Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Medicaid. Show all posts
Showing posts with label Medicaid. Show all posts

Friday, July 7, 2023

The Dobbs Decision — Exacerbating U.S. Health Inequity

Harvey, S. M., et al. (2023).
New England Journal of Medicine, 
388(16), 1444–1447. 

Here is an excerpt:

In 2019, half of U.S. women living below the FPL were insured by Medicaid. Medicaid coverage rates were higher in certain groups, including women who described their health as fair or poor, women from marginalized racial or ethnic groups, and single mothers. Approximately two thirds of adult women enrolled in Medicaid are in their reproductive years and are potentially at risk for an unintended pregnancy. For many low-income people, however, federal and state funding restrictions created substantial financial and other barriers to accessing abortion services even before Dobbs. Notably, the Hyde Amendment greatly disadvantaged low-income people by blocking use of federal Medicaid funds for abortion services except in cases of rape or incest or to save the pregnant person’s life. In 32 states, Medicaid programs adhere to the strict guidelines of the Hyde Amendment, making it difficult for low-income people to access abortion services in these states.

Before the fall of Roe, Medicaid coverage could determine whether women in some states did or did not receive abortion services. Since the implementation of the post-Dobbs abortion bans, abortion care is even more restricted in entire regions of the country. Access to abortion services under Medicaid will continue to vary by place of residence and depend on the confluence of restrictions or bans on abortion care and Medicaid policies currently in effect within each state. In the new landscape (see map), obtaining abortion services has become even more challenging for low-income women in most of the country, despite the fact that most states have expanded Medicaid coverage.

After Dobbs, complete or partial bans on abortion went into effect in more than a dozen states, forcing people in those states to travel to other states to access abortion care. More than a third of women of reproductive age now live more than an hour from an abortion facility and will probably face additional barriers, including costs for travel and child care and the need to take time off from work. Regrettably, people who already had poorer-than-average access pre-Dobbs face even greater health burdens and risks. For example, members of marginalized racial and ethnic groups that face disproportionate burdens of pregnancy-related mortality are more likely than other groups to have to travel longer distances to get an abortion post-Dobbs.

As a result of the overturning of Roe, a substantial proportion of people who want abortion services will not have access to them and will end up carrying their pregnancies to term. For decades, research has demonstrated that abortion bans most severely affect low-income women and marginalized racial and ethnic groups that already struggle with barriers to accessing health care, including abortion. The economic, educational, and physical and mental health consequences of being denied a wanted abortion have been thoroughly documented in the landmark Turnaway Study. Thanks to nearly 50 years of legal abortion practice, we now have a robust body of research on the safety and efficacy of abortion and the impact of abortion restrictions on people’s socioeconomic circumstances, health, and well-being.

Innovative strategies, such as telemedicine for medication abortion services, can improve access to abortion care. Self-managed, at home, medication abortions are safe, effective, and acceptable to many patients. In states where abortions are legal that are bordered by states where abortions are banned, telemedicine could mean the difference between patients being able to simply drive across the state line, in order to be physically in the state providing care, and having to drive to a clinic that could be hundreds of miles away. In addition, Planned Parenthood affiliates have plans to launch mobile services and to open clinics along state borders where abortion is illegal in one state but legal in the other.

Wednesday, October 16, 2019

Birmingham psychologist defrauded state Medicaid of more than $1.5 million, authorities say

Carol Robinson
Sharon Waltz
al.com
Originally published August 15, 2019

A Birmingham psychologist has been charged with defrauding the Alabama Medicaid Agency of more than $1 million by filing false claims for counseling services that were not provided.

Sharon D. Waltz, 50, has agreed to plead guilty to the charge and pay restitution in the amount of $1.5 million, according to a joint announcement Thursday by Northern District of Alabama U.S. Attorney Jay Town, Department of Health and Human Services -Office of Inspector General Special Agent Derrick L. Jackson and Alabama Attorney General Steve Marshall.

“The greed of this defendant deprived mental health care to many at-risk young people in Alabama, with the focus on profit rather than the efficacy of care,” Town said. “The costs are not just monetary but have social and health impacts on the entire Northern District. This prosecution, and this investigation, demonstrates what is possible when federal and state law enforcement agencies work together.”

The info is here.

