Chiropractic clinic to pay $650K for Medicaid and Medicare fraud

A chiropractic clinic in Williamsburg will pay $650,000 to settle claims it improperly billed Medicare and Medicaid, reports Trent Knuckles for The News Journal of Corbin. (News Journal graphic)

Ho Medical Clinic, Kenneth Ho and Ana Moreno allegedly filed false claims when they billed for physician services, though they were performed by a chiropractor (chiropractors are not medical doctors); billed for unnecessary and unreasonable MRI and X-ray services; billed for work performed by unqualified personnel; and received funds for being a rural health clinic when it did not meet Medicare requirements.

Of the $650,000, $525,000 will go to the Medicare and Medicaid trust fund. The remaining sum will go to Danette Freeman, who sued the company under the False Claims Act. The investigation was conducted by the Kentucky attorney general's office, the Department of Health and Human Services' Office of Inspector General and the U.S. attorney's office. (Read more)

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Kentucky hospitals say they gave back $1.67 billion to their communities in 2010, mostly by absorbing losses and bad debts

By Tara Kaprowy
Kentucky Health News

With the downturn in the economy part of the reason, Kentucky's hospitals say they gave back a whopping $1.67 billion to their communities in 2010, mainly by providing care for which they were never paid.

That's 13 percent more than the hospitals reported last year, and just one of many figures in the latest annual report from the Kentucky Hospital Association, which runs a little over a year behind because it takes a long time to compile the data from more than 100 hospitals.

KHA's 2010 Community Benefits Report shows hospitals absorbed $435.5 million in bad debt in 2010, which accrued when patients came to the hospital and were treated but did not pay their bills.

Shortfalls in Medicare and Medicaid payments cost even more — $456.2 million — because the federal government reimburses Kentucky hospitals for about 85 percent of the cost of Medicaid patients and 95 percent for those on Medicare. That's big, because 71 percent of patient days in Kentucky are covered by one of these programs, said Pam Mullaney, KHA's director of membership services. Hospitals also gave $274 million to charity-care programs that are set up to include free or discounted care to people who are unable to pay. Those three categories of losses increased by more than $158 million over 2009. KHAcalls them community benefits because "you're not getting any type of margin," Mullaney said.

A 2009 Thomson Reuters study showed the average U.S hospital reported an operating profit margin of 3.7 percent. The average operating margin at Kentucky hospitals was 2.44 percent in 2009. Forty percent of hospitals lost revenue from patient services that year, Mullaney said. Still, reported community benefits increased by 13 percent, a total of $190 million.

This is the third year of the report, which was based on a voluntary survey to which 104 of 123 hospitals responded (Eight hospitals were not surveyed because they treat limited types of patients, such as veterans, children or psychiatric cases.) Mullaney said the number of hospitals turning in figures "has grown a little bit each year, but it’s not consequential."

Hospitals are asked to describe and put a value on the programs and activities they provide at or below cost that help their community. Though community benefits are "the greatest single affirmation of not-for-profit hospitals' tax-exempt status," Mullaney said data show Kentucky's 26 for-profit hospitals "do every bit as much as the not-for profits."

In the past two years, Pikeville Medical Center has absorbed $70 million in charitable care and bad debt. The Murray-Calloway County Hospital is in the ninth healthiest county in Kentucky, but has felt the crunch too. From 2010 to 2011, bad debt increased from $7 million to $7.8 million and charity care increased from $5.1 million to $6.2 million.

T.J. Samson Community Hospital in Glasgow has also seen bad debt increase and business decrease when the economy crashed and then stagnated. "Our elective procedure volumes have come down. Patients often wait until they're sicker before they come in," said Laura Belcher, director of planning, marketing and development. The hospital has responded by cutting costs, adopting the "lean philosophy" of eliminating waste and streamlining processes.

Interestingly, the hospital is also pushing for more preventive care since the economy went south. "People ask us, 'Aren't you putting yourself out of business?' But we really want people to be proactive about their health. We've done a lot more health fairs, more screenings," Belcher said.

