Wednesday, March 5, 2014

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HHS FY 2015 budget to reduce Medicare-Medicaid fraud, waste

The Department of Health & Human Services has release its budget for fiscal year 2015, which the department claims is both “fiscally responsible” and aims to strengthen its two most important programs — and doing so by reducing healthcare fraud and waste.
“On the mandatory side, we’ll contribute a net $369 billion toward deficit reduction over the next decade,” Secretary Kathleen Sebelius said in a press conference earlier today. “By incentivizing high-quality and efficient care and by continuing to reduce healthcare cost growth, this budget also strengthens two very important programs — Medicare and Medicaid — with $415 million in net savings over the next decade and extends the solvency of the Hospital Insurance Trust Fund by five years.”
According to Sebelius, a major focus of the FY 2015 budget is to control the year-to-year growth of Medicare over the next ten years. “It will reduce the average annual growth in Medicare over the next decade from 6.3 percent to 5.3 percent. What’s more, by expanding competitive bidding for durable medical equipment, it also produces additional savings for Medicare and its beneficiaries alike,” she added.
An important part of these cost-reduction efforts highlighted in today’s press conference and budget was the work of Health Care Fraud and Abuse Control Program (HCFAC), whose investment is apparently paying off.
“[The budget] invests $428 million in HCFAC and the Medicare Integrity Program, both of which are proven to deliver results in fighting fraud. Every dollar we invest in HCFAC, for example, returns $8.10 of the money we recover. We’ve now announced recovering a record-breaking $4.3 billion,” she explained.
The budget indicates that preventing fraud and reducing improper payments are “top priorities” for the current administration. The investments in HCFAC and Medicaid program integrity funds are expected to yield $13.5 billion in gross savings for Medicare and Medicaid over the next decade.
The budget is also proposing the introduction of new tools via legislative action to increase program integrity oversight. For the Medicare program, these include:
• Allowing prior authorization for Medicare fee-for-service items;
• Allowing civil monetary penalties for providers and suppliers who fail to update enrollment records;
• Allowing the Secretary to create a system to validate practitioners’ orders for high-risk items and services;
• Increasing scrutiny of providers using higher-risk banking arrangements to receive Medicare payments
• Retaining a percentage of incentive reward payment recoveries
For Medicaid, the following proposal are being made:
• Increasing investment in and expanding authority of the Medicaid Integrity Program;
• Supporting Medicaid Fraud Control Unites for the territories;
• Expanding Medicaid Fraud Control Unit review to additional care settings;
• Tracking high prescribers and utilizers of prescription drugs in Medicaid;
• Consolidating redundant error rate measurement programs;
• Preventing use of federal funds to pay state share of Medicaid or CHIP;
• Improving program integrity for Medicaid drug coverage.
Read the complete HHS FY 2015 budget here.

Florida Health Choices launches state exchange

MIAMI (AP) — The troubled Florida Health Choices program launched an insurance exchange Tuesday, after several delays, that is separate from the Affordable Care Act marketplace.
CEO Rose Naff delayed the launch last month after 10 times higher than anticipated interest in the site prompted technology experts to retool the website. But Naff announced they were open for business with a single vendor, which is offering five different plans, including a prescription discount card and bundled discount products that includes vision, dental, telemedicine and prescriptions.
The program is separate from Obama's federal health law and will not offer tax credits. Consumers seeking to buy insurance on the federal exchange who mistakenly end up on Florida Health Choices' site will be directed to For now, major insurers have not signed on to offer plans through Florida Health Choices and coverage under the program will not count as comprehensive health coverage under the Affordable Care Act.
Instead, Florida Health Choices will cater to consumers who don't like the president's law or may be seeking gap coverage, pharmacy discount cards and limited vision or dental plans. The program will add more vendors going forward, which will provide coverage for prepaid health clinics, primary care and outpatient visits. Florida Health Choices also hopes to offer some type of coverage to the roughly 1 million Floridians who make a bit too much money to qualify under stringent Medicaid standards but not enough to qualify for tax credits through the federal exchange.
Naff said she learned from the bungled rollout of the federal health law and delayed the launch several times to ensure the website was ready. Site capacity was increased to handle 30,000 users a day, including 1,000 simultaneous applications, she said.
Critics have complained that Florida Health Choices, the brainchild of former House Speaker Marco Rubio, started in 2008 and still doesn't have a single enrollee more than five years later. But Republicans, many who were eager to an alternative to so-called "Obamacare," have championed the program. Lawmakers have given Florida Health Choices about $1.5 million over the years.
Florida Health Choices hopes to enroll 67,000 consumers in its first year to break even. Naff said she isn't planning to ask lawmakers for additional funds this year.

FCC Creates Task Force To Boost Wireless Health Adoption

Wednesday, March 5, 2014


On Tuesday, the Federal Communications Commission announcedthat it will create a new task force to examine ways to accelerate health care organizations' adoption of wireless technologies, The Hill's "Hillicon Valley" reports (Hattem, "Hillicon Valley," The Hill, 3/4).

Task Force Details

The task force -- called Connect2HealthFCC -- will be led by Michele Ellison, who has served as chief of FCC's Enforcement Bureau since 2009. Ellison will work with FCC's Director of Health Care Initiatives, the chiefs of the Wireline and Wireless Bureaus and the Office of Engineering and Technology, as well as, public and private health care stakeholders.
In a statement, FCC Chair Tom Wheeler said the task force would work to:
  • Identify regulatory barriers and incentives to expand the use of wireless health technologies; and
  • Strengthen partnerships with stakeholders in the telehealth and mobile health industries.
He said, "We must leverage all available technologies to ensure that advanced health care solutions are readily accessible to all Americans, from rural and remote areas to underserved inner cities" (Slabodkin, Health Data Management, 3/5).