director of the Wisconsin Homecare Organization, had some interesting …

In a Q&A with UPI, William Plested III, president of the AMA, discusses the impact of Medicare reimbursement rate cuts on physicians. He says that their primary concern is that physicians--particularly geriatricians--won't be able to afford taking on more elderly patients if Medicare doesn't reimburse them properly. According to an AMA study, 45 percent of physicians say the cuts will …

> Healthcare providers won't receive Medicare reimbursements for services provided during the last nine days of September--the end of the federal government's fiscal year. Report

> Need a doctor's note? It may cost you. Article

> More and more women are turning to …

The personal and medical information of 28,000 Beaumont Hospital Home Care patients was compromised when a nurse left a laptop containing the data in her unlocked car. Her car was stolen but fortunately the laptop has been recovered and none of the sensitive information seems to have been viewed. But in light of last week's massive HCA data loss and a Veterans Affairs loss back in May, many …

The state of North Carolina and 51 hospitals there will repay $151.5 million in Medicaid overpayments to the federal government over the next four years. Between 1997 and 2003, the hospitals received $1.2 billion as part of the Medicaid disproportionate-share program, $400 million of which was called into question when regulators investigate the program. Though there is no evidence of criminal wrongdoing or civil fraud, prosecutors say North Carolina used "an overly aggressive plan to …