COMPANY TO PAY $26 MILLION TO RESOLVE ALLEGATIONS OF IMPROPER CLAIMS FOR INPATIENT STAYS

FROM:  U.S. JUSTICE DEPARTMENT 
Monday, August 19, 2013
Shands Healthcare to Pay $26 Million to Resolve Allegations Related to Inpatient Stays at Six Florida Hospitals

Shands Teaching Hospital & Clinics Inc., Shands Jacksonville Medical Center Inc. and Shands Jacksonville Healthcare Inc. (collectively, Shands Healthcare), which operates a network of health care providers in Florida, will pay the government and the state of Florida a total of $26 million to settle allegations that six of its health care facilities submitted false claims to Medicare, Medicaid and other federal health care programs for inpatient procedures that should have been billed as outpatient services, the Justice Department announced today.  The six Florida hospitals are:  Shands at Jacksonville; Shands at Gainesville, also known as Shands at the University of Florida; Shands Alachua General Hospital; Shands at Lakeshore; Shands Starke and Shands Live Oak.

“The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire of health care providers to maximize profits,” said Stuart F. Delery, Assistant Attorney General for the Civil Division.  “Hospitals participating in Medicare must bill for their services accurately and honestly.”

Allegedly, from 2003 through 2008, the six hospitals knowingly submitted inpatient claims to Medicare, Medicaid and TRICARE for certain services and procedures that Shands Healthcare knew were correctly billable only as outpatient services or procedures.
           
“The public expects its medical professionals to operate with a high degree of integrity,” said A. Lee Bentley III, Acting U.S. Attorney for the Middle District of Florida.  “When health care providers seek higher profits at the expense of their professional judgment, the public trust in the medical system is compromised.”

“Regardless of the complexity of these schemes to siphon off crucial health care dollars,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, “our law enforcement officials will work tirelessly to seek justice.”

The six Florida hospitals were named as defendants in a qui tam, or whistleblower, lawsuit brought under the False Claims Act, which permits private citizens to sue on behalf of the government and receive a portion of the proceeds of any settlement or judgment awarded against a defendant.  The lawsuit was filed in federal district court in Jacksonville, Fla., by Terry Myers, the president of a healthcare consulting firm, YPRO Corp.  Of the $26 million settlement, $25,170,400 will go to Medicare and other federal health care payors.  The settlement also resolved allegations under the Florida False Claims Act; the state of Florida will receive $829,600.  Myers’ portion of these recoveries has yet to be determined.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $14.8 billion through False Claims Act cases, with more than $10.8 billion of that amount recovered in cases involving fraud against federal health care programs.

The settlement was the result of a coordinated effort among the U.S. Attorney’s Office for the Middle District of Florida, the Commercial Litigation Branch of the Justice Department’s Civil Division, the Department of Health and Human Services’ Office of Inspector General and Office of Counsel to the Inspector General, and the Florida Attorney General’s Office.

GOVERNMENT AWARDS $150 MILLION FOR ENROLLMENT ASSISTANCE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health centers to help uninsured Americans gain affordable health coverage
Obama administration awards $150 million to provide enrollment assistance

Health and Human Services (HHS) Secretary Kathleen Sebelius announced $150 million in grant awards to 1,159 health centers across the nation to enroll uninsured Americans in new health coverage options made available by the Affordable Care Act.  Speaking at the Mountain Park Health Center in Phoenix, Ariz., later in the day the Secretary noted that, with these funds, health centers are expected to hire an additional 2,900 outreach and eligibility assistance workers to assist millions of people nationwide with enrollment into affordable health coverage.

HHS Secretary Sebelius said, “Investing in health centers means that people in neighborhoods and towns across the country have one more resource to help them understand their insurance options and enroll in affordable coverage.”
Health centers have a long history of providing eligibility assistance to patients along with delivering high-quality, primary health care services in communities across the nation.  Today, health centers serve more than 21 million patients annually.

With these awards, which health centers in all 50 states have received, consumers will get help understanding their coverage options through the new Health Insurance Marketplace, Medicaid and the Children’s Health Insurance Program; determine their eligibility and what financial help they can get; and enroll in new affordable health coverage options.

These awards, issued by the Health Resources and Services Administration (HRSA), complement and align with other federal efforts, such as the Centers for Medicare & Medicaid Services-funded Navigator program.

Today’s announcement is part of the administration's broader effort to make applying for health coverage as easy as possible. The new, consumer-focused HealthCare.gov website and the 24-hour-a-day consumer call center help Americans prepare for open enrollment and ultimately sign up for health coverage.  These new tools will help Americans understand their coverage options and select the plan that best suits their needs when open enrollment in the new Health Insurance Marketplace begins Oct. 1, 2013.

“Health centers are excited to help individuals in their communities take advantage of the benefits of new health insurance coverage options that start January 2014,” said HRSA Administrator Mary Wakefield, Ph.D, R.N. “Having trained, face-to-face assistance in enrollment from trusted resources at local health centers means that more people will get the help they need.”

SEC. OF HHS SEBELIUS TALKS ABOUT NURSING DURING NATIONAL NURSES WEEK

Secretary Sebelius Statement in Honor of National Nurses Week 2012

During National Nurses Week, we recognize the tremendous contributions that nurses make to keeping America healthy. As passionate advocates, leaders and innovators for better health, America’s nurses have demonstrated their commitment to meeting the public’s health care needs.

The health initiatives called for by the new health care law, the Affordable Care Act, would not be possible without our nation’s nurses. By expanding investments in primary and preventive care programs in which nurses play a vital role, the Affordable Care Act strengthens the focus on keeping people healthy and managing chronic conditions. Through the law and other efforts, the Department of Health and Human Services is working to ensure that nurses get the support and training they deserve and need to do their job.

