The Pulse

Grady settles with state in overbilling case

Grady Health System has agreed to pay $2.95 million to settle charges that it improperly billed Medicaid for treatment to neonatal intensive care (NICU) patients, the Georgia attorney general announced Thursday.

Sam Olens

Sam Olens

The state of Georgia alleged that Grady inflated billings for certain services provided to these NICU patients, resulting in either unjustified or inflated payments from Medicaid.

“This settlement demonstrates our office’s continued commitment to protecting crucial Medicaid dollars from fraud and abuse,” said Attorney General Sam Olens in a statement. “The health of NICU patients is fragile, and we must ensure that every Medicaid dollar is properly spent on their care.”

A spokeswoman for Olens said the Grady billing problem occurred from March 2008 to November 2012. Lauren Kane, the spokeswoman, told GHN in an email that “no single individual’’ at Grady was responsible for the overbilling. full story

Georgia fires back on nursing home payments

The commissioner of Georgia’s Medicaid agency has written a sharply worded defense of nursing home payments now deemed improper by the federal government.

Clyde Reese

Clyde Reese

A federal ruling saying Georgia should return more than $100 million in nursing home payments “is factually and legally incorrect,’’ Clyde Reese, commissioner of the Department of Community Health, wrote in a February letter to a Centers for Medicare and Medicaid Services (CMS) official in Atlanta.

“Refunding payments previously approved by CMS would be inequitable and would result in unjust enrichment to the federal government,”  Reese said. It would probably also lead to the closure of the more than 30 nursing homes involved, he added.

In December, federal officials said Georgia Medicaid should return more than $100 million in payments made to a group of nursing homes. The feds said these payments were not permitted under the program’s regulations.

The payments were made in fiscal years 2010 and 2011. But CMS also asked Georgia to return any similarly inappropriate payments for more recent fiscal years as well. full story

Feds want $100 million back in Medicaid flap

Federal officials want Georgia Medicaid to return more than $100 million in payments made to nursing homes. The feds say these payments were not permitted under the program’s regulations.

nhomesThe payments were made in fiscal years 2010 and 2011. But the Centers for Medicare and Medicaid Services also asked Georgia to return any similarly inappropriate payments for more recent fiscal years as well.

In a Dec. 8, 2014, letter and report to Georgia about the nursing home problem, regional CMS officials told the state Medicaid agency to “cease and desist this unallowable funding mechanism immediately.’’

Georgia officials said in an email to Georgia Health News that the activity has been halted, but that the state has not paid back the funds to the federal government.

The nursing home money is not the only Medicaid funding that has Georgia grappling with federal health officials.   full story

The limits of physical evidence in sex abuse cases

Historically, the hymen, a thin piece of skin-like tissue that stretches partly across the opening of the vagina, has been known as the “virginity shield.”

It’s commonly believed that if the hymen is undamaged, sexual penetration has not occurred, particularly in the case of a child.

But this idea is false. Sometimes, a woman may have an intact hymen and show no signs of physical damage even after having been sexually assaulted. And the same is true of a little girl.

Gail Hornor, a pediatric nurse practitioner and child maltreatment researcher at Nationwide Children’s Hospital in Columbus, Ohio, says the myth about the hymen has been around forever and comes up often in her work. People find it especially hard to believe that a sexually abused child would not show some physical evidence of what happened.  full story

Report: State lags in public health spending

Georgia ranks 37th among states in per capita spending on public health, according to a newly released report.

Healthcare CostThe $18.48 that Georgia spent per capita on public health in fiscal years 2013 and 2014 is less than half the funding in some other Southeastern states, such as $59.22 in Alabama, $47.94 in Arkansas and $43.97 in Tennessee.

The Georgia public health budget did exceed those in Louisiana, Mississippi and North Carolina, said the report, released this week by the Trust for America’s Health.

Georgia’s per capita amount increased from the $18.08 per capita amount spent in 2012-2013. full story

Consumer Corner

Opioid abuse, HIV outbreaks linked

The CDC warns the epidemic of opioid abuse could lead to more severe outbreaks of HIV and hepatitis C.

Around the State

Operation Eagle Claw

Dr. Carlton Savory, an orthopedic surgeon in Columbus, was the chief medical officer on the 1980 U.S. military mission known as Operation Eagle Claw.

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Columbus Ledger-Enquirer

Fund for nursing students

The Georgia Southern School of Nursing Students’ Memorial Fund has been established to honor the five nursing students who lost their lives  April 22.

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Savannah Morning News

Laurens: Virus shuts schools

Laurens County closed its public schools Friday after an estimated 150 children went home sick the day with what health officials suspect is norovirus.

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Associated Press

Jefferson: Food recall

A recall of frozen vegetables and smoothie kits processed at a plant in Jefferson was announced by Georgia Agriculture Commissioner Gary W. Black.

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Athens Banner-Herald

Newnan: Behavioral hospital

It was standing room only at the beginning of Wednesday’s hearing regarding the future of the proposed behavioral health hospital in Newnan.

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Newnan Times-Herald


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