Archive for: Medicaid
Unapproved drugs still sold
Medicaid still covers drugs not reviewed by the government–about $200 million worth since 2004, the Associated Press reports.
The medications, linked to dozens of deaths, are decades old. The Food and Drug Administration had less restrictive measures then and has tried, to no avail, to eliminate them from the market.
Medicaid spending to exceed general economy growth rate
According to CMS’ annual report released October 17, Medicaid spending is expected to significantly surpass the growth rate of the U.S. economy over the next 10 years, HealthImaging reports.
The report, presented at the fall meeting of the National Association of State Budget Officers, predicts that Medicaid benefits spending will rise 7.3% from 2007, reaching $339 billion in 2008, and increasing annually at an average rate of 7.9% over the next decade, to $674 billion in 2017. The expected growth rate of the overall economy is 4.8%.
Click here to read the full HealthImaging report.
Federal judge dismisses $15M false claims case
A federal judge recently granted a summary for dismissal in the case that alleged East Texas Medical Center Regional Healthcare System of submitting false claims to Medicaid, according to the legal journal The Southeast Texas Record.
The lawsuit alleged East Texas Medical Center (ETMC) Athens, located in Athens TX, illegally submitted claims for additional reimbursement under the intergovernmental transfer program which applies to public rural hospital.
The judge decided ETMC is a private hospital and should not have received additional reimbursement from the intergovernmental transfers, but the Texas Organization of Rural and Community Hospitals (TORCH) told ETMC it was qualified. Because ETMC relied on the advice it received from TORCH, the judge decided ETMC did not knowingly submit a false claim and therefore cannot be in violation of the False Claims Act.
To read The Southeast Texas Record article click here.
Staten Island University Hospital to pay $89 million to settle fraud claims
The report, presented at the fall meeting of the National Association of State Budget Officers, predicts that Medicaid benefits spending will rise 7.3% from 2007, reaching $339 billion in 2008, and increasing annually at an average rate of 7.9% over the next decade, to $674 billion in 2017. The expected growth rate of the overall economy is 4.8%.
Click here to read the full HealthImaging report.
Staten Island University Hospital to pay $89 million to settle fraud claims
Staten Island University Hospital (SIUH) agreed to pay almost $89 million to settle four separate charges for alleged defrauded Medicare, according to a Department of Justice (DOJ) press release.
The DOJ alleges SIUH:
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Fraudulently billed Medicaid and Medicare for inpatient alcohol and substance abuse detoxification treatment
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Used incorrect billing codes for cancer treatment performed at the hospital to receive reimbursement for services not covered by Medicare
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Deliberately inflated the resident count from the 1996 cost report year through the 2003 cost report year
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Billed Medicare and Medicaid for treatment of psychiatric patients in unlicensed beds between July 2003 and September 2005
Whistleblowers filed two of the four counts.
Dr. Miguel Tirado, a former SIUH Director of Chemical Dependency Services, alleged SIUH performed alcohol and substance abuse in unauthorized beds. SIUH will pay the $11.8 million to the federal government and $14.9 million to the state of New York, according to an agreement. Tirado will receive $2.3 million from the federal government for filing the suit.
Elizabeth M. Ryan, widow of an SIUH cancer patient, alleged the hospital used incorrect codes to bill for outpatient cancer treatments. SIUH will pay the $25 million to settle this claim, and Ryan will receive $3.75 million of it.
The government filed the other two claims. According to the agreement, SIUH will pay the government $35.7 million for inflating cost report numbers and $1.5 million for allegedly performing psychiatric treatments in unlicensed beds.
To read the full DOJ press release click here.
