Doctors Kicked Out Of Medicare Still Billing State Medicaid Programs

first_img A doctor who took kickbacks from a Pennsylvania hospice involved in a multimillion-dollar fraud. An Ohio psychiatrist who billed for treating no-show patients. A Georgia optometrist who claimed he conducted 177 eye exams in one day. Their transgressions vary. What these doctors have in common is that each was paid by a state Medicaid health insurance program after being kicked out of another state’s Medicaid system or the federal Medicare program. That’s not supposed to happen. The Affordable Care Act, or Obamacare as it is popularly known, explicitly requires that states suspend the billing privileges of most providers who have been “terminated” or “revoked” by another state or Medicare. (Pell and Cooke, 4/29) Doctors Kicked Out Of Medicare Still Billing State Medicaid Programs Reuters’ special report analyzing state and federal data found that more than one in five doctors or health care providers of the thousands banned from billing Medicare or one state Medicaid program — usually due to an infraction — were still able to file claims under another state’s program. Several states have launched investigations based on the findings. The Philadelphia Inquirer: Medicare Coverage Will Soon Cost You More This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. If you’re on Medicare, you know that this generous government benefit isn’t free. Coverage for some services, like physician visits and outpatient prescription drugs, requires that you pay a monthly premium. And before most claims are paid, you have to meet an annual deductible. Those costs are about to grow. (Field, 4/29) Reuters: Figuring Out Who Can Bill Medicare And Medicaid, And Who Can’t Reuters: Special Report: Banned From Medicare, Still Billing Medicaid To determine how many healthcare providers were banned from Medicare or a state Medicaid program while still allowed to bill Medicaid in another state, Reuters compared states’ lists of approved providers against lists of providers terminated by other states or Medicare on a specific date in 2014. In response to open-records requests, all states and the District of Columbia supplied approved-provider lists. Only 23 states supplied terminated-provider lists, as did the Centers for Medicare and Medicaid Services, the federal agency that administers Medicare, and the U.S. Department of Health and Human Services Office of the Inspector General. (Pell and Cooke, 4/29) In other Medicare payment news, beneficiaries may soon face an increase in premiums and fees –last_img

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