NAHU Asks Pitts To Sponsor Oversight Bill
Regulating Insurance Navigators.
In a
legislative update posted in the Clarksville (TN) Leaf Chronicle   (4/5), state Rep. Joe Pitts
(D-Clarksville) wrote, "When Congress enacted the Patient Protection and
Affordable Care Act, it approved an important new provision in the law that
creates the role of a 'navigator' in helping consumers find the right health
insurance policy." Pitts was asked by "the National Association of
Health Underwriters...to sponsor HB0881 which will grant the Commissioner of
the TN Department of Commerce and Insurance rule making authority in
providing proper oversight of these entities."
Some GOP Governors Seeking To "Take
Advantage" Of ACA Provisions.
The Washington Post (4/7, Aizenman) reported that at a
time "when most states are preparing to expand their Medicaid programs
in line with the new healthcare law, tens of thousands of people in states
with historically generous Medicaid coverage could soon be kicked off the
rolls." Wisconsin officials "want to take advantage" of the
Affordable Care Act "to shift nearly 100,000 low-income people from the
health insurance program for the poor into subsidized private plans,"
and "an additional 180,000 people in five other states could lose
coverage because they are in experimental versions of Medicaid that expire
this year and may not be renewable under the new law."
Republican Questioning High
Salaries Of ACA Navigators.
The Hill (4/5, Wilson) "Regwatch"
blog reported that Rep. Kenny Marchant (R-TX) "says the new ObamaCare
insurance brokers known as 'navigators' are likely to cost more than they're
worth because of 'inflated' salaries," based on an HHS proposal about
the "fleet of individuals that will help Americans without
employer-provided insurance figure out how to use the new healthcare
exchanges set up by the Affordable Care Act." Marchant said he wrote to
HHS Secretary Sebelius this week about his concerns, noting that HHS outlined
that "assistance workers will be paid $20 per hour, project leaders will
be paid $29 per hour and executives will make about $48 per hour."
SHOP Exchange Delay May Not
Spell Future ACA Implementation Detours.
The Washington Post (4/5, Kliff) "Wonkblog"
looked into what the HHS' delay of the Small Business Health Options Program,
or SHOP Exchanges, "means for the Affordable Care Act." The blog
laid out two options as an explanation: "The first you might call the
apocalyptic reading, that this is just the first in a long line of delays
that will ultimately lead to the Affordable Care Act's unraveling. The
logistical challenges with this issue, cited by Health and Human Services,
will quickly become clear in other parts of the law as we edge closer to
2014. But there's another reading of this, one that suggests the Obama
administration has realized it can't do everything and, in lieu of that, is
smartly focusing on the absolutely essential parts of the health-care law, making
sure that those do turn out well."
Democrats Decry ACA Implementation Delays. The Hill (4/6, Baker)
"Healthwatch" blog reported that Democrats are openly complaining
that implementation delays in the Affordable Care Act "are hurting
it" with them, and they "are criticizing the White House for
delaying policies that could help build support for the unpopular law."
Last week, they "complained...about a one-year delay in a key program
designed to help small businesses - a central selling point for the
healthcare law that now won't be in place when voters head to the polls next
year" for midterm elections, "when vulnerable Democrats in
conservative states will have to defend their votes" for the ACA. The
Hill says the Democrats "are also complaining more openly about other
implementation delays."
Pre-Existing Condition
Insurance Program Funding "Running Out."
The Pittsburgh Post-Gazette (4/7, Mauriello) reports that
"Federal funding is running out" for the Affordable Care Act's
Pre-Existing Condition Insurance Program, which is "meant to provide
temporary health insurance for people with pre-existing medical conditions."
Critics say $5 billion "was never enough to fund" the program
"and that financial problems were exacerbated by overrepresentation by
enrollees with very serious medical conditions - such as cancer and heart
disease - that are expensive to treat. Even conservatives who want to repeal
the Affordable Care Act say the PCIP provision wasn't funded well
enough." Rep. Michael Burgess (R-TX) says Congress "should have
appropriated $30 billion for PCIP."