Indeed, the report shows Kentucky hospitals spent $500 million in 2010 to actively help their communities, through such activities as health screenings, support groups, research, training of nurses and doctors, addiction recovery and neonatal intensive care, or simply donating money to community functions. Many of these programs "are provided at no cost or at a financial loss and would not be provided if the decision was based on monetary decisions," Mullaney said.

Realizing there was a need in the area for children with special needs, the Glasgow hospital set up C.A.M.P. T.J. Kids, a weeklong day camp in the summer for children with special needs. "These children often receive services through school and during school," Belcher said. "But we found many of the families could not afford or handle the transportation to get here during the summer. This is almost like a summer booster."

The camp falls under the umbrella of the Discovery Academy, funded by the hospital and money raised by volunteers. The academy also hosts an annual overnight camp for children with autism. While the children swim in the hotel pool or interact with each other, parents are "in a conference setting to learn about ways they can learn to be better parents" to kids with autism, Belcher said. "In the evening, while children are being supervised, the parents get to go for a quiet, romantic dinner."

When tornadoes struck Kentucky March 2, Pikeville Medical Center kicked into high gear and co-hosted a radio-a-thon that raised $200,000. "We allowed our employees to donate their vacation time, which we converted to actual dollars based on their rate of pay, and we offered employees the ability to do payroll deductions to contribute to the cause," said Cindy Johnson, director of public relations and the Medical Leader, the hospital's community newspaper.

The Murray hospital has increased its community outreach efforts and adopted a mission to provide the local school system with athletic trainers, whose salaries are paid entirely by the hospital, as well as school nurses, which are partly hospital funded. The goal is to promote health and wellness, said marketing director Melony Bray.

The KHA's Mullaney said the annual report reminds people what their hospital does. "A lot of times people think of their hospital as a place to go when they need emergency help," she said. "They don't think of the hospital as one of the big providers in the community for health fairs, health professional education, types of efforts in the community to help improvements like playgrounds and common spaces. Those are things that hospitals often get overlooked for but they do that because they are part of the community."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Electronic health records are helping nurses provide better care, big study finds

Electronic health records are helping nurses get better health outcomes and are improving nursing care, the first big study on the subject has found.

The study conducted by the University of Pennsylvania School of Nursing involved 16,000 nurses at 316 hospitals in California, Florida, Pennsylvania and New Jersey. It found that "implementation of an EHR may result in improved and more efficient nursing care, better care coordination, and patient safety," wrote lead author Ann Kutney-Lee, a health-outcomes researcher at Penn Nursing.

The study, which was published in the Journal of Nursing Administration, also found, "having a basic EHR was associated with better outcomes independently of nurse staffing, indicating that they both play an important role in quality of care."

Nurses in hospitals that had comprehensive EHR systems were "significantly less likely to report unfavorable patient safety issues, frequent medication errors, and low quality of care," research-reporting service Newswise reports.

The most current estimates show just 12 percent of U.S. hospitals have an EHR system in place, but that will change with the Health Information Technology for Economic and Clinical Health Act. Starting in 2011, hospitals and physicians received incentive payments from Medicare and Medicaid to switch over to EHRs. The study did not measure outcomes in rural vs. urban settings "although we do know from other studies that hospitals that used electronic health records during this time period were less likely to be in rural areas," Kutney-Lee said. (Read more)

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Several pieces of federal health reform law taking effect in 2012

At the beginning of the new year, family doctors started facing a 1 percent cut in Medicare reimbursement if they hadn't nixed their paper-based prescription pads in favor of an electronic version. The change is part of another piece of the federal health-care reform law taking effect, USA Today reports.

"There will be a significant number of folks that will incur the penalty," said Robert Tennant, senior policy adviser with the Medical Group Management Association.

