The Fraud Dilemma

Fraudulent providers can rob taxpayers of money due to Medicaid beneficiaries.  Fraudulent offenses include: billing Medicaid for services provided to patients ineligible  for Medicaid; billing for services not rendered; upcoding (i.e., charging for more expensive services or equipment that the patient received); providing inappropriate, risky or unncessrary treatments; requesting reimubrsement for care provided by unlicensed…

How to cut State Medicaid Costs

In the third post using information from The Politics of Medicaid series, we will discuss how States often try to reduce Medicaid spending.  From a fiscal point of few, Medicaid spending is often attractive since it is accompanied by matching federal dollars.  On the other hand, Medicaid trails only elementary and secondary education in terms…

Are you a Genius?

The MacArthur Foundation named 23 fellows, recipients of the so-called “genius” grant.  The full list of winners is available here.  The fellows receive the fellows will receive $500,000 in “no strings attached” support over the next five years.  Some people whose work piqued my interest: Drew Berry is a biomedical animator whose scientifically accurate and…

Medicaid Overview

“If you’ve seen one Medicaid program, you’ve seen one Medicaid program.” This week, I will review some of the findings from a wonderful book titled The Politics of Medicaid.  Author Laura Katz Olson writes a well-researched book that evaluates Medicaid from the points of view of its various stakeholders including beneficiaries, providers (esp., physicians and…

How will Health Reform Affect You?

The Robert Wood Johnson Foundation has put together a series of briefs which explain how Health Reform will affect various types of consumers.  These briefs include: Young adults, Seniors, Children, Individual and small-group premiums. Hospitals, and Physicians. Although are a lot of these types of guides out there, the RWJ briefs are generally fairly comprehensive…

Does Health Reform Change the Malpractice System

Health Reform (a.k.a. Patient Protection and Affordable Care Act [PPACA]) provides two small provisions that will affect malpractice costs.  Randall Bobvjerg explains: “As enacted, PPACA contained only two, quite limited malpractice provisions.  Section 10607 authorized malpractice demonstrations by states, and section 10608 extended federal malpractice protections to free clinics’ nonmedical personnel. The demonstration authority comes…

Who’s running the Patient-Centered Outcomes Research Institute (PCORI)?

As part of Health Reform, the government created the a center to study clinical effectiveness of different health treatments.  This center, known as the Patient-Centered Outcomes Research Institute (PCORI), “does not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment.”  What leverage does the Institute have?  Not too…