As Exchange Enrollment
Approaches, Many Question Outreach Effort.
Kaiser Health News (4/8, Gold) reports that just six
months before enrollment in the Affordable Care Act's exchanges begins,
"questions are mounting about the scope and adequacy of efforts to reach
out to consumers – especially in the 33 states that defaulted to the federal
government to run their marketplaces, also called exchanges." According
to the article, "The Obama administration has said little about outreach
plans for those states, and neither the money nor the strategy is
apparent."
NAIC Offers Strategies To
Minimize ACA "Rate Shock."
Modern Healthcare (4/5, Block, Subscription
Publication) reported that the National Association of Insurance
Commissioners have released a draft paper, titled "Rate Increase
Mitigation Strategies," which offers strategies for states to
"minimize the likelihood of large premium increases, particularly for
young adults, as major provisions of the Patient Protection and Affordable Care
Act go into effect in 2014." Presented at the NAIC's annual spring
meeting in Houston, the "strategies suggested include capping rate
increases, supplemental subsidy programs, and reinsurance programs that would
supplement the federal government's reinsurance program and better spread the
costs of the sickest enrollees among insurers."
AARP Poll: Older Voters Oppose
Switch To Chained CPI.
The
results of AARP's recent survey, which found that more than two-thirds of
older voters oppose changing the formula that is used to make cost-of-living
adjustments in Social Security, veterans benefits, food stamps and other
federal programs, received extensive national and local coverage on
television, in print, and online. Offering detailed analysis of the findings,
many sources emphasized the political peril that can be expected by members
of Congress who back the proposed chained CPI anticipated in President
Obama's 2014 budget proposal. AARP's Nancy LeaMond, David Certner, Joyce
Rogers, and Beth Finkel are quoted in the coverage.
NBC Nightly News (4/5, 6:40 p.m. EDT, story 4, 2:15, Williams) reported that
details of President Obama's budget proposal for the coming year, including
"changes to Social Security and Medicare that will hit seniors...drew
fire from Democrats in Washington" and "didn't seem to do much to
sway Republicans." NBC chief White House correspondent Chuck Todd added,
"For the first time in the Obama presidency, a White House-proposed
budget would slow the growth of Medicare and Social Security, an idea many
Democrats call a cut," and one that is "part of a deliberate effort
to entice Republicans back to the negotiating table on a larger budget deal
that would include more tax increases." Noting that "any changes to
Social Security has Democrats upset," Todd also pointed out that
"not surprisingly, the nation's most powerful senior citizen lobby,
AARP" is "already out with polling data warning any member of
Congress that supports this change to Social Security will have...heck to pay
at the ballot box in 2014." The segment also appears on the NBC News (4/8) website.
Roll Call (4/6, Ackley, Subscription
Publication) reported that on Friday, AARP released a poll "with a
message for Congress: Vote for the budget proposal known as chained CPI at
your peril." The poll found that 66 percent of older American voters
would have a "considerably less favorable" view of their member of
Congress if the lawmaker voted for the proposal, which is expected to be
included in the Obama administration's fiscal 2014 budget. "This cut to
Social Security would break the promise to seniors and hurt veterans who've
sacrificed so much for this great country," said AARP Executive Vice
President Nancy LeaMond in a statement announcing the poll's results.
"The chained CPI reduction snowballs over time and would increase taxes
for most taxpayers - at the same time that it cuts benefits for children,
veterans, widows, retirees, and people with disabilities. As this survey
shows, older Americans oppose the chained CPI and they've historically made
their opinions known to their elected officials."
In an article that similarly quoted AARP's LeaMond, Salon (4/5, Walsh) reported, "The
AARP reveals that 70 percent of voters age 50-plus oppose the use of the
chained CPI to cut benefits, and two-thirds of them – including 60 percent of
Republicans - say they would be 'considerably less likely' to support a
congressional candidate if he or she backed a new way of calculating consumer
prices. And 84 percent of voters over 50 say Social Security has no place in
budget-deficit discussions, since it is self-financed." Noting that AARP
opposes the proposal "on policy terms," the article said "now
its new survey shows how risky it is politically."