Tuesday, January 15, 2019

Cheyenne Psychologist And His Wife Sentenced To 37 Months In Prison For Health Care Fraud

Department of Justice
U.S. Attorney’s Office
District of Wyoming
Press Release of December 4, 2018

John Robert Sink, Jr., 68, and Diane Marie Sink, 63, of Cheyenne, Wyoming, were sentenced on December 3, 2018, to serve 37 months in prison for making false statements as part of a scheme to fraudulently bill Wyoming Medicaid for mental health services, which were never provided, announced United States Attorney Mark A. Klaassen. The Sinks, who are married, were also ordered to pay over $6.2 million in restitution to the Wyoming Department of Health and the United States Department of Health and Human Services, and to forfeit over $750,000 in assets traceable to the fraud, including cash, retirement accounts, vehicles, and a residence.

The Sinks were indicted in March 2018 by a federal grand jury for health care fraud, making false statements, and money laundering. At all times relevant to the indictment, John and Diane Sink operated a psychological practice in Cheyenne. John Sink, who was a licensed Ph.D. psychologist, directed mental health services. Diane Sink submitted bills to Wyoming Medicaid and managed the business and its employees. The Sinks provided services to developmentally disabled Medicaid beneficiaries and billed Medicaid for those services.

Between February 2012 and December 2016, the Sinks submitted bills to Wyoming Medicaid for $6.2 million in alleged group therapy. These bills were false and fraudulent because the services provided did not qualify as group therapy as defined by Wyoming Medicaid. The Sinks also falsely billed Medicaid for beneficiaries who were not participating in any activities, and therefore did not receive any of the claimed mental health services. When Wyoming Medicaid audited the Sinks in May 2016, the Sinks did not have necessary documentation to support their billing, so they ordered an employee to create backdated treatment plans. The Sinks then submitted these phony treatment plans to Wyoming Medicaid to justify the Sinks’ false group therapy bills, and to cover up their fraudulent billing scheme.

The pressor is here.

Tuesday, December 25, 2018

Medical Ethicist Calls Trump Approved Medicaid Work Requirements Cruel

Jason Turesky
www.wgbh.org
Originally posted November 26, 2018

Here is an excerpt:

Medical ethicist Art Caplan called the idea of Medicaid work requirements “cruel” on Boston Public Radio Monday, and believes there are no clear benefits to these new rules. “It’s not really something that I think is going to instill good habits or get people off Medicaid,” Caplan said.

Caplan pointed out that many of the people on Medicaid in Kentucky may not be physically able to fulfill the 80 hour requirement.

“Remember, the overwhelming majority of people on Medicaid in Kentucky, and every state, are disabled or children or single head of household females, so getting them out 80 hours per month to do anything is very difficult, unless we are going to re-institute child labor,” he said.

The info is here.

Friday, June 8, 2018

The Ethics of Medicaid’s Work Requirements and Other Personal Responsibility Policies

Harald Schmidt and Allison K. Hoffman
JAMA. Published online May 7, 2018. doi:10.1001/jama.2018.3384

Here are two excerpts:

CMS emphasizes health improvement as the primary rationale, but the agency and interested states also favor work requirements for their potential to limit enrollment and spending and out of an ideological belief that everyone “do their part.” For example, an executive order by Kentucky’s Governor Matt Bevin announced that the state’s entire Medicaid expansion would be unaffordable if the waiver were not implemented, threatening to end expansion if courts strike down “one or more” program elements. Correspondingly, several nonexpansion states have signaled that the option of introducing work requirements might make them reconsider expansion—potentially covering more people but arguably in a way inconsistent with Medicaid’s broader objectives.

Work requirements have attracted the most attention but are just one of many policies CMS has encouraged as part of apparent attempts to promote personal responsibility in Medicaid. Other initiatives tie levels of benefits to confirming eligibility annually, paying premiums on time, meeting wellness program criteria such as completing health risk assessments, or not using the emergency department (ED) for nonemergency care.

(cut)

It is troubling that these policies could result in some portion of previously eligible individuals being denied necessary medical care because of unduly demanding requirements. Moreover, even if reduced enrollment were to decrease Medicaid costs, it might not reduce medical spending overall. Laws including the Emergency Medical Treatment and Labor Act still require stabilization of emergency medical conditions, entailing more expensive and less effective care.

The article is here.

Monday, August 7, 2017

Study suggests why more skin in the game won't fix Medicaid

Don Sapatkin
Philly.com
Originally posted July 19, 2017

Here is an excerpt:

Previous studies have found that increasing cost-sharing causes consumers to skip medical care somewhat indiscriminately. The Dutch research was the first to examine the impact of cost-sharing changes on specialty mental health-care, the authors wrote.

Jalpa A. Doshi, a researcher at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, has examined how Americans with commercial insurance respond to cost-sharing for antidepressants.

