RACs Find Overpayments
The recovery audit contractors (RAC) pilot program is successfully identifying improper payments, according to a report from the Centers for Medicare and Medicaid Services. The findings from the report will help the CMS improve the program as it expands nationwide within 2 years, the agency said. The report showed that $693.6 million in improper Medicare payments were recovered between 2005 and March 2008. Of the overpayments, 85% were collected from inpatient hospital providers, 6% from inpatient rehabilitation facilities, 4% from outpatient hospital providers, and 2.5% from physicians, the report said. The remaining 2.5% were collected from ambulance services, skilled nursing facilities, and durable medical equipment suppliers. The program began in California, Florida, and New York in 2005 and expanded to Arizona, Massachusetts, and South Carolina in 2007.
Mass. Plans to Pay Clinics
Massachusetts health plans in will join plans in two dozen other states in covering visits to urgent care clinics in chain drugstores, a CVS Caremark Corp. spokeswoman said. “We expect that both national and regional players in the state” will add MinuteClinics to their networks, spokeswoman Carolyn Castel said in an interview. In January, the Massachusetts Public Health Council gave CVS Caremark permission to open the clinics, and ordered new regulations governing how the clinics are run in response to concerns by physician groups that the clinics could, for some patients, replace an ongoing relationship with a physician. CVS Caremark intends to open 15-28 MinuteClinics in Massachusetts by the end of this year, and hopes to have 100 clinics operating in the state within 5 years, Ms. Castel said. The company is negotiating for coverage of clinic services with Blue Cross and Blue Shield of Massachusetts, the state's largest health insurer, she said.
Accreditation for Urgent Care
The Urgent Care Association said it will discontinue its own accreditation program and instead will partner with the Joint Commission on Accreditation of Healthcare Organizations, which currently provides an ambulatory care accreditation program. The two groups also said they will collaborate to develop quality standards specific to urgent care, for introduction in 2010. Discontinuing its own program and providing support services through the JCAHO's ambulatory care accreditation program will let the Urgent Care Association focus on other quality assurance issues specific to urgent care, executive director Lou Ellen Horwitz said in a statement. There are an estimated 8,000 urgent care centers in the United States, according to the association.
Medicare Pay Favors Specialists
Incomes vary widely among the four medical specialties—geriatrics, hematology-oncology, nephrology, and rheumatology—that derive more than half of their revenues from government-run health insurance programs, a study showed. For example, geriatricians' incomes averaged $165,000 annually, versus $504,000 for hematologists, even though the two specialties require a similar amount of training. The study, from Harvard Medical School researchers at Cambridge (Mass.) Health Alliance and published online in the Journal of General Internal Medicine, analyzed data from the national Medical Expenditure Panel Survey. The income disparity fuels the shortage of primary care physicians, lead author Dr. Karen Lasser said. “Debt-burdened medical students have much more lucrative career options,” Dr. Lasser said in a statement. “What is surprising is that government fee schedules are behind much of this income discrepancy.” In total, Medicare accounts for about 21% of payments to doctors, whereas Medicaid and other government programs account for 10%, according to the study.
Feds Scrutinize Generic Maker
India's Ranbaxy Inc., 1 of the top 10 generic drug makers in the world, is being investigated by various arms of the federal government for allegedly introducing “adulterated or misbranded products” into the U.S. market. The company's auditor, Parexel Consulting, is also under scrutiny. According to a subpoena for documents filed in the U.S. District Court for the District of Maryland by the federal Department of Justice and the U.S. Attorney's Office in Maryland, Ranbaxy submitted false information to the Food and Drug Administration on sterility and bioequivalence, covered up violations of good manufacturing practice, and defrauded Medicare. “If these allegations are true, Ranbaxy has imperiled the safety of Americans in a manner similar to the generic drug scandal we uncovered 20 years ago,” said Rep. John Dingell (D-Mich.). “I would like to know whether FDA officials knew about these allegations and what, if any, action was taken.”
OIG Okays Gift Cards
The Health and Human Services Department has granted permission to an unnamed health care system to manage and resolve patient complaints by offering dissatisfied patients $10 gift cards. The health system, which includes three hospitals, 22 clinics, a skilled nursing facility, and a health plan, had asked the HHS Office of Inspector General if it could offer gift cards for local restaurants and theater chains, the OIG said. The health system had suggested using the gift cards to resolve complaints about excessive wait times; cancelled appointments; delayed meals; excess noise; housekeeping or dietary concerns; equipment problems in hospital rooms; or loss of personal items, the OIG said. The OIG concluded in its opinion that the gift cards would not be considered illegal kickbacks to patients.