E-prescribing, which allows physicians to generate, transmit and file patient prescriptions, is part of the federal government's effort to get doctors to use electronic health records. Last year, doctors received bonuses from Medicare and Medicaid to set up EHRs, but this year they will start being penalized if they haven't already done so — 1 percent this year, 1.5 percent in 2013 and 2 percent in 2014.

Another piece of the federal health care reform law that will begin falling into place in 2012 involves Medicare's Shared Savings Program, "under which groups that qualify as accountable care organizations will be eligible for shared savings in 2013," USA Today reports. "Under the program, savings from participants in an ACO — including hospitals and doctors working together to improve patient care and reduce costs — would be shared between Medicare and the providers."

One study showed Kentucky already has three ACOs established, though several Kentucky experts have said no ACOs have been formed in the state yet.

Jan. 1 also marked the beginning of consumers being eligible for rebates if their insurer spent less than it should have on medical care. As per the new law, insurers have to spend 85 percent for large group plans and 80 percent for small groups and individuals on medical care as opposed to administrative and other costs. Kentuckians will not be privy to these rebates this year, however. Kentucky got a one-year break from the rule after applying for an exemption. (Read more)

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Doctor report cards will be as big a failure as No Child Left Behind, physician contends in op-ed piece

Tying physicians' reimbursements to how well they score on a Medicare report card is akin to the federal government having schools submit to No Child Left Behind, asserts Dr. Barry Schumer, a Lexington-based internal medicine physician. As the federal education-reform effort resulted in teachers "teaching to the test," the Physician Quality Reporting Initiative will only result in doctors treating to one, Schumer's op-ed piece in the Lexington Herald-Leader reads.

"The idea that a check-list of dos, don'ts and test scores will result in an upgrade of care delivery is reminiscent of the government supposition that it alone could legislate the teacher-student relationship in the interest of improving education outcomes," Schumer writes. "It didn't work in education, and it won't work in health care."

Schumer contends the program "did not ask patients what they believe are the key elements of a high-quality doctor-patient relationship, nor was their input or opinion sought on whether they want their physician financially penalized for non-compliance with these mandates." Also ignored, he says, were primary-care providers, "any of whom could easily describe how increasing government regulations, mandating the purchase and use of expensive technology, and the threat of stiff financial penalties will not only detract from the care of patients but, worse yet, will drive already overwhelmed providers out of practice altogether." (Read more)

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Pat Boone commercial about Medicare has many inaccuracies

A television commerical misleads seniors into believing the federal health-care reform law will ration and deny care and contains other inaccuracies, according to FactCheck.org, a non-partisan, non-profit service based at the University of Pennsylvania.

The ad features singer Pat Boone and is being aired repeatedly in Ohio (and presumably in Northern Kentucky) by the conservative 60 Plus Association. It claims the Patient Protection and Affordable Care Act will create the Independent Payment Advisory Board, made up of elected bureaucrats who "can ration care and deny certain Medicare treatments so Washington can fund more wasteful spending."Boone says,"Unaccountable bureaucrats should never have the power to deny you the care you deserve."

The board is neither made up of bureaucrats, nor can it ration care. "The IPAB is tasked with finding ways to reduce the growth in Medicare spending," FactCheck reports. "Its 15 voting members won't be bureaucrats, according to the health care law (see page 502); they will be doctors and medical professionals, economists and health care management experts."

The law also says proposals from the IPAB "shall not include any recommendation to ration health care, raise reveneues or Medicare beneficiary premiums ... increase Medicare beneficiary cost-sharing (including deductibles, coinsurance and copayments), or otherwise restrict benefits or modify eligibility criteria."

The ad says the law will cut $500 billion from Medicare, but fails to mention that cut is in the future growth of Medicare over 10 years and will come from the supplemental Medicare plans seniors can buy.  Moreover, though Boone suggests seniors should object to the $500 billion in cuts, they are meant to extend the funding of Medicare Part A by 12 years.

