Tagged with medicare medicaid
RESTON, VIRGINIA (BNO NEWS) – A new study reported that the recently passed health care reform legislation will require significant investment in information technology (IT) solutions and system upgrades throughout its implementation, INPUT said on Thursday.
The IT Implications of Health Care Reform report from INPUT, a business advising company, predicts that federal, state and local governments will need to invest more than $5 billion in health IT and traditional IT solutions in order to implement requirements of the new law.
Analysts identified four potential areas of opportunity including health IT, medical technology, IT in the business of health care and IT for health care reform management.
“Based on the numerous requirements for reform, IT investments are likely to occur within the first five years of implementation,” said Senior Analyst Angie Petty. “We estimate that the Internal Revenue Service will be required to spend as much as $2.5 billion in IT related to eligibility determination, documentation, and verification processes for premium and cost-sharing subsidies.”
“Health and Human Services will need to spend approximately $1.8 billion to implement changes to Medicare, Medicaid, and related systems, and to implement other legislative mandates. States will also be investing $2 billion in startup costs to implement health insurance exchanges,” she added.
The report also reviewed important issues such as the reform’s possible impact on federal, state, and local governments, market technology trends driving health IT, and existing IT solutions serving the health care market, among others.
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DES MOINES, IOWA (BNO NEWS) – A Newton, IA doctor found guilty Thursday on thirty one health care fraud charges.
Dr. Angel Serafin Martin, M.D., 62, was found guilty on thirty one counts of health care fraud at the completion of a five-day jury trial. These charges were initiated after a patient complained to Wellmark (insurance provider) about an explanation of the benefits form indicating a visit with Dr. Martin that did not in fact occur.
Wellmark began an investigation of these matters and referred it to the FBI. The FBI initiated its investigation and in November 2006, the FBI and HHS-OIG (Health and Human Services Office of Inspector General) executed a search warrant at Dr. Martin’s Newton, IA, clinic. This investigation disclosed that Medicare, Medicaid, Wellmark, and Prinicpal were defrauded by this scheme.
During the trial, 27 patients testified, in addition to other witnesses, concerning office visits during the 2005 to 2007 time period. According to the trial testimony, during the time period of 2004 to 2006, Dr. Matin was one of the top billers of the highest consultation rates in the 12 state region, and among the top 2 in Iowa. The consensus is that he performed a rather limited office visit, but billed it as though it were much more involved, sometimes referred to as “up-coding.”
Additionally, according to testimony, some of the consultations and visits were medically unnecessary under the circumstances and often times just outright ridiculous. In one circumstance Dr. Martin altered a medical record before providing it to law officials.
Analysis showed that on 53 days in the time period 2002 to 2006, Dr. Martin billed for visits which, if performed, would have exceeded a 24-hour day. This was based upon AMA averages of physician time spent on these types of visits.
A spokesperson for Wellmark said, “On behalf of Wellmark’s members, we are pleased that the U.S. Attorney’s Office has chosen to aggressively pursue health care fraud, because fraud drives up the cost of health care for all Iowans.”
Each count of Health Care Fraud is subject to a maximum sentence of ten years in prison and a fine of $250,000. The court will set a sentencing date for Dr. Martin at a future date.
