Virginia Beach-based Amerigroup Corp. has finalized an agreement under which the company will pay $225 million to settle claims that it avoided enrolling pregnant women and sick people in Medicaid programs. The company allegedly left those groups out of Medicaid health plans it was running in Illinois, which were designed for low-income patients. The U.S. Justice Department and the Illinois government charged that Amerigroup excluded those patients because they were more expensive to treat and would hurt its profit margins.
A federal judge has ruled against Schoolcraft Memorial Hospital in Manistique, MI, which sued the state due to a disagreement involving how long some patients are allowed to stay in swing beds—beds used for patients requiring short-term treatment of an illness or injury or recovering from surgery, and for those getting long-term care. Michigan officials said if a bed is open at a nearby nursing home, such patients must be transferred after five days, while Schoolcraft officials argued federal law lets the patients stay up to 100 days. The judge sided with the state, and fined the hospital $500,000.
The average monthly premium for Medicare's prescription drug plan will increase to an estimated $28 in 2009, an increase of three dollars when compared to this year's monthly premium, Medicare officials have announced. In a related development, Medicare officials also announced that 10 doctors-group practices participating in Medicare's Physician Group Practice Demonstration project showed improved quality of care for patients with congestive heart failure, coronary artery disease and diabetes. Due to the improvements, the groups involved in the project are being paid $16.7 million in incentives designed to reward healthcare providers for improving results and coordinating the healthcare needs of Medicare patients.
Insured children in the United States are much more likely than uninsured children to visit a doctor's office and to have a regular annual check-up, according to data released by the Robert Wood Johnson Foundation. The findings highlight the importance of government insurance programs such as Medicaid and SCHIP, according to the study's authors.
Floridians can now go online to find inspection reports and the results of complaint investigations involving most health facilities in the state. The data previously took a formal public-records request to obtain. The Florida Agency for Health Care Administration began posting the reports online to give consumers another tool for assessing 32,000 hospitals, nursing homes, clinics, surgery centers, dialysis units, and other healthcare facilities. Consumers can look up official state reports written after annual inspections, investigations into complaints, safety inspections, and unannounced visits. Such reports include details of violations such as cleanliness, medical mistakes, and procedural errors.
Missouri Medicaid, now renamed MO HealthNet, is offering to provide as many as 210,000 Medicaid recipients with "medical homes," a clinic or doctor's office they can rely on for their basic care. The $33 million program is aimed at Medicaid recipients who are not already covered through a managed-care program. Those eligible include virtually all people with disabilities and elderly people with low incomes who are receiving Medicaid.