Medicaid Fraud Busters Learn From Experience
Texas had an unusually high Medicaid orthodontics bill in 2010. At $185 million, the state was reportedly spending more than the other 49 states combined. Claims data showed that it had led the nation for three consecutive years in total dollars spent to help children with crooked teeth. Or at least that’s what state and federal regulators thought. As it turns out, Texas did not have a higher percentage of children with orthodontic needs. Crooked orthodontists are not the first health providers to prey on the state’s $27 billion Medicaid program, nor will they be the last. The total amount of money lost to fraudulent orthodontics in Texas over the last three years, though estimated in the hundreds of millions, is only a portion of the money Texas Medicaid loses to waste, fraud and abuse each year, despite increasingly sophisticated efforts to prevent it.
A National Problem. And Texas is far from the only state plagued by unscrupulous health care providers. Nationwide, the federal government estimates it lost $22 billion of its share of Medicaid funding last year to what it calls “improper payments,” according to its payment accuracy survey. This suggests that the loss to state treasuries was also in the tens of billions.
US unemployment aid applications fall
The Athens Banner-Herald
The number of people applying for U.S. unemployment benefits fell last week for the first time in five weeks. But the drop suggests only modest job growth after three months of weak hiring. The Labor Department said Thursday that applications for weekly benefits dropped by 12,000 to a seasonally adjusted 377,000. That’s down from an upwardly revised 389,000 the previous week. The four-week average, a less volatile measure, rose by 1,750 to 377,500, the highest level in a month. Applications are a measure of the pace of layoffs. When claims dip below 375,000, it typically suggests hiring is strong enough to reduce the unemployment rate. They have hovered near that level for most of the year after declining sharply last fall.
(AL) Alabama won't act until after U.S. Supreme Court ruling on Affordable Care Act
The Birmingham News
Alabama will wait until the 11th hour to set up a state health insurance exchange, with Gov. Robert Bentley saying he can establish one by executive order if the U.S. Supreme Court upholds the Affordable Care Act this summer. Bentley on Friday reiterated his position that the state should wait until the high court rules on a challenge to the federal health care legislation, a move that will give the state just a few months to get an exchange plan to the federal government before a November deadline. The 2010 Affordable Care Act mandates that most people have health insurance. It also directs the states to set up exchanges, which are essentially virtual marketplaces where people can purchase the plans. Some people will be given federal subsidies to help them buy insurance.
(GA) Ga. explores private management of Medicaid
The Athens Banner-Herald
Georgia is exploring whether private companies could better manage the state's Medicaid program. Department of Community Health Commissioner David Cook said the current Medicaid program cannot be sustained. He told The Atlanta Journal-Constitution that he expects an annual deficit of more than $600 million within three years. A consultant's report in January recommended using private companies to manage Medicaid, which pays for care of the needy, aged, blind, disabled and some poor families with children. Georgia has already experimented using private companies to manage part of its Medicaid program that largely covers children and pregnant women. Hospitals and doctors have criticized the results, though Cook said the program improved care and lowered costs.
(MS) Program provides child welfare training
A University of Mississippi-led team is at the forefront of improving child welfare training in the state. The new UM Child Welfare Training Academy, established through a four-year grant administered by the Mississippi Department of Human Services, has overhauled the pre-service training curriculum required for all Mississippi child welfare workers and supervisors. The academy began delivering the training this year. Previously offered by the MDHS Division of Family and Children Services, or DFCS, the state's child welfare training was outdated and not available on a regular basis, said academy director Martha Houston. The new training is ongoing to ensure that new hires are trained as soon as possible.
(OK) Oklahoma governor signs DHS reform measures
Legislation was signed into law Thursday that is intended to improve operations of the Oklahoma Department of Human Services and the care of children it oversees. “Today is a turning point when we add more safeguards for protecting our children in our state, more accountability, transparency and more funding,” Gov. Mary Fallin said before signing four measures dealing with the state's largest agency. Some key changes to how the state's largest agency is administered will be left up to voters. Lawmakers passed House Joint Resolution 1092, which asks voters in November to approve a constitutional amendment repealing the Commission for Public Welfare, which was approved by voters in 1936 to oversee DHS. The commission has nine members, each appointed to a nine-year term. If voters approve the ballot issue, then House Bill 3137 — which Fallin signed Thursday — would take effect and would require the DHS director to be appointed by the governor and confirmed by the Senate. The DHS commission now hires the director.
