Posts Tagged ‘medicaid’

Student Loan Forgiveness for Primary Care Physicians Announced

July 2, 2012 Leave a comment

Dr. Tom Price, MD of Georgia has a bill in the U.S. House geared directly at replacing the infamous health care reform bill officially known as the affordable care act. This bill is called HR 3000 “Empowering Patients First Act”. Below are key provisions of the bill. You can read the bill for yourself here:

Key Provisions
Loan forgiveness for Primary Care Providers

Federally Supported Student Loans for Medical Students

Refundable Tax Credit for low-income families

Deduction for health care costs

Credit for small employers adopting auto-enrollment

Improve beneficiary choice in S-CHIP

Financial Incentives for Treatment Compliance

Freedom of Choice, Right of Contract with Providers

Reduction in Medicaid DSH


Keywords: physician, health care reform, primary care physician, student loan, health policy


51% of Primary Care Physicians Stop Accepting Medicaid Patients

June 13, 2012 Leave a comment

Primary care physicians are struggling to survive in today’s economic climate. They of all the medical specialties have the lowest reimbursement rates and it is causing great harm to their bottom line. The fact that insurance  companies have been deliberately holding back reimbursement from physicians as well as continue to defraud Medicare and Medicaid in order to protect company profits does not help the matter either (Source 1). On the flip side of things, this is having a severely negative impact on patient access. According to a recent study released by Jackson Healthcare, 51% of physicians plan to no longer accept new Medicaid patients. In addition, 26% of primary care physicians have stopped accepting new Medicare patients (Source 2). Health and Human Services estimates that 13 million – 26 million will be new Medicaid enrollees thanks to the Affordable Care Act by 2020 (Source 3).  The private sector, states, and the federal government (HHS) need to fix this situation now before it gets any worse. Otherwise, we will have a huge crisis on our hands and thus no primary care physicians to care for Medicaid patients.





States dropping For-Profit Health Insurance Companies from Medicaid Programs

June 11, 2012 2 comments

As of today, The great state of Ohio has taken the right step and has kicked out private for -profit health insurance company Aetna from insuring people in Ohio’s Medicaid program. This comes only 2 months after Aetna received the green light to manage 1.7 million recipients. The contracts were supposed to go into effect January 1 of next year. It is unknown as to why Aetna was dropped (source 1).

Ohio is not the only state to have recently stopped awarding state Medicaid contracts to Aetna and other large 4-profit companies. In December 0f 2011, the great state of Connecticut made a great decision and kicked out UnitedHealthcare and Aetna from managing its Medicaid recipients as well. State officials are reported as saying to USA Today that the companies were dropped for “not fulfilling their promise to lower costs and provide better care.” (source 2). This whole thing of “not fulfilling their promise to lower costs and provide better care” is unfortunately becoming an epidemic in this country to when it comes to insurers. This goes ditto for the 4-profit ones. These especially are getting caught more and more by the federal government for defrauding Medicare and Medicaid on purpose in order to get profits for their shareholders. Sadly, this situation is turning into the “plague”.

According to research that I have done, I have found out that Aetna and UnitedHealthcare collectively have paid out over $596 million in settlements over the past 5 years for having been caught defrauding Medicare and Medicaid (actual amount defrauded before settlement to be posted on blog soon). Total amount by insurers over same time period is nearly $3,000,000,000 (source 3). This situation is clearly getting worse. State governments have finally “smelled the Starbucks” and have realized that the best prescription for curing this problem is to simply kick out the 4-profit companies from state Medicaid programs. Hopefully more states will follow suit and drop for-profit health insurance companies from their Medicaid programs.



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Hospitals Overbill Medicare and Medicaid by $2 Billion!

