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Medicare

Macon hospital to pay $20 million in billing case

A Macon hospital has agreed to pay $20 million to settle allegations that it violated the False Claims Act by overcharging Medicare on patient admissions.

The U.S. Attorney’s Office in the Northern District of Georgia said that from 2004 to 2008, the Medical Center of Central Georgia billed Medicare for inpatient services when the billing should have been for less costly outpatient or observation services.

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The Macon facility, with about 630 beds, is the second-largest hospital in Georgia. It’s now known as Medical Center, Navicent Health.

“We agreed to settle to avoid costly litigation,’’ Judy Ware, chief compliance officer with Navicent Health, said Monday. full story

Hospitals get financial rewards . . . or do they?

A majority of Georgia hospitals will get performance bonuses from Medicare for their quality of care, federal data show.

The 59 percent of Georgia hospitals getting the financial reward exceeds the national average of 55 percent, according to a Kaiser Health News article. The bonuses come from measurements that include patient satisfaction, lower death rates and how much patients cost Medicare.

Healthcare CostMeanwhile, 40 percent of the Georgia hospitals subject to the measurements are being penalized for quality-of-care problems, while 1 percent broke even in the Medicare quality category.

An official with the Georgia Hospital Association, when asked by GHN to comment on the bonuses Thursday, said, “We are proud of the fact that of the 10 states with the most hospitals assessed in the study, Georgia leads them all with 59 percent of its 99 hospitals receiving the quality bonus.”

“The Georgia hospital community still has a lot of work to do make great care even safer, but these numbers demonstrate that we are moving in the right direction,’’ said Kevin Bloye, a Georgia Hospital Association vice president.

Kaiser Health News reported that many of the bonuses nationally will be offset by hospital penalties that the government has also established as a part of the Affordable Care Act.

Fewer than 800 of the 1,700 hospitals that earned these bonuses nationally will actually receive extra money, according to a Kaiser Health News analysis. full story

Commentary: A message from Medicare

Marilyn Tavenner

Marilyn Tavenner

This past Wednesday, more than 1.3 million Georgians began the Open Enrollment period for Medicare.

It’s a time for seniors and people with disabilities to look through their choices for the government program’s coverage.

In a new GHN Commentary, the administrator of the Centers for Medicare & Medicaid Services urges Medicare beneficiaries to take their time in assessing the plans’ costs and benefits.

“This year, people with Medicare who choose to enroll in a Medicare health or prescription drug plan will have access to more high-rated, four- and five-star plans than ever before,’’ writes Marilyn Tavenner.

Here’s a link to Tavenner’s Commentary.

Georgia Health News welcomes Commentary submissions. If you would like to propose a Commentary piece for Georgia Health News, please email Andy Miller, editor of GHN, at amiller@georgiahealthnews.com

Use of antipsychotic drugs cut in nursing homes

Georgia has reduced its use of antipsychotic medications on nursing home residents by 26 percent, one of the largest drops in the nation.

smslogoThe decrease, occurring from the end of 2011 to the end of 2013, was powered in part by a pilot program targeting the Georgia nursing homes that had the highest use of antipsychotics.

Nationally, the prevalence of these drugs in long-stay nursing home patients dropped by 15 percent over that period, federal officials announced last week.

The federal Centers for Medicare and Medicaid Services has pushed for a decrease in the use of antipsychotics in managing dementia patients in nursing homes. full story

Another important change in state benefit plan

Blue Cross and Blue Shield of Georgia is dropping its Medicare Advantage plan for next year for retirees in the State Health Benefit Plan.

That means UnitedHealthcare will be the sole provider of the Advantage plans for 2015. (Blue Cross is the sole provider for 2014.)

The Georgia Department of Community Health is informing retiree health plan members about the Blue Cross move through email and letter this month, letting them know that the decision won’t affect the coverage in effect for the current year.

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Medicare Advantage is a health plan offered by a private company that contracts with the federally administered Medicare program to provide benefits. The majority of the 54 million people on Medicare are in the traditional Medicare program, with about 30 percent enrolled in an Advantage plan, according to the Kaiser Family Foundation.

More than 102,000 people are in Medicare Advantage plans under Georgia’s State Health Benefit Plan, according to Community Health, which runs the health plan.

Blue Cross said Monday that its decision to discontinue its Advantage plan was made jointly with the SHBP.

Still, in a comparison of next year’s rates, Blue Cross had premiums that were much higher than United’s. full story

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