(TN) New Tennessee law may aid pain pill epidemic
The Chattanooga Times-Free Press
Last year, the top 10 medical prescribers in Tennessee wrote prescriptions for more than 20 million doses of restricted pain medication, with the top prescriber in the state doling out more than one-quarter of those. That is more than three pills for each of the state's 6 million-plus residents, but it's only a small fraction of the doses handed out by more than 30,000 medical prescribers statewide. Together, all prescribers in the state wrote nearly 18 million prescriptions for controlled substances such as Oxycontin and hydrocodone, according to an April report to the Tennessee General Assembly. Excluding certain drugs that were added in 2011, the number of prescriptions written increased about 23 percent from 2010 to 2011. The numbers put Tennessee among the top states in the nation for so many things -- prescriptions written, oxycodone and hydrocodone sales and drug overdose deaths. But officials say a new law puts Tennessee in the top spot for something else -- being one of the first states to require doctors to check a drug monitoring database before they prescribe pain medication as part of a new treatment.
(TX) Doctors teaming up to treat patients
The Houston Chronicle
Dr. Ashu Verma didn't set out to be part of health care's hottest trend. She says she just wanted her patients to get the care they needed, when they needed it. But in going to work at Kelsey-Seybold's family medicine clinic in Kingwood, Verma joined a growing number of doctors who have agreed to work as a team, basing treatment decisions on research into what works, rather than doing what they've always done or agreeing to something their patient may have heard about on television or from a friend. The goal is better health, at lower cost. Kelsey-Seybold, founded in Houston in 1949, is one of the nation's oldest accountable care organizations, or ACOs, although it wasn't called that when it was created. The Mayo Clinic is another, as is Scott & White Healthcare in Central Texas. The Affordable Care Act is accelerating the movement, prompting doctors and hospitals to coordinate care to avoid duplication of services and prevent medical errors.
(VA) Doctors sue Virginia over health care law
The Washington Times
A group of doctors is suing Virginia over a provision in its heath care law that forbids medical professionals from offering certain new services or purchasing certain types of equipment without first getting an official go-ahead from the state Department of Health. The lawsuit, filed Tuesday in federal court in Alexandria, charges Virginia with violating the Commerce Clause of the U.S. Constitution — ironically the same charge the state is leveling at the federal government in requiring most Americans to purchase health insurance or face a penalty. Plaintiffs in the case against Virginia argue that they are not able to import goods like MRI machines or CT scanners via interstate commerce because of Virginia’s “certificate of need” requirement for pre-clearance of new services or equipment with the state Health Department, which some say favors already-existing businesses — or the ones with the right connections.
(WV) W.Va. small businesses part of health care debate
The Daily Mail
With the U.S. Supreme Court expected to rule this month on the federal health care law, its supporters are touting its potential benefits to West Virginia's small businesses. But some of these employers are among the overhaul's biggest critics. A recent report by the group Families USA highlights tax credits meant to encourage small businesses to provide coverage for employees. It estimates 16,730 West Virginia businesses employing 91,600 people qualify for these credits. The credits available to West Virginia employers were worth $80.7 million, or about $881 per worker in 2011, the report said. Perry Bryant, executive director of West Virginians for Affordable Health Care, noted 7,030 small businesses in the state qualify for the maximum credit, worth 35 percent of the employer's share of policy premium costs. The value of that credit will increase to 50 percent of the employer's share in 2014.
(AL) Alabama law could reduce prison overcrowding
The Montgomery Advertiser
State lawmakers are hoping a bill passed last month will alleviate overcrowding in a state that has the highest prison population growth in the country. The Anniston Star reports that Senate Bill 386 gives the Alabama Sentencing Commission power to shorten prison sentences for various crimes starting in October 2013 unless the Legislature specifically rejects the change. Bill sponsor Sen. Cam Ward, a Republican from Alabaster, said over time the prison population will decline. Alabama's prisons hold 27,000 inmates but they were built for half that. The commission hopes to reduce sentences for non-violent offenders who are behind bars for drug or property crimes.
