In The Know: Stay Informed with Health Care News
Posted by Pauline Heidemann on Mon, Jan 02, 2012 @ 06:02 AM
This week, In The Know, looks at the following news stories: Pioneer ACOs Selected;Government Recovers Record-Breaking Amounts in Whistleblower Fraud Cases;Nearly $300 Million Awarded to States for Enrolling Children in Health Coverage; Breaches of Health Care Information Reaches 18 Million and Counting.
Pioneer ACOs Selected
The Department of Health and Human Services (HHS) has announced the 32 organizations to participate in the Pioneer Accountable Care Organization model. The Pioneer ACO model will test the effects of several payment arrangements to support these groups in providing better care and outcomes at lower cost. The project is estimated to save up to $1.1 billion over five years, and provide improved care for approximately 860,000 Medicare beneficiaries. HHS said the groups were selected for their “significant experience” in offering coordinated, patient-centered care and operating in ACO-like arrangements. The groups participated in an open, competitive process in which HHS received 160 letters of intent and 80 applications. To read the Press Release, click on http://www.hhs.gov/news/press/2011pres/12/20111219a.html.
Government Recovers Record-Breaking Amounts in Whistleblower Fraud Cases
It an increased effort to fight health care fraud and abuse, the Justice Department secured more than $3 billion in settlements and judgments in fiscal year 2011 (which ended on September 30) in civil cases involving fraud under the False Claims Act. Of that, $2.4 billion involved fraud committed against federal health care programs, mostly Medicare and Medicaid. Whistleblowers, in particular, helped identify cases of fraud, with 638 whistleblower suits this past year, compared to 300-400 in past years. Medicare’s Fraud Strike Force also recently expanded to nine cities, allowing the government to bring in more than $1 billion fraud – up from $384 million in 2008. To read the Press Release, click on http://www.justice.gov/opa/pr/2011/December/11-civ-1665.html.
Nearly $300 Million Awarded to States for Enrolling Children in Health Coverage
More than $296 million has been awarded to states to ensure more children have health coverage. The performance bonus payments are funded under the Children’s Health Insurance Program Reauthorization Act, one of the first pieces of legislation signed into law by President Obama in 2009. To quality for these bonus payments, states must surpass a specified Medicaid enrollment target and adopt procedures that improve access to Medicaid and the Children’s Health Insurance Program (CHIP), making it easier for eligible children to enroll and retain coverage. To read the Press Release, click on http://www.hhs.gov/news/press/2011pres/12/20111228a.html.
Breaches of Health Care Information Reaches 18 Million and Counting
The total number of major health care breaches has reached 380 incidents affecting more than 18 million individuals since HHS began keeping score in 2009. These numbers don’t include the recent breach by Sutter Health, which will add an additional 4.2 million patients to the tally once HHS has confirmed the details of the breach. Of the 380 incidents that have been placed on the official tally after being reported to authorities as required under the HIPAA breach notification rule, more than half have involved lost or stolen electronic devices or media. About 22 percent have involved a business associate. To read the federal “wall of shame” listing the breaches, click on http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html.