The ad also states Medicare will be bankrupt in nine years. "The truth is that Medicare Part A — the hospital insurance trust fund, one of four parts of Medicare — is expected to be insolvent by 2020, according to the projections from the Congressional Budget Office, or perhaps 2024, according to the Social Security and Medicare Boards of Trustees," FactCheck reports. "Shortfalls have been projected for Part A 'almost from inception,' says a Congressional Research Service report," but Congress has always found a way to extend the program. (Read more)

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PIkeville Medical Center agrees to pay $36,000 to settle claim that it improperly billed Medicare

Pikeville Medical Center has agreed to pay more than $36,000, but does not have to admit any wrongdoing, to settle a lawsuit that accused it of improperly billing Medicare.

The suit was brought by Dr. Michael Fletcher, director of the pain management clinic from May 2005 to July 2007. "The hospital used improper billing codes for the pain management clinic, which indicated services were provided in a private physician's office, rather than a clinic," reports Brett Barrouquere of The Associated Press.

Fletcher alleged the same was being done at the hospital's radiation oncology and medical oncology units and told hospital administration as much, but nothing was done. Fletcher will receive $7,228 as part of the settlement of the suit, filed under the federal False Claims Act. (Read more)

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Justice Dept. accuses Erlanger nursing home of collecting on 'worthless services;' suit is first of its kind in Kentucky

The U.S. Justice Department has filed a civil complaint against Villaspring Health Care and Rehabilitation in Erlanger and its parent company, Carespring Health Care Management, claiming they "billed Medicare and Medicaid for services purportedly provided to its residents despite knowing that the services were so inadequate that they were essentially worthless," Valarie Honeycutt Spears of the Lexington Herald-Leader reports.

The complaint was the first in Kentucky alleging that a nursing home violated the federal False Claims Act. "Today's filing represents an important milestone in the effort to ensure effective care for Medicare and Medicaid recipients in long-term care facilities," U.S. Attorney Kerry Harvey said.

The list of allegations include failures to follow physicians' orders, treat wounds and pressure sores, update resident care plans, give enough to drink, give regular baths and monitor diabetics' blood-sugar levels, Spears reports. The complaint alleges there were numerous injuries and at least five deaths from 2004 to 2008 due to improper care.

Officials of the nursing home officials invited journalists to tour the facility and denied any wrongdoing. "We do not feel that the government's case has any merit, and we will defend ourselves vigorously," Carespring spokeswoman Kim Majick said. "Villaspring has consistently provided high-quality care to the residents of Kenton County and looks forward to doing so in the future." (Read more)

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State website helps Kentuckians get health insurance, info

A new government website is aimed at helping Kentuckians wade through the often overwhelming world of health insurance by providing information specific to the new health care law.

The Kentucky Health Insurance Advocate contains information for people who are uninsured, those who are soon to be uninsured, and those interested in private coverage options. It outlines specific information for seniors, children and young adults. It also contains a listing of companies selling individual, private insurance in Kentucky.

The website was compiled by the Kentucky Department of Insurance and has been in operation since the spring. "This is part of a consumer assistance grant we got as part of federal health reform," said Ronda Sloan, public information officer with the department. "We were trying to put all of the health reform information people would need in one location. ... We're trying to make it really user-friendly."

Part of of the effort is to get more Kentuckians insured. "And it's really for education too," Sloan said. "We're not trying to tell anybody, 'This is what you do,' we're trying to say, 'These are your options.' We're trying to walk people through the process."

In addition to perusing the website, people can call toll-free at 877-587-7222 to get more, personalized information. Since the department started advertising the site a few weeks ago, it has received more calls. "A lot of people are saying, 'I'm uninsured,' 'I have a pre-existing condition, what can I do?', 'I lost my job, I'm coming off COBRA,' things like that," Sloan said. "Insurance is not a simple thing and it's not something you think about until you need," she said. "We're trying to make it a little less complicated and try to ease people's minds a little."