Under ACA, Many Ex-Felons To
Receive Insurance Coverage.
The Huffington Post (4/6, Ollove) reported that under
the Affordable Care Act, starting in January, "many of the 650,000
inmates released from prison each years will be eligible for...health care by
way of Medicaid." And further, "A sizeable portion of the nearly 5
million ex-offenders who are on parole or probation at any given time will
also be covered." The "main vehicle" for extending coverage to
this population is the law's expansion of Medicaid.
Health Insurers Urged To Work
With Patients, Government Amid ACA Implementation.
In an
opinion piece in the San Jose Mercury News (4/8), Patrick Johnston, president
and CEO of the California Association of Health Plans, writes that "the
Affordable Care Act (ACA) will bring historic changes to California's
insurance marketplace over the next year" because "it will provide
subsidies so millions of uninsured Californians can purchase insurance,
lowering premium prices for many moderate- and low-income
beneficiaries." However, Johnston adds that "all these new enhanced
health plan products come at a cost," which "means those who earn
too much for a subsidy will see their premiums rise, which may come as a
surprise." Asserting that "quick fixes won't cure the
problem," Johnston claims that "only by all of us working together
- hospitals, doctors, patients, insurance companies and government - will we
find the right prescription for delivering more efficient and affordable
health care."
Public Health and Private
Healthcare Systems
Suit Against UnitedHealth Tests Mental Health
Coverage Rules.
The Minneapolis Star Tribune (4/7, Spencer) reports that a
class-action lawsuit filed against UnitedHealth Group Inc. will test the
Federal law that says insurance companies cannot treat "mental health
claims differently from medical and surgical claims." The lawsuit was
brought by the parents of a biopolar child, "two other individuals and
the New York State Psychiatric Association," and "could set a major
precedent for mental health coverage in the era of health care reform."
The case is notable because it does not rely solely on state law for an
individual claim but instead "relies heavily on the federal parity law,
as well as the federal Affordable Care Act." UnitedHealth, based in
Minnetonka, Minnesota, "declined to discuss the suit, which was filed in
New York on March 11."
Nearly 280,000 In Six States
Could Be Moved Off Medicaid Under ACA.
The Washington Post (4/7, Aizenman) reports that
"at a time when most states are preparing to expand their Medicaid
programs in line with the new health-care law, tens of thousands of people in
states with historically generous Medicaid coverage could soon be kicked off
the rolls." Wisconsin officials "want to take advantage" of
the Affordable Care Act "to shift nearly 100,000 low-income people from
the health insurance program for the poor into subsidized private
plans," and "an additional 180,000 people in five other states
could lose coverage because they are in experimental versions of Medicaid
that expire this year and may not be renewable under the new law."
Alabama Tells HHS It Will Not
Enforce ACA Provisions.
The Montgomery (AL) Advertiser (4/7, Troyan) reported that Alabama
Gov. Robert Bentley told HHS Secretary Sebelius in a letter that the state's
"insurance regulators will not enforce the consumer protection
provisions of the Affordable Care Act" and "said Washington - not
Montgomery - is responsible for making sure health insurance plans sold in
the state comply with requirements such as covering people who have
pre-existing medical conditions." Since Alabama won't act, the burden
shifts to CMS, the Advertiser says. Bentley, who is a physician, "also
rejected the option of expanding the state's Medicaid program." The AP (4/6) also reported.
States Continue To Move
Toward Medicaid Expansion Decisions.
Over
the weekend through Monday, Medicaid expansion continued to receive
substantial coverage, mostly in regional outlets. States in the news include
Texas, Florida, and North Carolina.
Appearing Less Likely, Texas Medicaid Expansion Debate Drags On.
