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The Government Accountability Office added two more federal programs to its "high risk" list in a report released this week, bringing the total up to 32. Those high risk programs are ones the GAO deems to be extremely vulnerable to fraud, waste, abuse and mismanagement, putting billions of dollars of taxpayer money at risk.

A bill has been introduced into the U.S. House by a Wisconsin Congressman which would stop abortion providers from “unbundling” abortion services so they can submit separate claims to Medicaid. U.S. Representative Sean Duffy (R-WI) said that he introduced the ‘‘Medicaid Abortion Funding Prohibition Accountability Act“ to target Medicaid providers who improperly submit reimbursement claims to pay for abortions, and related services. “These companies submit separate claims for abortion related procedures in order to receive increased Medicaid reimbursements. It is a process known as “unbundling” and is in violation of federal law,” Rep. Duffy said in his press release. “All...

On Friday, the Wyoming State Senate voted 19-11 against a proposal to expand Medicaid under the Affordable Care Act. The House Labor, Health and Social Services Committee then pulled its version of the bill. “With all of the Senate’s work, they still fundamentally believe this is not the right thing for Wyoming,” Committee Chairwoman Rep. Elaine Harvey stated. The proposal, known as the SHARE plan, would have called for a federal waiver permitting the state to charge monthly premiums and co-payments to low-income individuals participating in the program. However, the proposal would have almost assuredly been rejected by federal officials,...

In Rebuke of Tennessee Governor, Koch Group Shows Its Power "In December, Tennessee Gov. Bill Haslam, a Republican, got the deal he wanted from the Obama administration: Tennessee would accept more than $1 billion in federal funding to expand Medicaid, as allowed for in the Affordable Care Act, but Obama aides would allow Haslam to essentially write staunchly conservative ideas into the program's rules for the state. He dubbed the reformed Medicaid program "Insure Tennessee." But the state's chapter of Americans for Prosperity, the national conservative group whose foundation is chaired by controversial billionaire David Koch, argued Haslam was just...

A proposal to expand Medicaid under the Affordable Care Act failed 4-7 in Tennessee’s Senate Health Committee during a special session Wednesday as lawmakers expressed concern with increasing the federal government’s role in state affairs. The proposal, Insure Tennessee, had been in development since early 2013 when Governor Bill Haslam signaled interest in negotiating an expansion with federal officials. The two-part proposal included the Volunteer Plan, providing premium assistance to those with employer sponsored coverage, and the Healthy Incentives Plan, establishing health savings accounts and incentivizing healthy behaviors like physicals and appropriate emergency room use. Critics of the plan, however,...

Gov. Bill Haslam said he sees no point in returning to federal officials to ask for more concessions on his health care plan after the state legislature killed the proposal Wednesday, according to the Commercial Appeal. “I think it feels a little pointless right now to come back with the same plan. And so there has to be something that would show change (among lawmakers),” the governor told reporters after the defeat. ..Asked if he would return to the regular legislative session, which opens Monday for a three-month run, with the same plan or a modified version, the governor said:...

Health insurance giant Anthem Inc. said late Wednesday that hackers had breached its computer system and the personal information of tens of millions of customers and employees was possibly at risk. [Snip] The data breach extended across all of Anthem's business, possibly affecting customers at large employers, individual policyholders and people enrolled in Medicaid managed-care plans. Anthem has more than 37 million members in California and 13 other states. But the company warned that it also had information in its database on other Blue Cross Blue Shield patients from all 50 states who had sought care in its coverage area.

It should have been Mike Pence's strongest moment as Indiana governor -- a chance to showcase his style of executive leadership on the national stage. Instead, the week turned into a calamity of Team Pence's own making. The leaked details of a bizarre proposal to create what sounded like a state government-run news agency sucked all the oxygen out of Indiana's political media, right when Pence was supposed to explain a complicated conservative approach he's taking to expanding Medicaid. Pence immediately backtracked, but the damage was already done. (SNIP) Indiana's Republican House speaker, Brian Bosma, even taunted Pence a bit,...

In 2010, Planned Parenthood of the Inland Northwest agreed to pay the state $345,000 after settling a 2009 audit that uncovered the clinic used incorrect codes and provided insufficient documentation for some claims billed to Medicaid. The original audit finding estimated the Spokane family-planning organization improperly billed Medicaid more than $629,000 for 333 patient procedures from March 2004 through February 2007. During that time, the clinic collected about $7.6 million from Medicaid. Planned Parenthoods in New Jersey were also investigated that same year. In 2012, a published report said that Illinois Medicaid’s inspector general was investigating the billing practices of...

In his recent State of the Union address, President Obama was upbeat and inspiring, particularly if a listener had no prior knowledge of his many speeches that were quite similar but bore no fruit. It almost appeared that he was living in an alternate universe that bore no resemblance to present-day America and the current global stage. He boasted that the economy was doing very well and that unemployment had been cut in half since he took office. Perhaps someone should educate him about the labor force participation rate, which is at its lowest point in the past 36 years...