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Several Kentucky hospitals overdo CT scans, despite cost, risk

Despite the risk of exposing patients to more radiation and the fact that radiologists say it is very rarely necessary, Medicare outpatients are regularly receiving two CT scans on the same day at 12 Kentucky hospitals, according to analanysis of Medicare data by The New York Times, which produced a handy interactive map, a segment of which is copied here. To use the actual map, click on the map below.

Though only 5.4 percent of hospitals nationwide scan a patient's chest twice on the same day, nine Kentucky hospitals are double-scanning at least 15 percent of the time and three are doing it more than 30 percent of the time, accoding to data for 2008. Figures for 2009, which are expected to be similar, are due out next month from the federal Center for Medicare and Medicaid Services.

Clark Regional Medical Center in Winchester has the highest rate, double scanning 43 percent of the time. Monroe County Medical Center in Tompkinsville double scans 34 percent of the time, followed by Pineville Community Hospital at 32 percent.

Other Kentucky hospitals that are double scanning at least 15 percent of the time include: Clinton County Hospital, Albany, 30 percent; Paul B. Hall Regional Medical Center, Paintsville, 25 percent; Harlan Appalachian Regional Healthcare Hospital, 24 percent; Norton Hospitals, Louisville, 23 percent; Westlake Regional Hospital, Columbia, 23 percent; Spring View Hospital, Lebanon, 20 percent; Methodist Hospital Union County, Morganfield, 19 percent; T.J. Samson Community Hospital, Glasgow, 18 percent; and The Medical Center at Bowling Green, 18 percent.

There are two types of CT scans, one that uses iodine contrast to monitor blood flow and one that does not. In rare circumstances, performing both scans — each with a separate charge — could help spot a tumor, said Dr. Michael J. Pentecost, a radiologist and Medicare consultant. While doctors may opt to double scan to get the most information on their patient possible, experts say being so thorough is rarely necessary, particularly given the added cost to the system and the exposure to radiation for the patient.

As Kentucky's numbers indicate, double scanning happens more often at small, community hospitals, where treatment can involve transferring patients to larger facilities. Nationwide, 200 hospitals administered double scans more than 30 percent of the time.

The Medicare agency released the data last year to hospitals "to show how they performed relative to each other and to encourage more efficient, safer practices," Walt Bogdanich and Jo Craven McGinty of the Times report. "The Medicare agency believes hospitals can and should do more to change physician behavior ... The federal agency plans to use other, similar measurements to rein in what it considers to be unjustified — and potentially dangerous — medical procedures." (Read more)

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Data on hospital-acquired infections, other conditions online

The federal Centers for Medicare and Medicaid Services (CMS) has posted information about hospital-acquired conditions on its website, and The Courier-Journal not only has a story about it today, it has an easily searchable database of Kentucky hospitals.

This is not information that the Kentucky Hospital Association or the American Hospital Association wants online, at least in its current form. “You have to look at the totality of the care. And these little snapshots that CMS wants to pick out are very misleading,” KHA Senior Vice President Nancy Galvagni told C-J reporter Patrick Howington. She said the data don't allow for differences between hospitals, such as specialities, that may cause higher rates of acquired conditions.

However, Doug Leonard, president of the Indiana Hospital Association, told Howington that the industry needs to “embrace transparency. Sometimes we don't like the results of that, but I think transparency is good for us and good for the public.” Dr. Kevin Kavanagh of Somerset, chairman of the nonprofit group Health Watch USA, "said the data's greatest value may be to help hospitals spot areas that need improvement, rather than to help patients choose between hospitals," Howington writes. "In fact, a hospital shown as having a high complication rate 'may be the safest hospital to go to, because they were under pressure to get the problem corrected.'" (Read more)

The conditions tracked are trauma such as falls, infections from catheters, bedsores, poor blood-sugar control for diabetics, foreign objects left in bodies, air or gas bubbles in blood vessels, and transfusions of the wrong blood type.

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