Charity Hospital in New Orleans, formerly the city's largest healthcare provider for the uninsured, closed only because of the devastation left by Hurricane Katrina in 2005, attorneys for its managers told the Louisiana Supreme Court. The Supreme Court heard oral arguments in an Orleans Parish Civil District lawsuit filed in January 2008 that asks the courts to order Larry Hollier, chancellor of LSU Health Sciences Center, to reopen the Tulane Avenue hospital that long served poor families that couldn't secure healthcare elsewhere.
Nearly four million people in Pennsylvania and New Jersey live in households that will spend more than 10% of their pretax income on healthcare this year, according to new reports from Families USA. In the report, the group said 2.3 million Pennsylvanians under age 65 are in households that will spend more than 10% on healthcare. That is up from 1.9 million in 2000. In New Jersey, 1.5 million people now fall into that category, up from one million in 2000.
A consulting firm will look for more cost-effective ways to serve the poor at Nashville's public healthcare centers, Mayor Karl Dean announced. The firm, John Snow Inc., will work with an advisory committee with a goal to develop recommendations for a better business model for Nashville General Hospital and the city's other healthcare facilities.
Experts say the next few days will determine whether the swine flu outbreak will keep expanding or if it will recede in the fashion of seasonal flu at this time of year. "What happens this coming week will be essential in determining the fate of this outbreak," says pandemic model specialist Alessandro Vespignani of Indiana University in Bloomington.
San Francisco General Hospital's long waits for mammograms have been significantly shortened, and women needing appointments are now getting them within a week or two. In February, it was reported that the average wait time for a diagnostic mammogram at SF General after a woman had found a lump in her breast was 128 days, enough time for a very aggressive tumor to grow and affect the survival rate. Now, those women can get mammograms within seven to 14 days. The wait time for a precautionary screening mammogram has also been shortened, from 300 days to 90.
As unemployment and healthcare costs continue to rise, more people are buying cheap insurance plans with often financially devastating results. In 2008, Washington state announced a $20 million settlement with several companies, saying the companies had denied legitimate claims and misled thousands of consumers. Since 2003, more than 400 people have complained to state regulators about discount health plans.
A new report describes encouraging results for the Chicago Housing for Health Partnership, the first program in the country to link hospitals serving homeless, chronically ill patients with federally subsidized housing. The organization was formed in 2002 to deal with ill homeless people being discharged from hospitals that end up back on the streets without regular medical care. Inevitably, their health deteriorates. If there were some way to stabilize these patients with ongoing help, then perhaps they would have fewer medical crises and not return to hospitals as often, members of the partnership reasoned.
The New York State Office of Medicaid Inspector General (OMIG) last week released its 2009 work plan, which details the processes used by the agency to root out Medicaid fraud.
In the work plan's introduction, Medicaid Inspector General James Sheehan describes the document as a "road map" for the agency "reflecting OMIG's mission, developing competencies and carefully reviewing New York Medicaid expenditures and vulnerabilities."
The 2009 work plan is the second such document released by the New York OMIG, which continues to be among the most active Medicaid enforcement agencies. Within the work plan, the OMIG stated it also plans to publish compliance guidance for hospitals and managed care organizations in 2009.
However, according to experts, the work plan provides helpful guidance in its own right.
"New York state Medicaid work plan is a useful resource providers can certainly consider when identifying risk in the Medicaid program," says Sarah Kay Wheeler Sarah Kay Wheeler, partner at King & Spalding in Atlanta.
According to Wheeler, the work plan offers a transparent look into how the OMIG operates, which can be valuable to providers in any state. Providers can look to the work plan when determining possible Medicaid vulnerabilities. This is particularly important now because evidence indicated Medicaid enforcement efforts have been on an upswing.
Last week, New York State Attorney General Andrew Cuomo announced the state's Medicaid Fraud Control Unit (MFCU) recovered more than $263.5 million in fraud and abuse settlements in 2008. That total is more than double what the state recovered in 2007. New York's federal fiscal year 2009 goal is set at $322 million and if history is any indication, the state should meet that goal.
But New York agencies are not the only ones cracking down on Medicaid abuse. The federal Office of Inspector General also targeted Medicaid in its 2009 work plan.
"For those of us that have been following the law, this is not a surprise," says Wheeler.
According to Wheeler, the uptick in Medicaid enforcement has been in the works since 2006 when the Federal Deficit Reduction Act aimed to establish more resources to ensure the integrity for the Medicaid dollar.
The act increased funding at the federal level to establish data-mining, enact employee education provisions, encourage states to establish their own version of the False Claims Act, and created the Medicaid Integrity Contractors (MIC).
