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At Monday’s state budget hearing on health and Medicaid, many provider organizations discussed how Governor Cuomo did not include any targeted funds to help them raise the pay of their workers to reach the $15 minimum wage he has proposed. Hospitals and home care agencies said it will cost them millions phased in over several years and they would like to get funds to pay for the increase which is an unplanned expense.
Donald Trump says he would be willing to let Medicare negotiate drug prices. That position goes against the Republican orthodoxy on the Medicare drug benefit.
Some hospitals are reporting that because of data breaches with health insurance companies like Anthem, some patients are not willing to provide personal information and sometimes refuse to allow health records to be shared with other providers. This is hurting efforts to make health information more accessible to provide more coordinated care. The providers are forced to spend more time explaining why it is important to share the data so that other providers in the same health network have the patient’s medical record and information.
New York Attorney General Eric Schneiderman announced a $47 million settlement with CenterLight Health Care, a Medicaid managed long term care plan for services it did not provide to 1200 Medicaid recipients. Centerlight enrolled them in its Medicaid managed care plan after referrals from social adult day care centers they started. Centerlight got over $3000 per month, per member in the Medicaid managed care plan even though the individuals in question were not eligible for the services.
Schneiderman said “We won’t tolerate companies that seek to exploit the system for profit. My office will continue to be vigilant in protecting Medicaid against fraud.”
When some of these companies running Medicaid managed care plans saw the funded attached to them, they set up social adult day care centers to attracts seniors and others and then referred them to their plans and said that as participants in the day care centers they were part of the managed care plan. The settlement said “CenterLight used the day care centers to provide community-based MLTCP personal care services that did not qualify as personal care services under CenterLight’s Select plan.”
In October 2014, Schneiderman announced a similar $37 million settlement with VNS Choice, Visiting Nurse Service of New York.
These abuses led to legislation to better regulate social adult day care centers through the State Office for the Aging so that companies could not just pop up such a center and deem that it was providing reimbursable services.