The Dallas Morning News (4/5, Garrett) reported, "A
big push to add hundreds of thousands of poor Texas adults to Medicaid
appears to have fizzled - this session, at least." After detailing a few
of the setbacks proponents of expanding the program suffered last week, the
piece asserted, "For now, Medicaid expansion may be the dirtiest two
words you can utter at the Texas Capitol. Still, that doesn't mean the issue
is settled, as even Sullivan and other fiscal watchdogs agree."
The Austin (TX) Business Journal (4/8, Subscription Publication)
"ABJ@TheCapitol" blog reported on one such setback, in which, on
Thursday night, "an amendment related to potential negotiations between
the state and federal government on expanding Medicaid nearly made it -
apparently catching some legislators opposed to expansion off guard - before
a rallying led to it being pulled."
CNN (4/5, Abdullah) ran a lengthy
report on the implications of states opting out of Medicaid expansion. The
piece profiles a Texas woman who fought cervical cancer in 2012 and
attributes her survival to "narrowly qualifying for a Medicaid-sponsored
program," in order to illuminate the debate in that state between
advocates and opponents of expansion.
The Odessa (TX) American (4/6, Carman) reported, "Gov.
Rick Perry's opposition to expanding the state's Medicaid program rattled
Medical Center Hospital's administration, which predicted a 'foregone
benefit' totaling millions of dollars falling out of its grasp Thursday."
As the article explained, "Approximately 24 percent of Texans do not
have health insurance, the highest uninsured rate in the nation. Webster
estimates Ector County's uninsured rate to be closer to 30 percent, one of
the major reasons MCH and, he said, most hospitals differ with Austin on the
issue."
The Plano (TX) Star-Courier (4/7, Conrad) reported that despite
a high uninsured rate in Collin County, Texas, local legislators "oppose
Medicaid expansion."
Similarly, the El Paso Times (4/8, Schladen) reports,
"Expanding Medicaid would extend insurance to 135,000 of the county's
230,000 uninsured residents, said Margaret Althoff-Olivas, spokeswoman for
University Medical Center, El Paso County's only public hospital."
Debate Over Medicaid Expansion Continues In Florida. The Tampa (FL) Tribune (4/8, Cotterell) reports that
"members of the Legislative Black Caucus, backed by the NAACP and
organized labor, urged Republican legislators Friday to find some way to use
billions in federal money for expanding Florida's Medicaid program to provide
health insurance for more than 1 million poor people." Sen. Arthenia
Joyner, chair of the caucus, said, "This is about saving lives."
The article notes that this came the same week that "powerful"
House Speaker Will Weatherford "relented slightly, saying he would not
rule out expansion but remains skeptical the federal government will keep
promises to fully fund it through at least three years."
WJHG-TV Panama City, FL (4/8) reports on
the still-continuing debate over Medicaid expansion in the Florida
legislature, writing, "Now five weeks into a nine week legislative
session, the House has done nothing and the Senate has two competing
plans."
The South Florida Sun-Sentinel (4/8, White) reports on Florida's
Medicaid reform project, "a controversial and ambitious pilot launched
in 2006 in Broward and Duval counties to shift enrollees...into managed-care
plans." The plan was "expected to offer patients better quality and
more choices and, in turn, save the state billions." However, "the
mixed results about the program's effectiveness outlined in a 2011 University
of Florida study - which acknowledged patient confusion at the beginning and
participants eventually reporting improved access to care - have not provided
any clear-cut direction for lawmakers grappling with Medicaid
expansion."
In a separate but related account, the South Florida Sun-Sentinel (4/5, White) reported,
"Broward County's two major public hospital systems would lose more than
$8.3 million combined next year if the Medicaid reimbursement proposal
currently in the Senate passes, according to data released Friday by a group
that advocates for public, teaching and children's hospitals."