MICs are a quieter cousin to the Recovery Audit Contractors (RAC). Wheeler says MICs have not gotten as much attention as the RACs because MICs have not been as active. But Wheeler predicts MICs will be more active in 2009 than they have in previous years, and she wouldn't be surprised if this turns out to be a record year.
Ben Amirault is an Editorial Assistant for the revenue cycle division of HCPro. He manages the Compliance Monitor e-newsletter and has developed a number of online learning modules. He can be reached atbamirault@hcpro.com.
For the first time, there are three separate entities that hospitals can turn to for accreditation—the ubiquitous Joint Commission, the Healthcare Facilities Accreditation Program (HFAP), and newcomer Det Norske Veritas' (DNV) National Integrated Accreditation for Healthcare Organizations (NIAHO) program. With the option to move from one accreditation organization (AO) to another comes concerns of process and Medicare reimbursement.
"One of the issues that keeps coming up is, if I switch AOs, will that impact my Medicare reimbursement?" says Darrel Scott, senior vice president for regulatory and legal affairs for DNV.
To address this concern, DNV recently updated its FAQs to describe the process of switching accreditors.
"This applies regardless of which AO you are changing from or going to," says Scott. "We wanted to try to address in our FAQs the exact mechanic that occurs when a move is made."
So here's the process: when a hospital or hospital system decides to switch accreditation organizations, it can notify its current AO right away. The next step could go one of two different ways. First, the hospital and the AO can work out a plan for withdrawal and transition to the new AO. If this does not happen—that is, if the hospital and the AO cannot work out a transition strategy, the current AO may immediately withdraw the hospital's accreditation.
This is not as problematic as it may seem, however. The hospital's Medicare provider agreement is not affected should the current AO withdraw its accreditation before it is accredited by another AO. The current AO will, after removing the hospital's accreditation, notify the CMS Central Office and the applicable CMS Regional Office of its action. The AO will also provide those offices with an effective date of termination.
Again, there are two ways this next step can go. The simpler way is if the termination of one accreditation organization's accreditation is concurrent with a new recommendation for accredited, deemed status by the AO the hospital is transferring to. In that case, the hospital is simply transferred under the umbrella of the new AO.
However, if the current AO withdraws its accreditation and the hospital has not yet received accreditation from the new AO, the hospital is placed under the State Survey Agency (SA) jurisdiction. The hospital will remain under SA jurisdiction until it receives accredited, deemed status from the new organization. This new accreditation and deemed status must, of course, be approved by the CMS Central Office and the applicable CMS Regional Office as well.
"If the current AO informs the hospital that it is terminating its accreditation immediately and the AO notifies CMS, the hospital is moved over to the jurisdiction of the State Survey Agency," says Scott. "The hospital is then subject to a state survey until it is accredited by the new AO."
Throughout this process, the hospital's Medicare provider agreement and reimbursement is uninterrupted even though the hospital may be in transition from one AO to another. During this transition, there is always oversight from one of these entities and Medicare reimbursement is not affected.
A computer hacker wants $10 million for the return of more than 8 million patient records and 35.5 million prescriptions taken recently from a secure Web site for the Virginia Prescription Monitoring Program, reported the Web site Wikileaks.
Wikileaks says the hacker left a ransom note on the VPMP Web site which read: "I have your [stuff]! In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password."
The VPMP Web site is used by pharmacists and other health officials to monitor prescription drug abuse. Virginia Department of Health Professions Director Sandra Whitley Ryals released a statement on Thursday confirming a criminal investigation is underway regarding the security breach.
"While DHP cannot comment directly on an ongoing investigation, we can assure the public that all precautions are being taken for DHP operations to continue safely and securely," she said.
Since DHP recognized the unauthorized message posed on the Web site, Ryals said, her department has been working closely with federal and state law enforcement. The DHP system has been shut down for the past week to "protect the security of the program data," she said.
"We are satisfied that all data was properly backed up and that these backup files have been secured," she said.
Ryals added that her office will share additional details in the coming days on the agency’s Web site.
M.A. Myers, media coordinator for the FBI field office in Richmond, VA, told HealthLeaders Media Tuesday, "In conjunction with the Virginia State Police, we are looking into the incident, but we aren't making any further comment beyond that. Unless there is a reason for us to have media attention, we generally don't comment on pending cases."
In October 2008, hackers accessed millions of electronic patient files held by Express Scripts Inc. and threatened to expose the records unless the drug benefits company paid a ransom. Scripts, the nation’s third-largest drug benefits manager, posted a $1 million reward for help catching the culprits, who remain at large.