“Because Medicaid is the largest insurer of low-income individuals with serious mental illnesses such as schizophrenia and bipolar disorder in the United States, lawmakers should be cautious on whether an increase in cost sharing for such a vulnerable group may be a penny-wise, pound-foolish policy,” Doshi said in an email after reading the new study.

Michael Brody, president and CEO of Mental Health Partnerships, formerly the Mental Health Association of Southeastern Pennsylvania, had an even stronger reaction about the possible implications for Medicaid patients.

The article is here.

Sunday, July 9, 2017

Letter from the American Medical Association to McConnell and Schumer

James Madera
Letter from the American Medical Association
Sent June 26, 2017

To: Senators McConnell and Schumer

On behalf of the physician and medical student members of the American Medical Association
(AMA), I am writing to express our opposition to the discussion draft of the “Better Care
Reconciliation Act” released on June 22, 2017. Medicine has long operated under the precept of
Primum non nocere, or “first, do no harm.” The draft legislation violates that standard on many
levels.

In our January 3, 2017 letter to you, and in subsequent communications, we have consistently
urged that the Senate, in developing proposals to replace portions of the current law, pay special
attention to ensure that individuals currently covered do not lose access to affordable, quality
health insurance coverage. In addition, we have advocated for the sufficient funding of Medicaid
and other safety net programs and urged steps to promote stability in the individual market.
Though we await additional analysis of the proposal, it seems highly likely that a combination of
smaller subsidies resulting from lower benchmarks and the increased likelihood of waivers of
important protections such as required benefits, actuarial value standards, and out of pocket
spending limits will expose low and middle income patients to higher costs and greater difficulty
in affording care.

The AMA is particularly concerned with proposals to convert the Medicaid program into a
system that limits the federal obligation to care for needy patients to a predetermined formula
based on per-capita-caps.

The entire letter is here.

Wednesday, September 17, 2014

Expansion of Mental Health Care Hits Obstacles

By Abby Goodnough
The New York Times
Originally published August 28, 2014

Here is an excerpt:

The new law is a big opportunity for mental health providers to reach more people of all income levels. But in Kentucky and the 25 other states that chose to expand Medicaid, the biggest expansion of mental health care has been for poor people who may have never had such treatment before.

Still, private providers face considerable headaches in taking on Medicaid patients, beyond the long-term deterrent of low reimbursement. Ms. Wright, for instance, is still waiting to be approved by some of the managed care companies that provide benefits to Medicaid recipients. Eager to build her client base, Ms. Wright has taken on a handful of new Medicaid enrollees for free while she waits for those companies to approve her paperwork.

“It’s been months and months,” she said. “It’s always there in my mind: Am I going to make it?”

The entire article is here.

Friday, July 11, 2014

Why haven't more states expanded Medicaid yet?

By California Healthline
www.philly.com
Originally posted June 26, 2014

Two years after Roberts issued the majority opinion upholding the Affordable Care Act, the decision to expand Medicaid is far from settled. Despite predictions that all states will eventually embrace Medicaid expansion, a significant number continue to hold out.

At last count, 26 states and the District of Columbia intend to expand Medicaid, while four are actively considering it and 20 have no plans to expand the program at this time.

The Medicaid expansion was considered the sleeper issue in the legal case against the ACA that ultimately made its way up to the Supreme Court. Stakeholders were closely watching issues like the constitutionality of the individual mandate, not thinking Medicaid would be significant. And yet, in a surprise decision, the Supreme Court effectively took the teeth out of one of the law's major efforts to expand health insurance, by making it illegal to penalize states for not participating in the Medicaid expansion.

The entire article is here.

Wednesday, October 23, 2013

Professionalism and Caring for Medicaid Patients — The 5% Commitment?

Lawrence P. Casalino, M.D., Ph.D.
October 9, 2013 DOI: 10.1056/NEJMp1310974

Medicaid is an important federal–state partnership that provides health insurance for more than one fifth of the U.S. population — 73 million low-income people in 2012. The Affordable Care Act will expand Medicaid coverage to millions more. But 30% of office-based physicians do not accept new Medicaid patients, and in some specialties, the rate of nonacceptance is much higher — for example, 40% in orthopedics, 44% in general internal medicine, 45% in dermatology, and 56% in psychiatry. Physicians practicing in higher-income areas are less likely to accept new Medicaid patients. Physicians who do accept new Medicaid patients may use various techniques to severely limit their number — for example, one study of 289 pediatric specialty clinics showed that in the 34% of these clinics that accepted new Medicaid patients, the average waiting time for an appointment was 22 days longer for children on Medicaid than for privately insured children.

