More than 450 hospitals, including several in Georgia, will pay a total of more than $250 million to settle allegations that cardiac devices were implanted in Medicare patients in violation of the program’s coverage requirements, the Department of Justice announced Friday.
Georgia hospitals involved in the settlements include Emory University Hospital and Emory University Hospital Midtown in Atlanta, Saint Joseph’s Hospital of Atlanta, the Medical Center of Central Georgia in Macon, St. Mary’s Hospital in Athens, and Redmond Regional Medical Center in Rome.
The case involved an implantable cardioverter defibrillator (ICD), an electronic device that is implanted near the heart and connected to it. The device detects and treats chaotic, life-threatening heart rhythms, called fibrillations, by delivering a shock to the heart, restoring its normal rhythm.
Medicare coverage for the device, which costs about $25,000, is governed by a National Coverage Determination, which provides that an ICD generally should not be implanted in a patient who recently suffered a heart attack or recently had heart bypass surgery or angioplasty, the Justice Department said. full story
A patient’s right to choose. Legislative authority on health care. “Cherry picking’’ the privately insured.
These themes highlighted the vehement arguments made at a state agency hearing in Atlanta on Tuesday as advocates and critics clashed over a proposal to eliminate state requirements for a Newnan cancer hospital.
Cancer Treatment Centers of America’s hospital in Newnan
The Department of Community Health’s board will vote next month on the controversial proposal to allow Cancer Treatment Centers of America’s Georgia facility to reclassify as a general acute-care hospital.
The idea has generated strong reactions within political and health care circles. Leaders of key health committees in the Georgia Senate and House have voiced their concerns about the rule change.
The proposal, if it gains final approval from the board, would allow CTCA to seek a reclassification as a general hospital. And if the cancer hospital wins a “certificate of need’’ (CON) for that change, it could then avoid the current restriction of having no more than 35 percent of its patients come from Georgia. full story
Kaiser Permanente is again Georgia’s top-rated health plan in commercial insurance, according to the National Committee for Quality Assurance.
It’s the 11th straight year that Kaiser, a nonprofit, got NCQA’s No. 1 rating among commercial health plans in the state.
The NCQA rankings use a 1-to-5 scale, with 5 being the highest.
The 2015-2016 ratings also put Kaiser as the leader among Medicare insurers in Georgia – the only one operating in the state to achieve a 5 score. full story
WellStar Health System and Piedmont Healthcare are dropping key parts of their joint health insurance plan after just two years of operation.
Citing costs, the two metro Atlanta systems have told medical providers that they’re discontinuing their Medicare Advantage plan for next year. The current 12,000 Medicare beneficiaries will have options to switch to another Advantage plan or to receive care in the traditional program.
The health plan will also end its offering for employees of Piedmont and WellStar at the end of the year. About 35,000 employees and dependents were estimated to be eligible for coverage from the Piedmont WellStar HealthPlans at the launch of the program. They will be served by other health insurers in 2016.
The moves drastically reduce what was seen as a bold, high-visibility venture by the two nonprofit hospital systems to get into the health insurance business. WellStar and Piedmont leaders, at its outset, said the health plan was a new avenue to improve the quality of medical care and lower costs. full story
Last week, the hospital business in Georgia’s second-largest city received a double dose of financial misery.
The first round of bad news centered on Columbus Regional Health.
State Attorney General Sam Olens announced Friday that Columbus Regional and other related entities had agreed to pay Georgia and the United States up to $35 million to resolve allegations of false Medicaid claims.
Then the Columbus Ledger-Enquirer reported Saturday that the other hospital organization in town, St. Francis, has been told by the feds that it must repay $21.4 million and make major changes in the way it does business.
The federal audit report came 10 months after St. Francis said it could not account for about $30 million on its financial books.
The two situations are unrelated and very different, experts point out. But together they put a spotlight – and force large payouts – in Columbus. And what happens economically in the big city on the Chattahoochee River affects large areas of west Georgia and east Alabama. full story