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Posts Tagged ‘Medicaid’

State expansions of the Medicaid health insurance program for poor Americans reduced adult mortality rates by more than 6 percent compared to states that did not broaden eligibility for their plans, according to a study released on Wednesday.

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WV diocese joins call for expanding Medicaid
Tomblin is one of only two Democratic governors who have yet to decide whether to heed this call by the federal health care law. Nearly two-thirds of West Virginians … Tomblin is awaiting an analysis of the pros and cons of expanding. Bransfield …
Read more on State Journal

How Gay Marriage Won
They joined Hillary Clinton and her husband, the former President who signed the Defense of Marriage Act into law during his 1996 re-election bid but is now calling on the Supreme Court to undo his mistake. (MORE: Watching Kennedy: The Court's Swing …
Read more on TIME (blog)

Your Capitol Voice: One-time money should not go to ongoing expenses
Those two pieces of legislation are proof of how critical issues can be sent on their way to becoming law when you work in a bipartisan fashion. This week also marked the beginning of votes on budget bills. We voted … Here are some pros and cons …
Read more on West Branch Times

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Florida governor Rick Scott, one of the biggest critics of President Obama’s health reform efforts, said Wednesday he would do the administration’s bidding and expand the Medicaid program.

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Florida governor Rick Scott created a stir this week when he said he’d expand Medicaid as requested by the Obama administration. But health policy experts say it’s hard for any governor to say no to billions of dollars in federal subsidies.

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Florida governor Rick Scott created a stir this week when he said he’d expand Medicaid as requested by the Obama administration. But health policy experts say it’s hard for any governor to say no to billions of dollars in federal subsidies.

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WASHINGTON (Reuters) – President Barack Obama’s $ 1 trillion plan to expand Medicaid would raise state costs by only 3 percent and extend health coverage to more than 21 million low-income people as part of the new healthcare reform law, a study said on Monday.

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State expansions of the Medicaid health insurance program for poor Americans reduced adult mortality rates by more than 6 percent compared to states that did not broaden eligibility for their plans, according to a study released on Wednesday.

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Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview

Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview

A number of federal statutes aim to combat fraud and abuse in federally funded health care programs such as Medicare and Medicaid. Using these statutes, the federal government has been able to recover billions of dollars lost due to fraudulent activities. In March 2010, Congress enacted comprehensive health care reform legislation. One focus of this legislation, the Patient Protection and Affordable Care Act (PPACA) as amended, is improved health care fraud and abuse enforcement. PPACA, among other things, creates new health care fraud enforcement tools and expands upon the types of prohibited conduct. This report provides an overview of some of the more commonly used statutes used to fight health care fraud and abuse and discusses some of the changes made to these statutes by PPACA.

Title XI of the Social Security Act contains Medicare and Medicaid program-related anti-fraud provisions, which impose civil penalties, criminal penalties, as well as exclusions from federal health care programs on persons who engage in certain types of misconduct. PPACA amends these administrative sanctions and authorizes the imposition of several new civil monetary penalties and exclusions.

Under the federal anti-kickback statute, it is a felony for a person to knowingly and willfully offer, pay, solicit, or receive anything of value (i.e., “remuneration”) in return for a referral or to induce generation of business reimbursable under a federal health care program.The statute prohibits both the offer or payment of remuneration for patient referrals, as well as the offer or payment of anything of value in return for purchasing, leasing, ordering, or arranging for, or recommending the purchase, lease, or ordering of any item or service that is reimbursable by a federal health care program. PPACA revises the evidentiary standard under the anti-kickback statute and eliminates the requirement of actual knowledge of, or specific intent to commit a violation of the statute. This amendment may make it easier for the government to prove its case.

The Stark law and its implementing regulations prohibit physician self-referrals for certain health services that may be paid for by Medicare or Medicaid. Under the Stark law, if (1) a physician (or an immediate family member of a physician) has a “financial relationship” with an entity, the physician may not make a referral to the entity for the furnishing of these health services for which payment may be made under Medicare or Medicaid, and (2) the entity may not bill the federal health care program or any individual or entity for services furnished pursuant to a prohibited referral. PPACA limits certain exceptions to the Stark law.

The federal False Claims Act (FCA) imposes civil liability on persons who knowingly submit a false or fraudulent claim or engage in various types of misconduct involving federal government money or property. Health care program false claims often arise in billing, including billing for services not rendered, billing for unnecessary medical services, double billing for the same service or equipment, or billing for services at a higher rate than provided (“upcoding”). Civil actions may be brought in federal district court under the FCA by the Attorney General or by a person known as a relator (i.e., a “whistleblower”), for the person and for the U.S. Government, in what is termed a qui tam action. PPACA appears to make it easier for certain relators to bring qui tam actions, thus potentially allowing some FCA actions to proceed that would have been dismissed under prior law.

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(Reuters) – Illinois Governor Pat Quinn signed into law on Thursday a package of bills aimed at curbing the state’s Medicaid costs through program changes and revenue enhancements.

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(PRWEB) January 09, 2012

The primary mission of the Corporate Whistle Blower Center is to protect all corporate whistleblowers in every possible way. The group says, “We think its vital that individuals, who are courageous enough to step forward about Medicare, or Medicaid fraud should be protected in every way possible. While we are not a law firm, and our efforts are not an attempt to practice law, we want to make certain high end whistleblowers understand the playing field, and the basic rules. Rule number one is if you go public, or go to the Feds, prior to a skilled whistleblower attorney having the opportunity to review your information, your chance for a significant reward may have just gone out the window.” They say, “We know a great deal about healthcare, Medicare, or Medicaid fraud, and we want healthcare whistleblowers to get up to speed as quickly as possible, in order to help make certain they do not inadvertently mess up their chance of getting a significant reward for their information. As part of our service we will try our best to find the highest caliber whistleblower law firm, or attorney given the fact set we are presented with. No other group in the United States offers anything close to this service.” For more information please contact the Corporate Whistle Blower Center at 866-714-6466, or contact the group via its web site at http://CorporateWhistleBlowerCenter.Com.

According to The Corporate Whistle Blower Center, “Every US citizen needs to understand how huge the Medicare fraud problem is, so we can stop it. Medicare fraud alone is a $ 60 plus billion dollar per year enterprise.” To better illustrate this point, on Friday April 29th 2011, the Associated Press reported, “As the feds squeeze tighter, South Florida’s Medicare schemers have scurried into new territory to loot hundreds of millions of dollars from taxpayers, now billing the system for bogus mental health, physical therapy and other rehabilitation services. The magnitude of the region’s fraud is astonishing: Florida mental health clinics submitted $ 421 million in bills to Medicare last year — about four times more than Texas and a whopping 635 times higher than Michigan, both also hotbeds of healthcare rackets, according to government records. Florida rehabilitation facilities billed $ 310 million for physical and speech therapy — 140 times more than New York and 10 times higher than California, records show.” The Corporate Whistle Blower Center says, “We know healthcare executives are seeing multi million dollar Medicare, or Medicaid fraud first hand, and they can get rewarded for their information, provided the proof is overwhelming. We want to help them step forward.” For more information please call the Corporate Whistle Blower Center anytime at 866-714-6466, or contact the group via its web site at http://CorporateWhistleBlowerCenter.Com

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