(FL) Florida 'stand your ground' law yields some shocking outcomes depending on how law is applied
The Tampa Bay Times
Florida's "stand your ground'' law has allowed drug dealers to avoid murder charges and gang members to walk free. It has stymied prosecutors and confused judges. It has also served its intended purpose, exonerating dozens of people who were deemed to be legitimately acting in self-defense. Among them: a woman who was choked and beaten by an irate tenant and a man who was threatened in his driveway by a felon. Seven years since it was passed, Florida's "stand your ground" law is being invoked with unexpected frequency, in ways no one imagined, to free killers and violent attackers whose self-defense claims seem questionable at best. Cases with similar facts show surprising — sometimes shocking — differences in outcomes. If you claim "stand your ground" as the reason you shot someone, what happens to you can depend less on the merits of the case than on who you are, whom you kill and where your case is decided.
(KY) Painkiller crackdown could harm the truly needy, say patients, doctors
Pain patients and many doctors say they are feeling the backlash from a recent crackdown against pill abuse, which they fear lumps legitimate patients in with drug-seeking addicts, and legitimate prescribers with pill-pushing doctors. It’s a huge concern in a nation where chronic pain afflicts 116 million American adults and is associated with up to $635 billion in health care costs, according to a 2011 Institute of Medicine report. “Pain patients feel ashamed or weak that they have to take these medications … (and) shy away from being treated,” said Dr. James Murphy, a pain specialist in Louisville. “... Chronic pain is a condition; it’s not a character flaw. And we have treatments.” Compounding matters, doctors and health care experts said, a growing number of physicians are becoming reluctant to prescribe painkillers, fearing they might become targets of investigations. If physicians accidentally prescribe painkillers to doctor-shopping addicts, they could put their licenses in jeopardy or even be charged with a crime.
(LA) How Louisiana Became The World's 'Prison Capital'
A new expose by The Times-Picayune of New Orleans calls Louisiana the "world's prison capital." The state imprisons more people per capita than any other state or country in the world, with one out of every 86 adults behind bars. Its rate of incarceration is three times higher than Iran's and 10 times higher than Germany's. How did Louisiana double its prison population in the past 20 years? And what differentiates it from other states? The difference, says Times-Picayune reporter Cindy Chang, is that more than half of the inmates in the state are housed in local prisons run by sheriffs, and the state's correction system has created financial incentives for those sheriffs to keep prisons full.
(MS) Texting rises as crash issue
Texting while driving is becoming more of an issue in Mississippi courtrooms, with a Marshall County judge being asked to make public a video allegedly showing a driver texting as his vehicle collided with another. And in Massachusetts, the state's first texting-while-driving case is unfolding this week, with jurors deciding whether an 18-year-old was not just speeding but texting when he struck a car, killing its driver and severely injuring a passenger. The list of 38 states banning texting while driving doesn't include Mississippi, with Alabama being the latest to take up a ban. Only drivers with a learner's permit or behind the wheel of a school bus in Mississippi are barred from texting while driving, thanks to a scaled-back law passed in 2010.
(TX) Officials look to adult prison to help solve juvenile security problems
The Austin American-Statesman
Down the long central hallway at one of Texas' oldest prisons, through three sets of clanging steel-barred doors, convicts in white uniforms stand in sweaty lines waiting to go to their midday meal. Most have been convicted of violent crimes. Rape. Kidnapping. Sex assault. Murder. Most have been in criminal street gangs. All are legally still children, less than 18 years old. Had they not been certified as adults by Texas courts, the 63 youths in a little-known program at the Clemens Unit south of Houston would have landed in one of the state's six state-run lockups for juveniles. In those facilities, counseling and rehabilitation programs come first. But as the system has taken on more violent youths in recent years, escalating violence and gang warfare, even riots, have left dozens of people injured and sparked a legislative investigation. Advocates for youthful offenders say juvenile lockups can be made more secure without compromising important rehabilitation programs.