The entire story is here.

Thanks to Gary Schoener for this information.

Tuesday, August 27, 2013

U.S. Probes Use of Antipsychotic Drugs on Children

By LUCETTE LAGNADO
The Wall Street Journal
Originally published August 12, 2013

Federal health officials have launched a probe into the use of antipsychotic drugs on children in the Medicaid system, amid concern that the medications are being prescribed too often to treat behavioral problems in the very young.

The inspector general's office at Department of Health and Human Services says it recently began a review of antipsychotic-drug use by Medicaid recipients age 17 and under. And various agencies within HHS are requiring officials in all 50 states to tighten oversight of prescriptions for such drugs to Medicaid-eligible young people.

The effort applies to a newer class of antipsychotic drugs known as "atypicals," which include Abilify, the nation's No. 1 prescription drug by sales. The drugs were originally developed to treat psychoses such as schizophrenia, but some now have Food and Drug Administration approval for treatment of children with conditions such as bipolar disorder and irritability associated with autism.

The entire story is here.

Monday, July 29, 2013

Kentucky’s Rush Into Medicaid Managed Care: A Cautionary Tale For Other States

By Jenni Bergal
Kaiser Health News, in conjunction with the Washington Post
Originally published July 15, 2013

Here is an excerpt

Ever since Kentucky rapidly shifted patients from traditional Medicaid to private health plans that manage their care for a set price, problems have been widespread.

Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan’s network. Advocates for the mentally ill argue the care system for them has deteriorated. And hospitals and doctors say health plans have denied or delayed payments.

Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people in Medicaid, the state-federal program for the poor and disabled, to managed care in hopes of cutting costs and improving quality. Nearly 30 million Americans on Medicaid now belong to a private health plan, as states move away from the traditional program that paid doctors and hospitals for each service they provided.

The entire story is here.

Tuesday, February 19, 2013

SGR Repeal Bill Favors Primary Care

Robert Lowes
MedScape Medical News
Originally published February 06, 2013

Two members of Congress today reintroduced an ambitious bill that would repeal Medicare's sustainable growth rate (SGR) formula for setting physician pay and gradually phase out fee-for-service (FFS) reimbursement.

One major difference this time around for the bipartisan bill, originally introduced in May 2012, is that its price tag appears considerably lower, making passage more likely.

When Reps. Allyson Schwartz (D-PA) and Joe Heck, DO (R-NV), proposed this legislation last year, the Congressional Budget Office (CBO) had estimated that repealing the SGR and merely freezing current Medicare rates for 10 years would cost roughly $320 billion.

Since then, the CBO has reduced that 10-year estimate on the basis of lower than projected Medicare spending on physician services for the past 3 years. In a budget forecast released yesterday, the agency put the cost of a 10-year rate freeze at $138 billion.

The immediate effect of the bill from Schwartz and Dr. Heck, titled the Medicare Physician Payment Innovation Act, would be to avert a Medicare pay cut of roughly 25% on January 1, 2014, that is mandated by the SGR formula. Instead, the bill maintains 2013 rates through the end of 2014.

After 2014, Medicare would begin to shift from FFS to a methodology that rewards physicians for the quality and efficiency of patient care. From 2015 through 2018, the rates for primary care, preventive, and care coordination services would increase annually by 2.5% for physicians for whom 60% of Medicare allowables fall into these categories. Medicare rates for all other physician services would rise annually by 0.5%.

Meanwhile, the bill calls on the Centers for Medicare & Medicaid Services (CMS) to step up its efforts to test and evaluate new models of delivering and paying for healthcare (experiments with medical homes, accountable care organizations, and bundled payments are already underway). By October 2017, CMS must give physicians its best menu of new models to choose from. Two menu options would allow some physicians unable to fully revolutionize to participate in a modified FFS scheme.

The entire article is here.

Friday, January 25, 2013

Contracts Awarded Despite Inquiry


By Colleen Heild
Journal Investigative Reporter
Originally published on Jan 13, 2013
First of two parts

A Roswell, N.M.-based psychiatric services firm landed state Department of Health contracts that allow charges of up to $2,000 a day, even though it was under investigation for alleged Medicaid fraud at another state agency.

The contracts between the Department of Health and New Mexico Psychiatric Services signed last summer permit the company to bill up to $623,900 to provide on-call or temporary services to state-run health facilities.

They include the Sequoyah Adolescent Treatment Center in Albuquerque, a 36-bed residential treatment center for violent and mentally ill youth.