Ohio Governor Faces "Unrelenting Rebellion" Over
Medicaid Expansion Effort. The Columbus (OH) Dispatch (4/6, Candisky, Siegel) reported
that "the 'Obamacare' label could doom Gov. John Kasich's plan to accept
billions in federal dollars to cover 275,000 more uninsured poor
Ohioans." Although Kasich "has given impassioned speeches in
support of the expansion," he "faces an unrelenting rebellion
within his own party from lawmakers who oppose expanding Medicaid or even the
remotest association with President Barack Obama's Affordable Care Act."
The Marion (OH) Star (4/7, Lanka) reported that
"thousands of Ohio service-sector employees and their families rely on
Medicaid for health insurance, and those numbers could explode if Republican
Gov. John Kasich's proposal to expand the federal program is approved."
According to Eric Seiber, assistant professor of health services management
and policy at the Ohio State University College of Public Health, "the
increase largely will not be people leaving private health insurance to take
Medicaid because it is cheaper." Seiber "said most people join
Medicaid because they are unemployed, work for a company that doesn't offer
health insurance, or can't afford their company's insurance."
The Dayton (OH) Daily News (4/8, Tucker) reports that,
according to a report released Friday by the Health Policy Institute of Ohio,
"southwest Ohio residents would see a nearly $4 million increase in
general sales tax revenue and more than 6,000 new jobs by 2015 as a result of
a proposed Medicaid expansion included in Gov. John Kasich's state budget
plan." The report projected that "more than $16 million increase in
local general sales tax revenues" statewide.
Medicaid Expansion Deadline Looms In Indiana. On its
website, WTHI-TV Terre Haute, IN (4/8) reports that
"the deadline for a state health program that covers thousands of
Hoosiers is approaching this summer. As Governor Mike Pence moves to continue
it, he also runs the risk of losing a health care expansion that could help
close to a half a million Hoosiers." Although Indiana "is moving
towards expanding the Healthy Indiana Plan," the decision "for
which plan to choose has to come fast because at the end of June 40,000
Hoosiers on the Healthy Indiana Plan will lose their coverage."
However, the Merrillville (IN) Post-Tribune (4/8, Mikus) reports that
"state Democrats worry that the Centers for Medicare and Medicaid
Services (CMS) may not approve of the plan, leaving those who make less than
138 percent of the poverty level, but more than 24 percent stuck with paying
for their own health insurance."
Officials Continue To Mull Medicaid Expansion In Idaho. NPR (4/5, Messick) reported that,
during a press conference marking the closure of the 2013 legislative
session, Gov. C.L. "Butch" Otter stated: "There's no definite
decision on not expanding Medicaid, yet." However, Otter claim
"he's determined... to find ways to inject more personal accountability
into Idaho's Medicaid system." Otter added: "We'll get eight months
and some change in order to continue to study that. I will try to keep, to
the extent that I can, all of the legislators in the state aware of our
progress toward the first of next January."
The Southwest Iowa News (4/8, Rohwer) reports that Senate
Majority Leader Mike Gronstal (D-IA) "made it clear his thoughts on Gov.
Terry Branstad's plan to improve Medicaid services calling the governor's
details 'absurd.'" Branstad, "who has rejected federal funding in
fear that it won't be sustainable, has a plan with accountability by
Medicaid-eligible patients requiring them to pay $500 to $1,000 with the
state matching that amount." Gronstal added that "the governor's
plan would only help a portion of low-income people leaving up to 60,000 who
are eligible without any coverage."
Medicaid Expansion Discussion Continues In Montana. The Belgrade (MT) News (4/5, Sisk) reported that "the
momentum behind expanding Medicaid in Montana came to a grinding halt last
week when Republicans voted down three measures to accept $6 billion in federal
money over the next eight years." Those who oppose Gov. Steve Bullock's
"Access Health Montana bill argued against extending government's reach
under an Obamacare provision that allows states to decide whether to expand
the low-income health care program." The News noted that "some
Republican legislators want to postpone the decision for two years."
Democrats, however, "say stalling would kill the expansion, and in the
meantime, those 70,000 people would continue to go uninsured."
