State highlights: Audit says $93M in Medi-Cal payments could be fraudulent; Mass. insurers press on Medicaid pay

Aug 21 2014

A selection of health policy stories from the District of Columbia, California, Massachusetts and Minnesota.

Los Angeles Times: Auditor Says $93 Million In Medi-Cal Payments Could Be Fraudulent
The audit released Tuesday reviewed billing data from July 2008 to December 2013 for Medi-Cal's Drug Treatment program, which reimburses rehabilitation clinics. The audit found the state's Department of Health Care Services and the Department of Alcohol and Drug Programs failed to administer the program "and created opportunities for fraud" (Karlamangla, 8/19).

Reuters: California May Have Paid Millions For Fraudulent Drug Treatments
A California program that covers addiction treatments for the poor may have paid $93.7 million in fraudulent claims, a state audit showed. The report released Tuesday by the California State Auditor showed that the state's Drug Medi-Cal program may have paid more than $3 million in claims for patients who were actually dead, and found serious deficiencies in the agency's records for 30 drug treatment program providers. The audit was spurred by a 2013 investigation by The Center For Investigative Reporting and CNN, which found questionable billing practices at drug-treatment clinics in Southern California. The program is a division of the state's healthcare program for the poor, known as Medi-Cal (Mendelson, 8/19).

The Boston Globe: Medicaid Insurers Prod State On Funds
Buckling from more than $140 million in losses since the start of the year, companies that insure Medicaid patients are pressing the Patrick administration to increase payments they receive from the state for serving low-income residents. The health insurers say the deficits are the result of an expensive new hepatitis C drug and a surge of nearly 190,000 new members -- many with serious medical issues -- assigned to the companies by MassHealth, the state Medicaid program. Insurers say the state did not budget enough money this year to cover the added costs (8/20).

The Associated Press: Medicaid Insurers Seek More From Massachusetts
Companies that insure Medicaid patients in Massachusetts are pressing for an increase in the payments they receive from the state for serving low-income residents. The health insurers say $140 million in losses since the start of the year are the result of an expensive new hepatitis C drug and a surge of nearly 190,000 new members assigned to the companies by MassHealth, the state Medicaid program. Insurers say the state did not budget enough money to cover added costs (8/20).

The Washington Post: Rare D.C. House-Call Doctor Straddles Two Washingtons
[Dr. Ernest] Brown is a rarity: a family medicine doctor who performs house calls. Working mostly in the District, he's fully independent and unaffiliated with insurance programs. His work straddles two Washingtons. His paying patients are foreign and domestic travelers, including foreign dignitaries, staying at the city's hotels. Treating those clients allows him to serve as the primary care doctor -- pro bono -- for more than a dozen elderly homebound residents in poorer neighborhoods (Najarro, 8/19).

The Star Tribune: National Group Tries To Halt Union Election Of Personal Home Care Providers In Minnesota
U.S. District Judge Michael Davis is expected to decide Wednesday whether to stop the biggest unionization election in Minnesota history. Davis said at a hearing Tuesday that he'll decide by noon whether to issue a temporary injunction that would halt an election, now in progress, to determine if nearly 27,000 personal home health care workers will be represented by the Service Employees International Union (SEIU). The injunction is being sought by the National Right to Work Foundation, a Florida-based organization that has fought unionization. It sued on behalf of some home care providers who oppose the union (Furst, 8/19). 8/19).