Insurers that contract with the state to manage the care of low-income Medicaid patients are expected to save money, in part by negotiating lower prices with health providers. But a new report by the state inspector general found that the plans pay higher fees to many hospitals and doctors than the traditional Medicaid program pays for the same services.
In the 2011 fiscal year, the higher payments cost taxpayers $328 million, the report said.
Hospitals that dominate their region or have a highly recognizable name and strong reputation were paid the most, up to 2.5 times the standard Medicaid rate, the investigation found.
“We are talking about a lot of money, especially a lot of money that’s being paid to select providers with geographical and other market power, not to others,” said Gregory W. Sullivan, whose last day as inspector general is Friday.
The report did not examine whether the managed care plans, which rely on case managers to prevent unnecessary care and help people manage chronic illnesses, save money over the long term. It focuses instead on shorter-term variation in payments to health care providers.
See: Massachusetts Health Model Means Return of Hated HMOs
But it's a good thing because they are calling it a different name.
Also see: Memory Hole: Why the Nation Doesn't Need Massachusetts Health Care
The Massachusetts Model: The AG's Amnesia
Must have fallen down the memory hole.
Massachusetts is one of many states that have moved more and more Medicaid enrollees into managed care plans in the past two decades, trying to improve coordination of care and lower costs.
And it is supposed to be a liberal state.
Most enrollees in MassHealth, the state Medicaid program, can choose one of two tracks of coverage. In the traditional plan, they have a primary care doctor and the flexibility to see any physician who accepts Medicaid. The state sets payment rates for providers who treat this group, about 350,000 people last year, by regulation.
Participants can also enroll in one of five managed care plans, each of which negotiates its own contracts with a network of providers: Boston Medical Center HealthNet Plan, Fallon Community Health Plan, Health New England, Neighborhood Health Plan, and Network Health.
I'm in one. The best course of action is to avoid getting sick, or if sick do not access the plan.
Sullivan said these plans, which covered 490,000 people last year, fear losing members to competitors if they exclude popular hospitals and doctors. That undermines the plans’ leverage in negotiations, allowing these hospitals and doctors to charge higher rates....
It's about this time I start going down the single-payer road.
--more--"
More milking:
"Medicaid providers owe taxes" by Ricardo Alonso-Zaldivar | Associated Press, August 03, 2012
WASHINGTON — Thousands of Medicaid health care service providers still got paid by the government even though they owed hundreds of millions of dollars in federal taxes, congressional investigators say. A legal technicality is making it harder for the Internal Revenue Service to collect.
In a report released Thursday, the Government Accountability Office said Medicaid payments to doctors, hospitals, and other providers aren’t technically considered federal funds, since they’re funneled through state health care programs.
Because of that distinction, the IRS can’t just shut off the payment spigot to collect tax debts. Investigators only looked at three states, so the full extent of the losses is even greater.
One dentist who received more than $100,000 from Medicaid while owing back income taxes was spending money on fine dining, trips, spas, shopping, and wine, the report said.
In another case, a medical transport company received more than $1 million from Medicaid while owing millions in unpaid payroll taxes for its employees. Not paying the payroll taxes is a violation of federal law.
Medicaid, a federal-state program that mainly serves low-income people, is the companion to Medicare, which primarily serves seniors.
While the IRS can block Medicare payments to scofflaw providers using something called a continuous levy, it is precluded by law from using the same strategy to go after Medicaid payments — even though the federal government pays about 60 percent of the costs of Medicaid.
GAO investigators recommended that the IRS immediately reassess its policies to find more efficient ways of collecting back taxes from Medicaid service providers. Part of the problem seems to be coordination with states.
In a formal response to the report, the IRS said it agrees action is needed. Congress has an opportunity to close the loophole during budget deliberations after the elections.
--more--"
"Harvard study links Medicaid expansion, fewer deaths" by Pam Belluck | New York Times, July 26, 2012
Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.
Is that a surprise?
The New England Journal study reflects a recent effort by researchers to get and allow policy makers to make ‘‘evidence-based decisions,’’ said Katherine Baicker, an investigator on the study who served on former president George W. Bush’s Council of Economic Advisers....
That would be a first.
--more--"
Now some mother's milk for you:
"Medicaid official rules against Indiana abortion law" July 09, 2012
INDIANAPOLIS — Indiana’s decision to deny Medicaid funds to Planned Parenthood because it performs abortions denies women the freedom to choose their health care providers, a federal hearing officer has concluded....
The changes to Indiana’s plan resulted from a 2011 law that would have made the state the first to deny the organization Medicaid funds for general health services, including cancer screenings. The law has been on hold while the dispute works its way through the courts.
The Indiana attorney general’s office, which is appealing a federal judge’s order blocking the law, said it may also contest the panel’s recommendation.
The state had argued that the dispute should be decided administratively by the centers, not in court.
‘‘Because this is a recommendation, the attorney general’s office has a chance to file an exception to it before the CMS administrator makes a final decision,’’ the agency said in a statement.
Planned Parenthood of Indiana said it was gratified by the decision.
‘‘Through its appeal, the State was continuing its attack on women’s rights and attempting to restrict access to basic, lifesaving services such as Pap tests, breast exams, STD testing and treatment, and birth control,’’ Betty Cockrum, chief executive officer of Planned Parenthood of Indiana, said in a statement.
--more--"