Oklahoma Governor Among Republicans Still Opposing Medicaid
Expansion. The Oklahoman (4/8, Cosgrove) reports that
"Gov. Mary Fallin announced in November that Oklahoma would not expand
its Medicaid program or create a state-based health care exchange."
Although Fallin "is among about 15 Republican governors who have said
their states will not expand Medicaid," the Oklahoman notes that
"Republican governors in several states have voiced support for
expanding Medicaid in some version in their states."
Poll Finds Nearly Half Of Likely Voters Support Brewer's
Medicaid Expansion Plan. The Arizona Republic (4/5, Reinhart) reported that,
"as both sides of the political debate dig in for weeks, or perhaps
months, of tough negotiations over Gov. Jan Brewer's proposal to expand
Medicaid in Arizona, a statewide poll indicates nearly half of likely voters
support the plan, but more than a third have never heard of it." The
poll, paid for by the national polling firm Public Opinion Strategies,
"also found that almost half of Republicans surveyed back the idea of
broadening health-care coverage to low-income and disabled Arizonans under
federal health reform." Among those surveyed, "47 percent said they
supported Brewer's expansion plan, 17 percent opposed it, and 36 percent had
not heard of it."
In other Arizona Medicaid expansion news, the Havasu (AZ) News-Herald (4/8, Fischer) reports that,
"saying the move would make no sense, Gov. Jan Brewer on Friday refused
to insert an anti-abortion provision into her plan to expand the state's
Medicaid program." The News-Herald notes that Brewer "signed
legislation last year to preclude funds from the Arizona Health Care Cost
Containment System from being used to pay for services provided by Planned
Parenthood." The News-Herald adds that "Brewer, still shopping for
votes for her Medicaid expansion plan, also cannot afford to alienate the
Democrats who have been largely supportive - and whose votes are necessary
given soft GOP backing."
North Carolina Medicaid Reform Could Reverse Other State
Efforts. In continuing coverage of North Carolina Governor Pat
McCrory's plan to reform Medicaid in the state, the Winston-Salem (NC) Journal (4/8, Craver) reports, "Gov.
Pat McCrory's proposal to overhaul the state's Medicaid program is likely to
throw a monkey wrench into the managed-care organization initiative for
behavioral health that began in earnest statewide just four months ago."
If "the legislature and the federal Centers for Medicare and Medicaid
Services approve McCrory's proposal, CenterPoint Human Services and the other
10 managed-care organizations could have a significantly diminished oversight
role at the start of the fiscal 2015-16 year on July 1, 2015, or could
possibly serve in a subcontracting-type role for one of the selected
groups."
Republicans Look To Protect Washington State Amid Medicaid
Expansion Efforts. The Puget Sound Business Journal (4/5, Bauman, Subscription
Publication) reported that "Washington state Senate Republicans are
including Medicaid expansion in their budget proposal – but they want the
state to have an 'out' if the federal government stops paying at the levels
promised." Senate Republicans "have introduced a Medicaid expansion
bill that would create protections for the state if the federal government
ever stopped paying that remaining 90 percent. The bill would also create a
system for anonymously tracking health care outcomes for Medicaid patients,
so the state could determine if the expansion was achieving what it is
supposed to: Healthier people in Washington."
Advocates Call For Medicaid Expansion In West Virginia. The Charleston (WV) Gazette (4/8, Nyden) reports that
"religious, community, labor, medical and political leaders gathered at
Christ Church United Methodist in Charleston Sunday afternoon to urge Gov.
Earl Ray Tomblin to expand Medicaid coverage in the state." According to
Perry Bryant, who heads West Virginians for Affordable Health Care (WVAHC),
"expansion would also bring an additional $500 million in federal funds
to West Virginia, as well as 6,200 new jobs."
Pennsylvania Welfare Secretary At Center Of Medicaid Expansion
Debate. The Pittsburgh Tribune-Review (4/8, Bumsted) profiles Beverly
Mackareth, acting secretary of Pennsylvania's Department of Public Welfare,
who is now "at the epicenter of a decision with enormous long-range
implications for the state: whether to expand Medicaid under President
Obama's health care overhaul." Mackereth, Governor Tom Corbett,
"and other Pennsylvania officials met last week in Washington with
Health and Human Services Secretary Kathleen Sebelius." And "on
Monday, she will speak at the Pennsylvania Association of County Human
Services Administrators' spring meeting in Harrisburg about the budget and
the Medicaid issue."