May 15, 2012 Leave a comment
Hospitals have been caught overbilling Medicare and Medicaid over $2 billion (what is being reported publicly) over the past decade. Cases of overbilling has risen dramatically over the past two years. According to reports, $106.9 million has been recovered from the hospitals since January 1 of this year. Reasons for overbilling range from being innocent to purely fraud. Failure to comply with federal law and having untrained billing/coding staff seems to be at the root of the problem. However, claiming to have “untrained staff” and pleading ignorance of U.S. federal billing regulations are not excuses that the Office of Inspector General or U.S. Department of Health and Human Services accepts as a valid cause of overbilling the government. Hospitals MUST make sure that all billing/coding staff (internal and external) are properly trained and are completely up-to-date on all federal billing regulations. Internal risk management departments MUST make this compliance and training a TOP priority!  Below is a history of hospitals overbilling Medicare/Medicaid.
California health systems fined $2.3 million  – December 2011 (Source 18)
– improperly billed Medicare for infusion and lithotripsy procedures
California health system fined  $9.1 million   – February 2011  (Source 30)
– submitted false inflated bills for home health services
California hospital system fined $423 million  – January 2007  (Source 31)
-grossly overbilled uninsured and Medicare / Medicaid patients
California hospital fined $8 million                – September 2005 (Source 12)
– tried to bill for an adult day care center and a fundraising resale store
Colorado hospital fined $6.3 million             – January 2012    (Source 6)
– overbilled Medicare by calling patients “inpatients” when they only received outpatient care
Colorado teaching hospital hospital fined $1.2 million                 -September 2001 (Source 13)
-improperly billed for patients hospitalized with pneumonia and angina
CT hospital fined $43,000                                – April 2012 (Source 1)
– overbilled inpatient same-day re-admissions
CT hospital fined $284,773                              – April 2012 (Source 1)
– overbilled due to failure to understand federal billing regulations
CT university hospital fined $475,000            – June 2007   (Source 32)
-overbilled Medicare for cancer treatments
DC teaching hospital fined $659,4000          – April 2012  (Source 2)
– overbilled Medicare due to staff unaware of federal billing regulations
Florida hospital fined $405,000                      – February 2012 (Source 23)
– improperly billed outpatients as inpatients in order to get higher reimbursement
Florida hospital fined $3.9 million                 – February 2012  (Source 4)
-overbilled for kyphoplasty procedure
Florida hospital fined $1,660,134                  – January 2011  (Source 9)
– overbilled Medicare for kyphoplasty procedure
Florida hospitals fined $4.3 million               – February 2003 (Source 10)
– upcoded, submitted false claims
Georgia hospital system fined $2.7 million    – August 2010   (Source 16)
-billed for cross-over claims (patients enrolled in both Medicare and Medicaid at the same time)
Kentucky healthcare system fined $1.3 million  –  August 2011 (Source 19)
-improperly billed Medicaid program in neighboring TN
Kentucky hospital fined $8.9 million              – August 2011     (Source 11)
– overbilled Medicare at higher than justified by the treatment they actually provided
Kentucky health system fined $782,842       – April 2011          (Source 29)
-fraudulently submitted charges for wound care, infusion, oncology services performed in outpatient setting
Illinois hospital fined      $100 million – March 1999   (Source 14)
-upcoded deliberately in order to “bilk” money from government
Indiana teaching hospital fined $1 million    –  May 2012 (Source 17)
-improperly used DRG codes
Massachusetts hospital fined $1.5 million    –   May 2012  (Source 1)
– overbilled outpatient and inpatients
Michigan hospital fined           $260,000         – May 2010         (Source 21)
– overbilled and billed kyphoplasty procedure as an “inpatient” procedure
Mayo Clinic fined $1.26 Million                        – August 2012
– submitted false claims
Minnesota hospital system fined $16 million  – January 2002 (Source 10)
– upcoded, submitted false claims
MO hospital fined $1 million                            – May 2012 (Source 17)
– excess charges for manufacturer credits for medical devices
MO hospital fined   $420,0000                          – October 2011 (Source 27)
-failure to understand and comply with federal billing regulations
NC hospital fined  $6,000           – April 2012  (Source 1)
– overbilled for brachytherapy due to untrained coding staff
NC hospital fined $2 million                            – April 2011          (Source 8)
-overbilled Medicare by ordering higher cost services for patients who only needed outpatient care
NJ hospital system fined $265 million            – June 2006 (Source 25)
-inflated prices for outpatient and inpatient care
NY hospital fined $11.75 million                      – May 2012  (Source 20)
-inflated prices for Medicare patients in order to get higher reimbursements
NY hospital fined $2.3 million                      – April 2012  (Source 5)
– overbilled Medicaid for physician-administered drugs and in trying to turn a profit
NY hospital fined $13.03 million                    – March 2012 (Source 25)
– deliberately “turbocharged” in order to get more outlier fees
NY university hospital fined $995,000                          – October 2011 (Source 28)
– fraudulently overbilled Medicare for urological procedures that were not necessary
NY university hospital fined $88.9 million     – September 2008  (Source 24)
-fraudulently billed Medicare and Medicaid for inpatient detox treatments
TN hospital chain fined $1 million                    – August 2010   (Source 22)
– submitted false claims, billed outpatients as “inpatients”
TN hospital chain fined $1 million                    – August 2010   (Source 22)
– submitted false claims, billed outpatients as “inpatients”
TN hospital chain fined $840 million             -December 2000 (Source 10)
– formerly run by Rick Scott (current FL Gov), upcoding, submitted false claims
TN hospital chain fined  $31 million               – May 2000       (Source 10)
-upcoded, submitted false claims
TX hospital chain fined $42.75 million   – April 2012 (Source 7)
– improperly billed for rehabilitation services
Ohio clinic (major academic clinic)  fined $254,000  –  October 2011  (Source 26)
-failure to understand federal billing regulations
Utah hospitals fined $22 million                    – February 2012 (Source 3)
– overbilled Medicaid by charging emergency level fees for non emergency care
Washington teaching hospital fined $100 million   – August 2011 (Source 19)
-improperly billed Medicare
 Total overbilling fines:   $2,051,475,149 Billion