At the time the contacts were awarded last year, the company was facing allegations of Medicaid billing fraud at the state Human Services Department. Its payments for services for HSD have been suspended pending the outcome of the inquiry.

A top health department official said in an interview last month that he didn’t know New Mexico Psychiatric Services was under investigation at the time he helped evaluate proposals for the so-called “locum tenens” psychiatric services last April.

But in a follow-up response last week, the agency’s spokesman said others in the agency did know and the inquiry by the state Attorney General’s Office wasn’t a “determinative” factor.

DOH spokesman Kenny C. Vigil told the Journal that the president of New Mexico Psychiatric Services, Dr. Babak Mirin, made a “self disclosure” about the investigation before any contracts were signed last year.

Asked whom Mirin had informed at the DOH and when, Vigil responded: “I don’t have that information.”

The Department of Health and the Human Services Department are separate state agencies, albeit with some overlapping missions involving assistance to New Mexicans.

The Human Services Department, which administers behavioral health services, notified New Mexico Psychiatric Services nearly a year ago of the billing fraud inquiry by the AG’s Medicaid Fraud Control Unit.

Mirin’s attorney, David H. Johnson, told the Journal in an email last week that the company has been cooperating with the AG’s investigation “and is committed to the repayment of any overpayments that it may have received.

“At this point there has only been an allegation of billing fraud,” Johnson’s email stated. “Fraud has not been established.”

The entire story is here.

Thursday, November 17, 2011

Glaxo to Pay $3 Billion to Settle U.S. Cases on Sales, Marketing

By Phil Serafino and Makiko Kitamura
Bloomberg News

GlaxoSmithKline Plc (GSK) agreed to pay $3 billion to resolve U.S. criminal and civil investigations into whether the U.K. company marketed drugs for unapproved uses and other matters, its biggest legal settlement.

Negotiations over the terms will be completed next year, the London-based company said in a statement today. The cost is covered by existing legal provisions and will be paid from the company’s cash resources, Glaxo said.

The potential settlement brings Glaxo closer to putting years of legal probes behind it. The company set aside 2.2 billion pounds ($3.5 billion) in the fourth quarter last year in anticipation of reaching an agreement on the cases. Glaxo said it will have about 1 billion pounds of its 2.9 billion pounds in total legal provisions remaining after today’s settlement is completed, and it hasn’t decided what to do with the money.

“This news essentially draws a line under a 10-year legal saga,” Gbola Amusa, an analyst at UBS AG in London who recommends buying Glaxo shares, said in an e-mail. “This removes significant uncertainty on ongoing legal issues.”

There rest of the story can be found here.

Sunday, October 2, 2011

In Deal, Hundreds of Mentally Ill People Will Leave Confinement of Nursing Home

By Anemona Hartcollis
The New York Times
Published September 12, 2011

Hundreds of mentally ill people who have been confined to nursing homes, sometimes in prisonlike conditions, would move to apartments or other housing within three years under a legal settlement with New York State.

The settlement resolved a case that was filed in Brooklyn federal court in 2006 and that accused the state of violating the spirit of its own longstanding rules for housing mentally ill people.

In researching the case, the plaintiffs found that psychiatric centers and nursing homes had developed “turnaround agreements, which essentially were written agreements to transfer patients back and forth,” Veronica S. Jung, senior staff attorney for New York Lawyers for the Public Interest, which helped to represent plaintiffs, said Monday.

“This certainly raises broader, troubling questions about the role of nursing homes, and their financial stakes, within the mental health care system,” Ms. Jung said.

The settlement came as the judge in the case, Brian M. Cogan, set a trial date for early October, Ms. Jung said.

“It did seem pretty clear that the specter of going to trial in the next few days probably motivated the state to move more quickly in negotiations,” Ms. Jung said. The state has agreed to pay $2.5 million in legal fees and costs to the plaintiffs’ counsel.

Andrew J. Zambelli, counselor to Gov. Andrew M. Cuomo, said the state had settled the case because “it just jibed with our kind of policy viewpoint — care for the vulnerable, into the community, using money appropriately.”

Under longstanding legal principle in New York and elsewhere, the mentally ill cannot be confined unless they are considered a threat to themselves or others, and should be housed in the least restrictive setting appropriate for their needs.

Under the terms of the settlement, the Cuomo administration has agreed to reform the process used to assess whether patients are capable of living in the community and want to live there. The state has also promised to hire independent contractors who would be trained to make the assessments.

The entire story can be found here.