The Department of Health and Human Services is almost certain to take on responsibility for creating the criteria used to decide what health records technologies qualify for billions of dollars in reimbursements to medical offices under a new stimulus program, officials said. The decision represents a restriction of the role played by Certification Commission for Healthcare Information Technology, which until recently had served as the government's gatekeeper for endorsing systems designed to improve the sharing of medical records.
The Miami operator of 11 shell corporations that billed Medicare for $123 million in bogus durable medical equipment claims has pleaded guilty to Medicare fraud in federal court.
According to the documents attached to the plea, Guerra owned 11 corporations that purported to supply DME to Medicare beneficiaries. He used straw owners to disguise his control over the companies and submitted approximately $123 million in fraudulent claims to Medicare for DME that had not been ordered by a physician nor delivered to a Medicare beneficiary. Based on those claims, Medicare paid Guerra’s DME companies $35 million.
Federal prosecutors have long acknowledged that Miami and South Florida are a Medicare fraud hotbed.
In March 2007, the Department of Justice established a Medicare fraud strike force in Southern Florida that has filed about 100 indictments charging more than 170 people with fraud. However, there is also concern that the fraudsters are migrating to other parts of Florida and the country as investigations intensify in South Florida.
In May, U.S. Attorney Eric Holder said that during the first year of strike force operations in Miami, the federal government estimated that billing for durable medical equipment fell by $1.75 billion in claims and $334 million in payments.
Interest groups on all sides of the healthcare reform debate have spent more than $57 million on television advertisements in six months, most of it in the last 45 days, said Evan Tracey, chief operating officer of the Campaign Media Analysis Group, which tracks television advertisements. Supporters of President Obama's plan to overhaul the system have outspent opponents, with $24 million worth of advertising, compared with $9 million from opponents. An additional $24 million has been broadly spent in support of overhauling the system without backing a specific plan.
As Congress debates a national healthcare overhaul, state experiments like Tennessee's are informing the discussion. As originally envisioned, the Tennessee plan expanded Medicaid to cover people who couldn't afford insurance or who had been denied coverage by an insurance company. Unlike Massachusetts's more recent universal coverage law, the TennCare plan is most often cited by opponents. They say TennCare's runaway costs show that the public health-insurance proposal by House Democrats could bankrupt the federal government.
A pilot project by Medicare that links hospital payments to the quality of care has helped prevent infections in pneumonia patients and cut death rates in heart-attack patients, according to data. In the project, hospitals compete for cash incentives from Medicare, the government insurance program for the elderly and disabled. Medicare officials are expected to announce that 225 hospitals will divide $12 million in bonuses; three poor performers will be penalized.
Horizon Blue Cross Blue Shield of New Jersey said it will terminate in-network coverage of about 3,000 current and retired state employees at Capital Health's Helene Fuld hospital, prompting Gov. Jon Corzine to propose state intervention in the contract negotiations. The breakdown in contract talks follows several weeks of unsuccessful negotiations between Horizon and Capital Health.