Tag Archives: Medicaid
15 things for healthcare leaders to know about Obama’s 2017 budget
Anthem’s Good, Bad and Ugly News
Anthem had some good headlines on Wednesday. The insurer reported second-quarter earnings and revenue that topped estimates, with the latter jumping 7.2 percent from a year earlier. It expects to insure more people than it initially forecast this year, after surprisingly robust growth in its Medicaid business.
But beneath the good, there was also bad and ugly.
Two Insurance Giants Planning To Jump Into California’s Medicaid Market
Two of the nation’s largest insurers are reaching out to doctors as they prepare to offer health coverage to low-income residents in California’s Medicaid program.
UnitedHealth and Aetna plan to join Medi-Cal managed care in San Diego and Sacramento counties beginning next year, pending final state approval.
Their participation shows that “Medi-Cal is a good business to be in,” said Stan Rosenstein, a consultant with Health Management Associates and a former Medi-Cal administrator. “Insurers are recognizing that with Medi-Cal covering a third of Californians, [they] really can’t ignore it.”
Seven healthcare questions the candidates aren’t answering
Hillary Clinton is quick to tout that she will defend the Affordable Care Act (ACA) and build on it to slow the growth of out-of-pocket healthcare costs while Donald Trump vows to repeal the ACA and have a series of reforms ready for implementation that follow free-market principles.
But when taking a closer look at their proposals, Clinton and Trump are keeping mum about some healthcare issues, and that’s raising some critical questions. Managed Healthcare Executive asked industry experts to comment on what topics presidential candidates are being quiet about, and why they suspect they’re not talking about them.
3 charged in $1 billion scheme to defraud Medicare in Florida, DOJ dubs biggest ever
The owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician’s assistant were charged with conspiracy, obstruction, money laundering and healthcare fraud in connection with a $1 billion scheme involving numerous Miami-based providers, the United States Department of Justice announced.
Assistant Attorney General Leslie Caldwell of the Justice Department’s Criminal Division said in a statement that the charges represent the largest single criminal healthcare fraud case ever brought against individuals by the DOJ.
Philip Esformes, 47, Odette Barcha, 49, and Arnaldo Carmouze, 56, all of Miami-Dade County, Florida, were charged in an indictment claiming that Esformes operated a network of more than 30 skilled nursing homes and assisted living facilities known as The Esformes Network, which gave him access to thousands of Medicare and Medicaid beneficiaries.
Healthcare CEO faces life in prison for fraud that led to 2 patient deaths
The CEO and co-owner of a Maryland diagnostics company is facing life in prison after a federal jury convicted him of two counts of healthcare fraud that resulted in death, according to the Department of Justice.
On Wednesday, a federal jury found 67-year-old Rafael Chikvashvili, PhD, guilty of healthcare fraud. Dr. Chikvashvili was the co-owner and CEO of Owings Mills, Md.-based Alpha Diagnostics, which was a portable diagnostic services provider, principally of X-rays.
According to evidence presented at trial, Dr. Chikvashvili was involved in a scheme to defraud Medicare and Medicaid. He and others allegedly conspired to create false radiology, ultrasound and cardiologic interpretation reports. He also allegedly submitted insurance claims for medical examination interpretations that were never completed by licensed physicians, according to the DOJ.
Dr. Chikvashvili allegedly instructed his nonphysician employees to interpret X-rays, ultrasounds and cardiologic examinations, which, according to testimony provided at trial, resulted in two patient deaths.
Where’s the value in accountable care?
Accountable care is supposed to be about paying for value. But six years after passage of the Affordable Care Act heralded the shift away from fee-for-service, Dr. Greg Carroll, corporate clinical leader of GOHealth Urgent Care, has an important question: “Where’s the value?”
Healthcare spending will make up 20% of U.S. economy within a decade
Healthcare spending will comprise 20 percent of the U.S. economy by the middle of next decade, according to new data from the Office of the Actuary of the Centers for Medicare & Medicaid Services and published in Health Affairs.
Expenditures on healthcare services will grow at an average rate of 5.8 percent per year between 2015 and 2025, about 1.3 percent higher than projected annual growth in the U.S. gross domestic product, CMS concluded. By 2025, healthcare spending will comprise 20.1 percent of the U.S. economy, up from 17.5 percent in 2014. Expenditures totaled $3.2 trillion last year.
Despite the seemingly robust spending growth, it remains lower than the 8 percent annual growth clip that occurred in the two decades before the Great Recession of 2008, which helped to slow expenditures significantly. In 2015, spending grew at a 5.5 percent rate. This year, it is projected to be 4.8 percent, attributable in part to the slower expansion of newly insured under the Affordable Care Act.
“The Affordable Care Act continues to help keep overall health spending growth at a modest level and at a lower growth rate than the previous two decades. This progress is occurring while also helping more Americans get coverage, often for the first time,” said CMS Acting Administrator Andy Slavitt in a statement.
Drop in Percentage of Physicians Participating in Medi-Cal Raises Red Flags
http://www.chcf.org/aca-411/insights/physician-participation?_cldee=aGVucnlrb3R1bGFAeWFob28uY29t
The share of physicians accepting new Medi-Cal patients is an indicator of the program’s capacity to meet demand. If a decreasing share of participating physicians are willing or able to take new Medi-Cal patients, beneficiaries in the program may have trouble getting the care they need. The proportion of physicians accepting new Medi-Cal patients has historically lagged behind the proportion accepting new patients covered by Medicare, which has a higher reimbursement rate, as well as behind the proportion accepting new patients with private health insurance.
New 2015 data now available on ACA 411 show the percentage of physicians participating in Medi-Cal has declined since 2013 — during the same period Medi-Cal enrollment skyrocketed by 39%. This raises serious concerns about whether the supply of physicians participating in Medi-Cal can meet the increased demand.
Physicians’ willingness to treat Medi-Cal beneficiaries is critical to ensuring Medi-Cal enrollees have adequate access to care. Without a sufficient number of doctors serving Medi-Cal beneficiaries, Medi-Cal enrollees may not be able to receive care in a timely manner. Beneficiaries may delay seeking needed care with disastrous effects or may end up receiving care in more costly settings.
HENRY KOTULA 