Details of Health Care Cuts and Spending in 2013 Federal Budget

February 14, 2012 Leave a comment

The Obama Administration has recently presented its 2013 Budget proposal to Congress. According to the White House and HHS websites, healthcare is expected to be effected in the following ways:


$362 billion in cuts to Medicare and Medicaid over 10 years

Drug companies to provide $156 billion in discounts on top of $80 billion in discounts used to pay for healthcare reform legislation

$63 billion in cuts to long-term care facilities (i.e. Kindred Healthcare)

$177 million cut to Children’s Hospital Graduate Medical Education programs

$327 million cut to Community Services and Preventive Health grants


Medicare spending to increase by $45 billion in 2013 and total $523 billion.  Seniors to see premiums go up in order to save $28 billion by 2022.


$385 billion in savings for Medicare and Medicaid over 10 years


$1 billion additional for implementation of healthcare reform

$2 billion for Administration on Aging

$599 million for “effectiveness” research

$8 billion for Head Start


$1 trillion in new taxes (Buffet rule, etc)


200,0000 pharma jobs to be lost according to Pharmaceutical Research and Manufacturers of America Association

278,000 hospital jobs to be lost according to American Hospital Association

Facts on “RomneyCare” and “ObamaCare”

January 19, 2012 Leave a comment

For those of you keeping up with this year’s election, you know that there is a lot of talk about “RomneyCare” and “ObamaCare”. Believe it or not, there are more similarities than there are differences.  Here is what we know.


Real Name: St. 2006, c.58
Passed and signed into law in 2006 by Republican governor Mitt Romney
– 70 pages long
-opt out provision for health insurance mandate
– no federal government insurance option
– No new taxes
– No cuts to Medicare benefits
– Costs state only an additional 1% to state budget
– ruled constitutional by Massachusetts Supreme Court
Real Name: P.L. 111-148
Passed and signed into law in 2010 by Democrat President Barack Obama
Modeled off of “RomneyCare” said by Fox, CNN, MSNBC, NBC, CBS, ABC
– 2,074 pages long
– CO-OP option that is exempt from federal health insurance mandate
– Increases taxes by $500 billion (
– Cuts Medicare by $500 billion (
– expands medicaid eligibility to families with incomes up to 133% of poverty level
– insurance companies must pay 85% of premium dollars on medical services
– medicare “fee-for-service” changed to bundled payment structure
– Total new tax revenue amount to $409.2 billion over the next 10 years. $78 billion will be realized before the end of fiscal 2014. Summary of revenue sources:
  • Broaden Medicare tax base for high-income taxpayers: $210.2 billion
  • Annual fee on health insurance providers: $60 billion
  • 40% excise tax on health coverage in excess of $10,200/$27,500: $32 billion
  • Impose annual fee on manufacturers and importers of branded drugs: $27 billion
  • Impose 2.3% excise tax on manufacturers and importers of certain medical devices: $20 billion
  • Require information reporting on payments to corporations: $17.1 billion
  • Raise 7.5% Adjusted Gross Income floor on medical expenses deduction to 10%: 15.2 billion
  • Limit contributions to flexible spending arrangements in cafeteria plans to $2,500: $13 billion
  • All other revenue sources: $14.9 billion


U.S. Senate Investigating United Healthcare, Cigna, Aetna for Medicare and Medicaid Fraud

November 10, 2011 3 comments


The U.S. Senate is now officially investigating United Healthcare, Cigna, and Aetna for one of the largest fraud schemes yet against the Medicare and Medicaid programs. The amount of fraud is said to be in the hundreds of billions of dollars. The fraud was done on purpose as to rake in billions of profits for the insurers at the demand of company executives and shareholders, according to the U.S. Senate.

In addition, FierceHealthcare is reporting that United Healthcare, Cigna, and Aetna have also been caught in a multi-billion dollar pull-through scheme involving Quest Diagnostics and LabCorp. This scheme specifically involves Quest and LabCorp offering contracts for discounted or below-cost pricing in exchange for in-network physician referrals for lab testing business. The companies have clearly violated the U.S. federal anti-kickback law which protects patients and Medicare/Medicaid beneficiaries from potential influence of financial arrangements on care decisions. (Source:

This is only the tip of the iceberg. It has also been reported that Blue Cross/Blue Shield and Humana are also being investigated for a very very similar multi-billion dollar fraud scheme as well.

Stay tuned to here for more on this BREAKING NEWS story.

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