The Downside Of Health Care Job Growth
Kaiser Health News
Health care employment has been the bright spot in the otherwise lackluster recent jobs reports. As overall employment decreased by 2 percent from 2000 to 2010, employment in the health care sector actually increased by 25 percent. But that’s not necessarily a good thing, according to an opinion piece published in the most recent edition of the New England Journal of Medicine. “Treating the health care system like a (wildly inefficient) jobs program conflicts directly with the goal of ensuring that all Americans have access to care at an affordable price,” write Katherine Baicker and Amitabh Chandra, two researchers from Harvard. By 2020, almost one out of nine American jobs will be in health care, an April study from the Center for Health Workforce Studies projects.
Analysis: HHS has missed nearly half of healthcare law’s deadlines
The Health and Human Services Department has missed nearly half of its legal deadlines while implementing President Obama’s healthcare law, according to an analysis by the American Action Forum. HHS has faced 42 statutory deadlines in the roughly two years since the Affordable Care Act became law — and it missed 20 of them, according to the AAF’s count. The highest-profile item on the list of missed deadlines is the CLASS, or Community Living Assistance Services and Supports, program, which would have provided insurance for long-term care such as nursing-home stays. But HHS decided not to implement the program, saying it simply couldn’t work as it was written.
Sebelius: ‘We’ll be ready’ if Supreme Court strikes healthcare law
President Obama's top health official told an audience Thursday that the administration will be prepared to react if the Supreme Court strikes down its healthcare reform law. Health and Human Services Secretary Kathleen Sebelius said she is "confident and optimistic" that the high court will uphold the law, but added "we'll be ready for contingencies" if it does not. The remark, at a White House town hall on women's health, comes as the president and Democrats brace themselves for the court's decision, which is expected by the end of the month.
Voting-Rights Surprise at High Court May Foreshadow Health Care
When U.S. Supreme Court justices picked apart the government’s arguments in defense of President Barack Obama’s health-care overhaul, they buoyed the hopes of the law’s opponents that it would be ruled unconstitutional. A 2009 challenge to the landmark 1965 Voting Rights Act offers a cautionary note. In both cases, the justices repeatedly interrupted as the administration made its case. They injected comments and posed questions that pointed toward a court-ordered upheaval.
WHO: Sexually-transmitted superbug could be major crisis
A major public health crisis is emerging, in the form of a sexually-transmitted disease that doesn't respond to antibiotics, World Health Organization officials said Wednesday. About 106 million people worldwide become infected by gonorrhea every year. The organization has just released a global action plan encouraging greater awareness and advocacy, research, increased prevention efforts and monitoring of gonorrhea treatment failure.
Report: Hackers could access US weapons systems through vulnerable chip
The Christian Science Monitor
A secret nanoscale "backdoor" etched into the silicon of a supposedly secure programmable chip could give cyberattackers access to classified US weapons systems, including guidance, flight control, networking, and communications systems, according to a new report by cybersecurity researchers in Britain. The Cambridge University study is apparently the first public documentation that such a serious vulnerability has been deliberately built into a class of microchips used across the military and in key industrial applications such as power grids, the researchers say. The discovery underscores the Pentagon's growing concerns over the vulnerability of the "supply chain" for computer chips it relies on. The new research illustrates how spying or even destructive functions, such as a "kill switch" that could make a plane fall out of the sky like a brick, could be added unnoticed to microchips while they are being designed and manufactured either at home or overseas, hardware-security experts say.
(CA) Opting out of vaccinations could get tougher in California
The re-emergence of some vaccine-preventable diseases has prompted the California legislature to consider a bill that would make it more difficult for parents to opt out of vaccinating their kids. The legislation would require that parents get counseling from a doctor before opting out of immunizations for their children. Last year, the United States saw its highest number of reported measles cases in 15 years, even though the disease was eliminated from the country in 2000, according to the Centers for Disease Control and Prevention. One theory behind this rise, according to Dr. Richard Pan, the state assemblyman who introduced the bill, is that the recent trend away from immunizing children. That's why he wants to make it more difficult to bypass vaccine requirements in his state.
(CA) A $1 Cigarette Tax Starts a $47 Million Brawl in California
The New York Times
California has some of the toughest antismoking laws in the country — it is illegal, in some places, to smoke in your own apartment — and boasts the second-lowest per capita smoking rate in the 50 states. But for all the disdain toward smoking, it has been 14 years since California raised its cigarette tax, a tribute to the power of the tobacco industry here and the waning of this state’s antitobacco dominance. That may be about to change. An array of health and anticancer groups has rallied behind a ballot initiative to impose a new $1-a-pack cigarette tax to finance cancer research. And that has provoked a $47 million storm of advertisements, overwhelmingly financed by the tobacco industry, which is outspending proponents by nearly four to one to defeat the biggest threat it has faced in California in more than a decade.