Since the beginning of the administration, the number of mostly uninsured or under-insured patients getting care at community health centers has grown by 2.4 million people, primarily due to funding by the Affordable Care Act and the Recovery Act. About 16,000 nurses now work at community health centers, an expansion of about 3,000 nursing positions. With continued support from the Affordable Care Act through fiscal 2014, the number of nurses at health centers will continue to grow.

More nurses are getting assistance in securing needed training or repaying educational loans, partly through an expansion of the National Health Service Corps (NHSC), under the Health Resources and Services Administration, which ensures that primary care providers practice in  underserved areas in exchange for receiving scholarship support or loan repayment. The Affordable Care Act allocated $1.5 billion over five years to expand the NHSC.

And recognizing that better training and support for nurses will mean higher quality care for seniors and other Medicare beneficiaries, the Centers for Medicare and Medicaid Services recently announced a four-year, $200 million Affordable Care Act demonstration partnering certain hospitals with nursing schools and non-hospital community-based care settings to provide advance practice registered nurses with clinical training to help strengthen primary care across the country.  

Please join me during this National Nurses Week in thanking our nation’s nurses for the critical work they do in bringing better care and better health to all Americans.

HHS AND NEW OPTIONS FOR COMMUNITY-BASED CARE

FROM:  DEPARTMENT OF HEALTH AND HUMAN SERVICES

HHS announces new Affordable Care Act options for community-based care

Medicaid and Medicare introduce greater flexibility for beneficiaries to receive care at home or in settings of their choice

New opportunities in Medicaid and Medicare that will allow people to more easily receive care and services in their communities rather than being admitted to a hospital or nursing home were announced today by Health and Human Services Secretary Kathleen Sebelius.

HHS finalized the Community First Choice rule, which is a new state plan option under Medicaid, and announced the participants in the Independence At Home Demonstration program. The demonstration encourages primary care practices to provide home-based care to chronically ill Medicare patients.

Both are made possible by the Affordable Care Act. Studies have shown that home- and community-based care can lead to better health outcomes.

“We know that people frequently prefer to receive services in their own homes and communities whenever possible. The rule and demonstration announced today give people choice and provide states with flexibility to design programs that better meet the needs of beneficiaries,” Secretary Sebelius said. “Prior to passage of the Affordable Care Act, many families had few choices beyond nursing homes or other institutions for their loved ones. The actions taken today will help change that and can lead to better health for these individuals.”

The final rule released today on the Community First Choice Option provides states choosing to participate in this option a six percentage point increase in federal Medicaid matching funds for providing community-based attendant services and supports to beneficiaries who would otherwise be confined to a nursing home or other institution. 

Also today, the first 16 organizations that will participate in the new Independence at Home Demonstration were announced. They will test whether delivering primary care services in the home can improve the quality of care and reduce costs for patients living with chronic illnesses. These 16 organizations were selected from a competitive pool of more than 130 applications representing hundreds of health care providers interested in delivering this new model of care.                                                           

The Independence at Home demonstration, which is voluntary for Medicare beneficiaries, provides chronically ill Medicare beneficiaries with a complete range of in-home primary care services.  Under the demonstration, the Centers for Medicare & Medicaid Services (CMS) will partner with primary care practices led by physicians or nurse practitioners to evaluate the extent to which delivering primary care services in a home setting is effective in improving care for Medicare beneficiaries with multiple chronic conditions and reducing costs. Up to 10,000 Medicare patients with chronic conditions will be able to get most of the care they need at home.

The demonstration is scheduled to begin on June 1, 2012, and conclude May 31, 2015.

HHS is also seeking comment on a proposed rule that describes a separate Home and Community-Based Services state plan option, which was originally authorized in 2005 then enhanced by the Affordable Care Act. Like the Community First Choice Option, this benefit will make it easier for states to provide Medicaid coverage for home and community-based services.

“Our goal is to provide person-centered support to every Medicare and Medicaid beneficiary, regardless of their physical ability or chronic health conditions,” Acting CMS Administrator Marilyn Tavenner said. “These services and programs will help keep these individuals’ health stable, and keep them home where they want to be, while giving us even more tools to achieve better care for the patient, better health for the population, all at lower costs.”

The announcements made today are one part of the Obama administration’s efforts to help people with disabilities and those living with chronic illness stay in their own homes when they wish to do so.  Earlier this month, Secretary Sebelius announced the creation of the new Administration for Community Living, bringing together key HHS organizations and offices dedicated to improving the lives of Americans with functional needs into one coordinated  and stronger entity. This new agency will work on increasing access to community supports and achieving full community participation for seniors and people with disabilities.

HHS SAYS WATCH OUT FOR MEDICARE SCAMS

FROM: DEPARTMENT OF HEALTH AND HUMAN SERVICES
HHS HealthBeat (April 17, 2012)
 Calling out Medicare scams
Diabetes patients, beware when you pick up the phone. Calls claiming to be from Medicare are not. If they offer you free glucose meters or diabetic test strips, that’s a red flag, because Medicare never makes calls offering supplies or services.
Gary Cantrell is deputy inspector general for investigations with HHS’ Office of the Inspector General.

“The scammers sometimes use names like “MED-‘EE’-CARE, or “MED-“UH’-CARE, “MEDIC-CARE,” in order to trick the listener.”
The number one no-no is giving your away personal information over the phone.
“Don’t provide callers with your Medicare number, bank account information, or credit card numbers.” If you think you’re the target of a scam, report to the OIG hotline, at 1-800-HHS-TIPS.