Indiana Republican Gov. Mike Pence is moving ahead to extend Medicaid coverage to hundreds of thousands of Hoosiers under the federal health law after securing a key concession from the Obama administration. The deal, to be announced Tuesday, could pave the way for half a dozen more states to seek similar deals, boosting Medicaid expansion proposals in Republican-led states including Florida, North Carolina and Wyoming. Indiana and Washington officials had been locked for months in negotiations over an issue that could shape the future of Medicaid, the 50-year-old federal-state health program that covers more than 60 million low-income Americans. Mr....

Lillian Palermo tried to prepare for the worst possibilities of aging. An insurance executive with a Ph.D. in psychology and a love of ballroom dancing, she arranged for her power of attorney and health care proxy to go to her husband, Dino, eight years her junior, if she became incapacitated. And in her 80s, she did... But one day last summer, after he disputed nursing home bills that had suddenly doubled Mrs. Palermo’s copays... Palermo was shocked to find a six-page legal document waiting on her bed. It was a guardianship petition filed by the nursing home, Mary Manning Walsh,...

Governor Andrew M. Cuomo today announced new regulations to include transgender health care services under New York State’s Medicaid program. The proposed regulations provide treatment for hormone therapy and gender reassignment surgery.... New York will join California, Massachusetts, Oregon, Vermont, and Washington D.C., which cover transgender health care through their Medicaid programs. In May, the federal government also ended its decades-long exclusion of coverage for certain services related to gender transition under Medicare. The introduction of this Medicaid regulation follows last week’s announcement that New York State law requires private health insurance companies to cover transgender health care on the...

Nationally, 724 hospitals have had their Medicare funding reduced after the Centers for Medicare and Medicaid Services found that each had high rates of potentially avoidable “hospital-acquired conditions,” including falls, bed sores, and certain infections, including ventilator acquired pneumonia and catheter-associated urinary tract infections. CMS scored hospitals on the prevalence of three risk factors to their Medicare population patients: central line bloodstream infections, catheter-associated urinary tract infections, and serious complications, a catch-all group made up of eight types of injuries, including blood clots, falls, and bed sores. Funding can be reinstated for hospitals whose scores improve in the targeted areas.

Medi-Cal applicants who have been waiting for more than 45 days can receive temporary health benefits while officials determine eligibility for the public insurance program, a state Superior Court judge ruled this week. The suit, which was filed in Alameda County Superior Court by a coalition of health advocates and legal services groups, cited delays in enrolling pregnant women, children and adults with life-threatening conditions. Advocates said many either had to postpone treatment or pay cash to see doctors. Medi-Cal is California’s version of Medicaid, the publicly funded insurance program for poor and disabled residents. Prompted by the Affordable Care...

In his State of the Union Tuesday, President Obama claimed that Obamacare has helped cut the deficit by two thirds by slowing the rate of health care spending growth. Not only is this claim false, but Obamacare has created a deficit time bomb that will explode just as he is leaving office.Now it is true that the growth of health care spending has fallen during Obama's presidency. But that slowdown began not only before Obama passed Obamacare, but even before Obama took office. The reality is that larger economic factors, including the growth of cost-sharing health care plans, began slowing health care spending...

Under President Obama’s new program to protect millions of illegal immigrants from deportation, many of those affected will be eligible to receive Social Security, Medicare and a wide array of other federal benefits, a White House official said Tuesday. In his speech Thursday night, the president touted his plan as a means of bringing accountability to a broken immigration system, under which 11 million or more people are estimated to be living in this country illegally. “We’re going to offer the following deal: If you’ve with been in America more than five years. If you have children who are American citizens...

Marilyn Tavenner, head of the U.S. Centers for Medicare and Medicaid Services, plans to step down at the end of February, she told her staff in an e-mail.As Bloomberg reports, Tavenner didn’t say why she was leaving.In November, she acknowledged that her agency had made a mistake in its calculation of the number of people enrolled under Obamacare. As a reminder... from November The Obama administration said it erroneously calculated the number of people with health coverage under the Affordable Care Act, incorrectly adding 380,000 dental subscribers to raise the total above 7 million. The accurate number with full health-care plans...

Hey, are you one of the 9.7 million Americans who have been put onto the Medicaid rolls since 2013 mostly as a result of theAffordable Care Act? Congratulations! But that and $2.75 will get you one ride on the New York City subway. That's because finding a doctor who accepts Medicaid payments – never all that easy to do even before 2013 – is getting harder than ever thanks to a steep drop in reimbursement rates for doctors who treat patients on Medicaid. When I say "steep," I mean it. We're talking an average of 43 percent nationwide and almost...

PALM BEACH GARDENS, Fla. — Rita Gorenflo’s 7-year-old son Nathaniel was in severe pain from a sinus infection. But since the boy was covered by Medicaid, she couldn’t immediately find a specialist willing to see him. After days of calling, she was finally able to get Nathaniel an appointment nearly a week later near their South Florida home. That was in 2005. Last month, ruling in a lawsuit brought by the state’s pediatricians and patient advocacy groups, a federal district judge in Miami determined Nathaniel’s wait was “unreasonable” and that Florida’s Medicaid program was failing him and nearly 2 million...