(MI) Efforts to ban synthetic marijuana prove to be difficult
The Detroit Free Press
Michigan lawmakers, police, judges, health professionals and parents say they're on a mission to get the products banned. It's not the first time the state or federal government has tried to outlaw synthetic marijuana. In the last two years, both have banned certain chemicals that were being used to make the products. Manufacturers quickly skirted the laws and developed new formulas. Today, it's easy to find across much of the nation. Last year, for the first time, high school seniors were asked in the annual Monitoring the Future survey, conducted by the University of Michigan, whether they had used the substance. About one in nine seniors said they had. Synthetic marijuana is usually sold in packets or clear containers with names like Legal Devil, the Presidential, Demon, LOL, Tsunami and Scooby Snax. It comes in flavors like grape, blueberry, mango, strawberry, apple and watermelon.
(NY) NYC proposes 16-ounce soda limit
The News and Observer
Want to super-size that soda? Sorry, but in New York City you could be out of luck next year. In his latest effort to fight obesity in this era of Big Gulps and triple bacon cheeseburgers, Mayor Michael Bloomberg is proposing an unprecedented ban on large servings of soda and other sugary drinks at restaurants, delis, sports arenas and movie theaters. Drinks would be limited to 16 ounces, which is considered a small at many fast-food joints. It is the first time an American city has directly attempted to limit soda portion sizes, and opponents again accused the three-term mayor of creating a “nanny state” and robbing New Yorkers of the right to choose for themselves. But city officials said they believe the plan – expected to win approval from the Bloomberg-appointed Board of Health and take effect as soon as March – will ultimately prove popular and push governments around the U.S. to adopt similar rules.
(AL) Alabama prison violence rising in overcrowded system
(AL) Alabama's Bullock Mental Health Facility is the most violent prison in state's system
(AL) Alabama prisons: Reports of rising violence, sexual assaults to get legislative hearing
(AL) Opponents plan legal, economic challenge to immigration law
(FL) State will use newspaper's analysis for 'stand your ground' review
(FL) Gov. Rick Scott looks ready to fight DOJ over voter purge
(FL) 35-state study: Fla. led in increasing prison time
(FL) Disney to restrict junk-food ads
(FL) Florida denies unemployment benefits to thousands, groups say
(FL) Gov. Scott requests review of 3 justices' actions
(KY) Ky. to change execution method from 3 drugs
(KY) Pharmacists have to share responsibility, authorities say
(KY) Feeding the epidemic: One in 16 Kentuckians misuse prescription painkillers
(KY) The case of Purdue Pharma: Kentucky suit against pill maker stalled for years
(MO) Mo. bill targets parents facing ‘poverty trap’
(MO) Contraceptive health insurance bill awaits Nixon’s decision
(MS) State fights worst teen pregnancy rate in US
(MS) Miss. looking to Ariz. case regarding proposed immigration law
(NC) Senate unanimously OKs legislation on child lunches
(OK) Measure to add Oklahoma medical residencies is signed into law
(SC) SC hospitals question grading system
(TN) Willed property can help pay for TennCare costs
(TN) Children's welfare report examines state spending
(TN) Small firms resist health-care law aid
(TX) Court to Hear Texas Case on Planned Parenthood
(TX) City Council agrees to hand crime lab to independent board
(TX) Prisoners' misuse of antibiotics examined
(TX) Hunger Study: One in Four Texas Children at Risk
(TX) Sunset Commission: TDCJ Can Improve in Communication
(TX) Texas courthouses land on national endangered list, again
(TX) Groups cast doubt on validity of state hospital's electrotherapy consent forms
(US) Morning-after pill's ties to abortion questioned, yet again
(US) Medicaid Director Association Head: Uncertainty, Legislative Politics Have Slowed State Implementation
(VA) Virginia Tech shooting victim urges more gun control
(VA) Sebelius talks health care in Richmond
(WV) State's top health official leaving post