Physicians and hospitals hail N.Y. reimbursement ruling

Article Abstract:

A New York state regulation which required lower reimbursement rates for the treatment of poor, elderly patients was overturned by the 2nd US Circuit Court of Appeals. The New York rule had required medical caregivers to accept lower reimbursement rates when treating patients 'dually eligible' for Medicare and Medicaid. The federal ruling requires the state to make up any difference between the providers' charges and the amount Medicare pays, a difference that may run into the millions of dollars.

Accident and health insurance, New York, Health insurance, New York (State)

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Why hospitals hate the 'hit list': the lament of the 'bottom 22.' (Medicare Mortality Muddle)(Health Care Financing Administration's report on hospital mortality among Medicare patients)

Article Abstract:

Hospitals that show up on the Health Care Financing Adminstration's (HCFA) list of 'outlier' hospitals - those with the highest mortality rates for Medicare patients - are perplexed by the HCFA's formula for calculating rates. They claim that the report does not take their client mix into account. HCFA's 1991 list would tend to support that assertion. Most of the 22 hospitals rated as outliers were public hospitals serving poorer, sicker patients. Six of them were located in Puerto Rico.

General medical & surgical hospitals, Standards, Reports, Mortality, Hospitals, Statistics, United States. Centers for Medicare and Medicaid Services

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Congress accelerates fraud and abuse juggernaut

Article Abstract:

The Health Insurance Portability and Accountability Act of 1996 grants government investigators plus Medicare and Medicaid groups more funding and more power to pursue fraud and abuse cases. The act, which creates new incentives to launch investigations, makes ineffective changes in the punishment of health care providers that engage in misconduct. The new provisions of the law are detailed.

Health Care, Health Care and Social Assistance, Police Protection, Administration of Public Health Programs, Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs), Fraud, Health Care Services, Office of the Inspector General (HHS), Health care industry, Column, Medical care, Powers and duties, United States. Congress, United States. Department of Health and Human Services. Office of Inspector General

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