Saturday, September 14, 2013

State temporarily suspends doctor charged in Sacred Heart health care fraud case

The state has temporarily suspended the license of a doctor charged in the Sacred Heart Hospital Medicaid and Medicare fraud scandal after his attorneys asked a judge in Indiana to delay his unrelated trial there because he is was "medically unfit."
Dr. Subir Maitra, one of four doctors named in the alleged Sacred Heart conspiracy, faces trial in November in the Northern District of Indiana on similar fraud charges. This week his attorneys asked a judge to delay the start of that trial, saying the 73-year-old was physically frail, had suffered several medical setbacks recently and had lost the ability to concentrate for long periods.
That filing prompted the Illinois Department of Financial and Professional Regulation on Friday to temporarily suspend Maitra's license, saying the filing indicates he "may be "physically and/or mentally impaired" and his practice "presents an immediate danger to the safety of the public."
A hearing on the suspension is set for next week. Thomas Anthony Durkin, Maitra's attorney, declined to comment.
Maitra and three other doctors are charged along with hospital CEO Edward Novak and its chief financial officer, Roy Payawal, in a scheme that allegedly involved paying kickbacks for patient referrals and performing unnecessary procedures, including tracheotomies. Five deaths tied to tracheotomies performed at the hospital are under investigation as part of the probe.
Novak sought to last month have his unusually high $10 million cash bond reduced, based on what his attorneys said were emerging questions about the evidence against him. U.S. Magistrate Judge Daniel Martin on Thursday denied the request, saying it was not appropriate for him to weigh the evidence. He also noted Novak's extraordinary wealth.
"Mr. Novak's personal wealth is estimated at approximately three times the amount posted on his behalf," Martin wrote in his order. "He has set forth no argument demonstrating any type of financial difficulty suffered as a result of the cash amount posted."

Health Literacy Could Reduce Medicare Expenses

By Clara Ritger | Friday, September 13, 2013 | 1:09 p.m.Kathleen SebeliusPhoto: AP Photo/Anja Niedringhaus
Patients – particularly minorities and those on Medicare – are not actively making decisions about their treatments and procedures because doctor-patient communication is poor, according to a study presented Thursday to MedPAC, the Congressional advisory committee on Medicare.
The result is a greater expense for Medicare and a lack of empowerment among patients.
"Once patients understand the risks and benefits of expensive procedures, they tend to opt for more conservative treatment options," said Rita Redberg, a MedPAC member and professor at the University of California San Francisco School of Medicine.
It's the reason physicians and hospitals are resisting training programs that would teach care providers to include patients in the decision-making process, Redberg said, because they lose money when patients choose less-costly options.
The deliberations of the 17 MedPAC members will be presented as recommendations to Congress and the Department of Health and Human Services.
Improving health literacy, or the ability of patients to understand their health care and make informed decisions, is a stated priority for HHS Secretary Kathleen Sebelius.
It's a priority that could come with significant financial implications for the United States. In 2007, a team of researchers estimated that low health literacy costs the U.S. between $106 and $236 billion annually. A number of factors account for those costs, including a patient's inability to find the best provider, treatment and services for his or her condition. The researchers argue the savings would be enough to insure all of the more than 47 million patients who were uninsured in the U.S. in 2006.
There's room to grow – only 22 percent of Americans are reported to be "proficient" when it comes to their understanding of health care costs and services, according to a U.S. Department of Education study.
Low-income adults are disporportionally affected. Health literacy was lower on average for adults living below the poverty level than those living above, the DOE's 2003 National Assessment of Adult Literacy found. As income increased, so did health literacy.
Racial and ethnic minorities had lower average health literacy scores than White adults, the study showed. Forty-one percent of Hispanic adults and 24 percent of Black adults had below basic levels of health literacy, compared with 9 percent of White adults.
Those numbers complement MedPAC's findings that Hispanic and Black patients report poorer communication with providers than Whites and the 2012 National Healthcare Disparities Report which found that Hispanic and Black patients were less likely to be asked their preferences in treatment decisions.
The health literacy problem also poses a challenge for the success of the Affordable Care Act. Once the exchanges open on Oct. 1, the millions of new patients added to the system in the coming years are expected to have high rates of health illiteracy, as many of them may not have had health insurance before.
How to inform patients – and who to hold accountable for health information – remains controversial. Some MedPAC members argued that health literacy wasn't only the responsibility of the patient, but also the provider, to explain health options in ways patients can understand.
"What if patients were treated with dignity and respect?" said George Miller, a MedPAC member and CEO of CommUnityCare in Austin, Tex. "Maybe then they'd feel empowered."
The consensus among the group was that patient engagement was an important issue that needs to be addressed, but they were unsure how Medicare would play a role.
"Health literacy is a responsibility of the Medicare program in that we should be paying for care that supports shared decision-making," said Mary Naylor, MedPAC member and a professor at the University of Pennsylvania School of Nursing.
But that, commission members said, leaves the question of how MedPAC would measure success, and providing financial incentives for patient-inclusion appeared contentious.
The commission will wrap up its meeting Friday at the Ronald Reagan Building, International Trade Center in the Horizon Ballroom.

Fla. hospitals and clinics to pay $3.5 million

Radiation oncology providers in Pensacola will pay $3.5 million to the federal government and the state of Florida to resolve allegations they improperly billed government health-care programs.
The U.S. Department of Justice announced Friday that the providers — which included Sacred Heart Health System and West Florida Medical Center Clinic — had been accused of improperly billing Medicare, Medicaid and the health care program used by uniformed military.
The allegations included billing for services that were performed while doctors were on vacation as well as billing twice for the same services.
The improper billing is alleged to have taken place between 2007 and 2011 at locations in Pensacola and Destin. The allegations were first raised in a whistleblower lawsuit.
The whistleblower, Richard Koch, will receive nearly $610,000.

Read more here:

Humana IT systems down Friday

Health care and insurance benefits provider Humana Inc. (NYSE: HUM) experienced some significant technical problems Friday, including problems with its online systems for customers.
A statement on the company’s website says:
“ is currently experiencing intermittent issues. We’re working hard to resolve all issues as soon as possible. We apologize for any inconvenience.”
In an email, Humana’s vice president for corporate communication Tom Noland said Humana also has been experiencing technical difficulties regarding its ability to receive inbound communications, such as telephone calls and emails.
“Connectivity is now being restored, and we are doing everything we can to complete this work as quickly as possible,” he said. “We apologize for any inconvenience anyone may have experienced.”
It is unclear whether the problems are limited to Humana's Louisville operations.
Humana provides insurance products and health and wellness services nationwide. In 2012, the company had revenue of $39.13 billion. Nationwide, the company has more than 43,000 employees. Locally it has more than 11,000 workers.