Is Medicaid Managed Care a Fraud?

What you can't see won't embarrass you.

The recently released report from the DHHS Office of the Inspector General entitled “ACCESS TO CARE: PROVIDER AVAILABILITY IN MEDICAID MANAGED CARE” raises some serious issues about the fraudulent tactics many of these plans use to support state funding of their activities. The OIG’s summary of their study to assess availability of Medicaid managed care providers indicated that: “slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not … Continue reading

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The Twelve Days of Healthcare

what is a partridge doing in a pear tree, anyway?

On the first day of Healthcare my health plan gave to me: Coverage they just had to deny On the second day of Healthcare my health plan gave to me: Wrong E-O-Bs On the third day of Healthcare my health plan gave to me: Big co-pays On the fourth day of Healthcare my health plan gave to me: Un-answered calls   On the fifth day of Healthcare my health plan gave to me: Huge Bal-ance Bills On … Continue reading

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Audited by a Health Plan? Fight Back!

Responding to Audits and Recoupment Demands

If there is one thing that really angers physicians, it is the experience of having a health plan or government payer audit a dozen claims, declare that these audits reveal a pattern of inappropriate claims coding, extrapolate these dozen claims to imply the miscoding of hundreds or even thousands of other claims, and demand repayment of tens of thousands of dollars in ‘overpayments’. These recoupment demands are not uncommon, either by private health plans or … Continue reading

Posted in Health Care Reform, Managed Care Contracting, Medicaid, Payment Reform, Rants | Tagged , , , , , , , , , , , | Leave a comment

A Thanks Giving Story

'thanks' is the best gift

Emergency physicians will, on occasion, hear back from patients who want to express their thanks, and it can really make your day. I got such a call today, and with this patient’s express permission, I decided to tell her story in this blog as she related it to me because it is rare to have so many positive messages that derive from a single ED visit. It also makes me feel good to repeat this … Continue reading

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Should We Ban the Handshake in the ED?

terrorist fist jab per Fox News

The handshake is a custom and ritual that goes back to at least the 5th century B.C., and is often thought to have originated as a way of demonstrating peaceful intent by showing that the hand holds no weapon. Unfortunately, handshaking will, on occasion, convey a very different message, in the form of very dangerous, even deadly, biological ‘weapons’ like pathogenic viruses and bacteria.   There have been quite a few articles and publications on the … Continue reading

Posted in Peering into the Future, Rants, The ER Experience | Tagged , , , , , , , , , , | 2 Comments