The Texas Health and Human Services Commission (HHSC) announced in the October 20 Texas Register that there will be a public hearing for comments on proposed interim Medicaid reimbursement rates that will apply to large, state-operated Intermediate Care Facilities for Persons with Mental Retardation. Included are state schools operated by the Texas Department of Aging and Disability Services. The hearing will be held on Monday, November 6, 2006, at 2:00 p.m. in the Lone Star Conference Room … [Read more...] about Hearing on Proposed Provider Reimbursement Rates
The False Claims Act–A Significant Hammer!
For an example of how whistleblowers and the False Claims Act interact, read this article, Home Health Care Industry Reels from Medicare Scandal. Whistleblowers can bring qui tam lawsuits against providers and benefit hugely. In this particular case, the whistleblower benefits as follows: The False Claims Act permits individuals to file qui tam lawsuits against companies that defraud the government. Liable companies pay as much as three times the government's losses plus penalties for … [Read more...] about The False Claims Act–A Significant Hammer!
Over 41,000 Qualified Nursing School Applicants Rejected in 2005
Nursing schools had to turn away over 41,000 qualified applicants in 2005 because there weren't enough faculty to teach. This is an unfortunate trend because of the overall nursing shortage nationwide. According to USA Today, 7.9 percent of faculty positions at nursing schools remain unfilled, and the Department of Health and Human Service reports that the 10 percent RN vacancy rate will increase to 36 percent by 2020. In July, I blogged about the high turnover rate in health care jobs and … [Read more...] about Over 41,000 Qualified Nursing School Applicants Rejected in 2005
CMS Says No to Maryland Drug Plan Proposal for Uninsured
In an effort to provide low-cost prescription drugs to the state’s uninsured, Maryland proposed to offer them prescription drugs at Medicaid prices, but the Centers for Medicare and Medicaid Services (CMS) rejected the plan. (Kaiser Network) The state sought to finance the plan through various sources, including through pharmaceutical company rebates. This is not a legitimate source for matching funds, says CMS spokesperson Mary Kahn. The federal government matches state Medicaid … [Read more...] about CMS Says No to Maryland Drug Plan Proposal for Uninsured
Provider Letter: Changes To Dental Evaluation Approval Process
In a provider letter dated September 27, 2006, the Texas Department of Aging and Disability Services (DADS) informed Community Based Alternatives (CBA) Home and Community Support Services (HCSS) providers about changes to the approval process for dental evaluations. Under the new process, an HCSS provider's registered nurse is allowed to get multiple evaluations for CBA participants without obtaining prior approval from the DADS case manager. For more information, you may download the … [Read more...] about Provider Letter: Changes To Dental Evaluation Approval Process
Texas Register Updates: Transfer of Assets, Provider Payments
Texas Health and Human Services Commission (HHSC) has adopted new rules that affect various provisions of Chapter 358, Medicaid Eligibility. The following are new sections: (from the September 22 Texas Register): §358.431 Transfer of Assets §358.432, Home Equity Treatment §358.433, Treatment of Entrance Fees for Individuals Residing in Continuing Care Retirement Communities HHSC adopted the changes to incorporate mandatory provisions of the Social Security Act. In related … [Read more...] about Texas Register Updates: Transfer of Assets, Provider Payments
Whistleblower Actions Under the Federal False Claims Act
Go the federal Department of Justice website (www.usdoj.gov), and you can read how the largest health care system and second largest employer in New Jersey agreed to pay $265 million to resolve a qui tam lawsuit’s allegations in of defrauding Medicare. Click here for the web page. The agreement could also mean huge rewards for the three whistleblowers who started the whole thing. As part of the settlement, St. Barnabas Care System entered into a corporate compliance agreement with the … [Read more...] about Whistleblower Actions Under the Federal False Claims Act
Physicians Reject Offer To Block Reimbursement Rate Cuts
Last month I mentioned that the American Medical Association (AMA) and other doctors groups planned to lobby Congress during the August recess to block a scheduled reduction in Medicare reimbursement rates. In the ongoing saga, one lawmaker recently made an offer that was easy to refuse: send us quality-of-care reports, and we’ll block the reduction. (Kaiser Network) No thanks, said the AMA. Physicians are not only trying to block the cut; they’re seeking a 2 percent increase in … [Read more...] about Physicians Reject Offer To Block Reimbursement Rate Cuts
Texas Register Publishes New Rule, Hearing Notices
The Texas Health and Human Services Commission (HHSC) adopted §354.1450, which governs auditing of Medicaid providers. HHSC must notify providers of an upcoming audit no later than seven days before the field portion of the audit starts. If a pharmacy is being audited, HHSC must notify the pharmacy's corporate office. For more information on the new rule, see this section of the July 21 Texas Register. HHSC has extended comment periods and issued hearing notices for two proposed amendments of … [Read more...] about Texas Register Publishes New Rule, Hearing Notices
The End of Medicine : How Silicon Valley (and Naked Mice) Will Reboot Your Doctor
That's the name of a new book by Andy Kessler. I haven't read the book yet, but it is about amazing new breakthroughs (via Silicon Valley) in diagnostic tools that will be able to detect potential problems long before they become a problem. The book description at Amazon.com says the following about the book: Your doctor can't be certain what's going on inside your body, but technology will. Embedding the knowledge of doctors in silicon will bring a breakout technology to health care, and … [Read more...] about The End of Medicine : How Silicon Valley (and Naked Mice) Will Reboot Your Doctor
