State roundup: Texas Medicaid fraud probes use controversial tool

Jul 21 2012

A selection of health policy stories from Texas, Michigan, Oregon, Georgia, Massachusetts, Maine, Ohio and Colorado.

Texas Tribune: In Medicaid Fraud Investigations, A Controversial Tool
When it comes to finding cost savings in the state's unwieldy Medicaid program, the Health and Human Services Commission's Office of Inspector General gets high marks. … But OIG's dollar-recovery strategy -- which includes an increased reliance on a rule that allows investigators to freeze financing for any health provider accused of overbilling -- has enraged doctors, dentists and other providers who treat Medicaid patients (Ramshaw, 7/20).

Detroit Free Press: State To Block Preferential Hospital Pricing By Insurers
Michigan Insurance Commissioner Kevin Clinton today issued an order saying the state will prohibit the use of preferential hospital pricing policies by insurers unless he approves them. The decision is effective February 1. It applies to all health insurance companies operating in Michigan. These preferential pricing policies -- known in the hospital and insurance industries as most favored nation clauses -- go to the heart of a 2010 landmark suit filed by the United State Justice Department against Blue Cross Blue Shield of Michigan. The federal government contends the policies unfairly cause hospitals to charge other insurance companies more to offset big discounts they give to the Blues. Aetna, one of the nation's largest health insurers, also filed a lawsuit last year with similar allegations (7/19).

Oregonian: Targeting Wasteful Health Care Spending In Oregon
Wasted spending isn't the biggest driver of health care costs, but it is a glaringly obvious target for improvement. For instance, a new report by the Oregon Health Care Quality Corporation suggests the state could save more than $26 million a year by preventing unnecessary visits to hospital emergency rooms (Rojas-Burke, 7/19).

Georgia Health News: Health Insurance Rebates On Their Way For Many
A new rule on health insurer spending will deliver nearly $20 million in policy rebates to Georgians by Aug. 1. Several other states, including Tennessee and Florida, have much higher rebate totals. But in the small-employer market, the rebates in Georgia for 4,614 consumers will average $811 -- a higher average payout than in any other state. The next highest is Ohio, with an average of $783. No other state is close to those figures. The Georgia insurance department said Thursday that the high rebates in small-group plans were due from only two health insurers -- John Alden Life Insurance Company and Nippon Life Insurance Company of America (Miller, 7/19).

Boston Globe: Massachusetts Lawmakers To Draft A 'Sober Homes' Bill
A leader of the Legislature's substance abuse committee said Thursday that she and her colleagues will draft a bill to try to weed out the growing numbers of private group homes for recovering addicts that are triggering neighborhood complaints about drug overdoses and reckless partying (Wen, 7/20).

Modern Healthcare: Cigna Adds To ACO Count In Maine, Ohio
Cigna on Thursday announced that its tally of accountable care programs nationwide stands at 32 following the signing of agreements for new ACOs in Maine and Ohio. The Bloomfield, Conn.-based insurer's contracts with Martin's Point Health Care and Mercy Health System in Maine and Mount Carmel Health Partners in Ohio follow Cigna's announcement on Wednesday of accountable-care partnerships in California, Colorado, Texas and Vermont (Evans, 7/19).

Modern Healthcare: Colo. Court Says Nurses Can Administer Anesthesia
A Colorado state appellate court in Denver upheld a lower court decision today to allow nurse anesthetists to administer anesthesia without physician supervision in the state's critical-access and rural hospitals. The case has pitted the state's doctors against the governor, hospitals and nurses in what has turned into a scope-of-practice fight in 16 states -- including California, where the state Supreme Court last week also ruled in the nurses' favor (Robeznieks, 7/19).

California Healthline: Moving 'Almost A Million Children' To Medi-Cal
The Managed Risk Medical Insurance Board, which oversees the state's Healthy Families program, yesterday took a long look at the first outline of a plan to facilitate the state-ordered shift of an estimated 873,000 children enrolled in the HF program to Medi-Cal managed care. The conclusion was, the current time frame to make such a big change is too tight, said Janette Casillas, executive director of MRMIB. … Dealing with that kind of complicated transition could be hard, she said, when you multiply all of that by 415,000 -- the number of children slated for transition to Medi-Cal on Jan. 1, 2013. That's almost half the kids in Healthy Families (Gorn, 7/19).

Detroit Free Press: State Is Taking Bids To Privatize Prison Health Care
The State of Michigan has called for bids in what could be the largest privatization of state government services in Michigan history. Proposals are due Aug. 29 for a massive deal to provide medical services -- physical and mental -- to all 43,000 inmates held in Michigan prisons. Services include wound care, treatment of heart disease and diabetes, dental care, optometry and sex offender treatment. The contract could replace the work of 1,300 state employees, Department of Corrections spokesman Russ Marlan said Thursday. Prison medical and mental health services cost the state $306 million in 2011, and the state wants to test the waters through competitive bidding to determine how much or whether it can reduce that, he said (Egan, 7/20).

Bloomberg: Silicon Valley Surgeons Risk 'Moral Authority' For 200% Returns
The anesthesiolgists' ball in December 2010 was already raging when Dr. Thomas Elardo and his wife arrived. … By rejecting the discounted contracts that participating in-network providers sign with insurers, the surgery centers bill insurance companies at their own out-of-network rates, which are 5 to 35 times as much as the in-network facilities charge, and make a killing. … The company pays profits to some 60 surgeon-partners at rates of return that often exceed 200 percent a year (Waldman, 7/19).