Some Doctors Improperly Bill Medicare Patients Who Also Qualify For Medicaid, Feds Warn
The government says doctors are incorrectly trying to collect deductibles, co-payments and other costs from these patients. Also in the news: A look at a lawsuit about Medicare billing that involves the head of the hospital chain Prime Healthcare Services, an article about Medicare's expansion of bundled payment programs, and a Washington state hospital is facing the loss of Medicare funding.
The New York Times:
Doctors Are Improperly Billing Some On Medicare, U.S. Says
Doctors are improperly billing poor people on Medicare for deductibles, co-payments and other costs from which they are supposed to be exempt, the Obama administration says. Federal officials have warned doctors that they may be subject to penalties if they persist in these practices. They could, for example, be fined or excluded from Medicare. The people who are being billed improperly are “qualified Medicare beneficiaries” who are also enrolled in Medicaid. They are 65 and older or disabled and have low incomes, generally less than $1,010 a month for an individual or $1,355 for a married couple. (Pear, 7/30)
The Wall Street Journal:
Hospital Chain’s CEO Faces Lawsuit Over Business Practices
Over the past decade and a half, California cardiologist Prem Reddy has built Prime Healthcare Service Inc. into one of the largest for-profit hospital chains in the U.S. by targeting distressed hospitals for acquisition. He boasts that his aggressive turnaround strategies have righted the finances of each and every one. But the chief executive has also attracted criticism, including claims that he plays hardball with insurers. Now Dr. Reddy is the central figure in a lawsuit brought by an employee and the Justice Department alleging that he strong-arms doctors in an effort to unnecessarily hospitalize patients at Medicare’s expense. (Evans, 7/31)
Modern Healthcare:
Bundled-Payment Expansion Brings Providers More Risk—And Opportunity
The CMS announced a proposal last week to put three new episodes of care under mandatory experiments with bundled payments, potentially compelling hundreds of additional hospitals into becoming financially accountable for what happens to Medicare patients long after they leave the hospital. It was just one in a series of steps in an effort to move Medicare and the entire industry toward models that pay for the quality of healthcare rather than the quantity of services. (Whitman, 7/30)
The Seattle Times/Skagit Valley Herald:
Skagit Regional Health Addressing Issues To Keep Medicare Funding
Skagit Regional Health is working to improve policies and practices that if left unaddressed could leave the hospital without Medicare funding. Skagit Regional Health gets about 70 percent of its revenue from Medicare and Medicaid, so losing that funding would be disastrous, said President and CEO Gregg Davidson. (Weinberg, 7/30)