Small Business Owners Consider Ways To Avoid
Cost Increases From ACA.
On the
front page of its Marketplace section, the Wall Street Journal (4/8, B1, Maltby, Needleman,
Subscription Publication) reports that some small business owners are
considering paying a penalty rather than be subject to the Affordable Care
Act's so-called "employer mandate." Other strategies these firms
are considering to offset the cost increase they expect under the health law
include reducing hours and increasing their part-time work forces.
In a similar report focusing on Maine, the Portland (ME) Press Herald (4/8, Burgess) notes, "The
penalties go into effect in January. For a 70-employee company, the penalty
will be $2,000 per full-time employee minus the first 30 employees, or
$80,000."
HHS, SBA Regional Leaders
Tout ACA's Effect On Small Businesses.
In an
op-ed for the Paramus (NJ) Post (4/6), HHS Regional Director Jamie
R. Torres and Small Business Administration Acting Regional Administrator
Bernard Paprocki wrote, "For years, we had a health insurance market
that was broken for small businesses," but "because of the
Affordable Care Act, New Jersey's small businesses and their employees are
getting better choices, starting with new protections that limit the
outrageous rate hikes many small business owners faced in the past. Insurance
companies must now publicly justify every rate increase of 10% or more, which
has led to a sharp decline in double-digit rate hikes. … Beginning in 2014,
New Jersey small business owners will have access to a new Health Insurance
Marketplace...that will allow them to make side-by-side comparisons to find a
plan that fits their budget and that's right for their businesses and
employees."
LATimes Offers Tips To Handle Complex Medical
Bills.
The Los Angeles Times (4/7, Zamosky) offered a range of
tips from medical billing specialists on how consumers can get accurate
hospital bills and how to handle billing that goes awry. The advice included
demanding itemized bills, knowing how much hospitals can charge uninsured
patients by state law, knowing what your insurance network has negotiated for
charges, and taking complaints - "in writing" - "to the
top." The Times also pointed out that some consumers should simply fold
and hire a professional to navigate complex billing problems.
Lawsuit Claims Medicare Fraud
At Evansville Hospital.
The Evansville (IN) Courier & Press (4/7, Wilson) reports that a former
CEO and two other former employees have filed a lawsuit in US District Court
in Evansville alleging that "Select Speciality Hospital and its
Pennsylvania-based owner manipulated the length of stays for Medicare and
Medicaid patients to increase revenues from the government health care
programs. As a result, patients were kept longer than medically necessary
while others were discharged before treatments were complete." The case
is being investigated by both the Indiana Attorney General and the US
Attorney's Office, although neither would comment. The long-term acute care
hospital is owned by publicly traded Select Medical of Mechanicsburg,
Pennsylvania, and the Evansville Physician Investment Company. Two physicians
are also named in the lawsuit.
Idaho Clinic's Medicaid
Provider Status Suspended Amid Fraud Probe.
The AP (4/6) reports that "Idaho
officials have suspended the Medicaid provider status for an eastern Idaho
mental health and developmental therapy clinic." Reports indicate that
"the Idaho Department of Health and Welfare took the action last week
against Seasons of Hope following an 18-month investigation." According
to officials, "the company billed for services that weren't covered,
misrepresented services, billed for services not documented, billed for
services not provided, and billed for medically unnecessary services."
The Idaho State Journal (4/6, Hancock) reports that Health
and Welfare has also "told Seasons of Hope that more than $439,000 in
Medicaid payments it deemed were overpayments must be repaid. The department
also levied a $110,000 civil penalty. That means Sommer must pay $550,000 in
all to Health and Welfare."
|
No comments:
Post a Comment