FBI Gains $1.2B In Healthcare Fraud Restitution

HMS Healthcare Management SolutionsEarlier this week, the FBI reported its crackdown on healthcare fraud led to $1.2 billion in restitution last year.  In 2011, the FBI investigated 2,690 cases, which led to 1,676 indictments and 736 convictions.

Some of the most common reasons were billing for services not provided, duplicate claims, medically unnecessary services, upcoding of services or equipment and kickbacks for referring patients for services paid for by Medicare and Medicaid.

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Information Exchange Presents Challenges For Stage 2 Meaningful Use

One of the greatest challenges in Meaningful use Stage 2 will be the health information exchange and related transitions-of-care requirements. So many organizations have had trouble with the Stage 1 requirement that they test their ability to trade key clinical data with other providers that the Centers for Medicare & Medicaid Services (CMS) dropped that criterion. But in Stage 2, providers will have to go beyond testing and actually exchange the information.

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Courtney Touts Health Reform Two Years After Passage

Joe Courtney held up the poster-sized chart and pointed to the numbers printed in purple: 7,700 seniors in his Eastern Connecticut district got a discount on their prescription drug payments last year, thanks to federal health reform. That included 530 seniors from Enfield, where he had come to chat at the senior center, 143 in neighboring Suffield and hundreds more in several other towns listed on the chart.

The third-term congressman from Vernon hasn’t missed many chances to tout the upsides of a law that many of his fellow Democrats have not gone out of their way to promote. Courtney brought a primary care doctor to town hall meetings last year to talk about patients whose cancers were discovered because of free wellness visits that Medicare now covers because of health reform. He’s delivered speeches to point out what he considers positive developments from the law, about which many Americans remain divided.

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CT Docs Get Medical Home Credentials

Thirteen physician practices from across the state have received recognition as patient-centered medical homes. The practices all recently participated in a pilot program which provided training on how to adopt methods used by a patient-centered medical home.

A medical home is a model of care that is considered a key aspect of health care reform. The idea behind it is to use primary care physicians as central figures in coordinating patient care among specialists, hospitals and other health care providers. It requires doctors to improve access to care, increase preventive care services, and employ care coordinators, among other things.

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Doctor Arrested For Alleged Role in Healthcare Fraud

A physician and the office manager of his medical practice, along with five owners of home health agencies, were arrested today on charges related to their alleged participation in a nearly $375 million health care fraud scheme involving fraudulent claims for home health services.

“Using sophisticated data analysis we can now target suspicious billing spikes,” said Health & Human Services (HHS) Inspector General Levinson.   “In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people – Dr. Roy certified more than 5,000.”

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Yale, St. Raphael’s Detail Plans For Merger

HMS Healthcare Management SolutionsThe proposed merger of Yale-New Haven Hospital and the Hospital of Saint Raphael, received by the Office of Health Care Access (OHCA) earlier this month, lays out an ambitious merger plan that would spare Yale-New Haven the expense of constructing a fifth “bed tower,” estimated to take five years and cost about $400 million. It also would provide St. Raphael’s with both financial stability and the retention of its Catholic directives for reproductive services and end-of-life care.

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1 In 5 Scrimp On Healthcare To Save Money

If you’ve ever thought twice about going to the doctor or taking a pill because of the cost, you likely aren’t alone.

About 20% of Americans over the age of 50 are switching to cheaper prescriptions, failing to take the medicine they are supposed to or skipping trips to the doctor to save money, according to a report from the Employee Benefit Research Institute.  It’s the latest example of how high health care costs are forcing some Americans to choose between financial and physical health.

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