Below are the 3 most recent journal entries recorded in medicaiddoctors' InsaneJournal:

Sunday, December 12th, 2010
1:13 pm	Los Angeles, Ca - Health Care Before it was recently closed, Martin Luther King Jr.-Harbor Hospital was a public hospital in Los Angeles, CA that was run by the Los Angeles County Department of Health Services. For a while, there had been widely discussed problems related to endemic incompetence and mismanagement, which ultimately caused the available number of hospital beds to be decreased to only 42. In the past three years, over 200 hospital employees had either been terminated or resigned for disciplinary reasons. In 2000, before its crisis and closing, the hospital possessed 537 beds and was the teaching hospital for Charles R. Drew University of Medicine and Science. Located near high crime areas, the hospital had a very involved trauma unit. During 2003, it treated over 2,000 gunshot wounds and other such life-threatening injuries. Martin Luther King Jr.-Harbor Hospital's establishment was due to the 1965 Watts Riots when it was determined that poor access to adequate healthcare was one of the contributing factors to the unrest. Tellingly, the closest public trauma center was located over ten miles away. In 1966, a medical task force was formed to examine the matter. Actual construction began in April 1968. It opened in 1972 as a full-service medical center and was viewed as a source of pride and jobs in the community. Despite this excellent start, after 2000 an array of problems rocked the hospital. It was known by the dubious nickname of 'Killer King' and was the object of a number of special investigations by local newspapers. On August 10, after failing a comprehensive review by the U.S. Centers for Medicare and Medicaid Services, 200 million dollars in federal funding was canceled. The emergency room was closed later that day and the rest of the hospital by August 27. Employees were reassigned to jobs at other county facilities. At a later Los Angeles County board meeting, a 124-page report by federal inspectors was revealed that detailed dozens of errors and failures by hospital employees during the fateful review. Info About Medicaid Doctors
1:07 pm	Government option already a failure As the Senate weighs a 2,074-page healthcare "reform" bill, supporters of a government option for medical coverage consider this the finest federal initiative since the Emancipation Proclamation. Yet today's headlines show government severely bungling its current healthcare duties. Expanding Uncle Sam's medical portfolio is a prescription for fraud, fiscal incompetence, and rampant mismanagement on the clinical frontlines. Fraud devours some $60 billion - or 13.3 percent - of Medicare's $452 billion budget. "Rather than stealing $100,000 or $200,000," federal prosecutor Kirk Ogrosky said last month "60 Minutes," criminals "can steal $100 million." One thief named "Tony" told CBS' Steve Kroft that he robbed $20 million from Medicare. It was "real easy," he said. "It was like taking candy from a baby." He registered bogus medical companies, bought stolen doctor and patient ID numbers, and then billed Medicare for phantom wheelchairs, phony artificial limbs, and more. Medicare soon delivered $20,000 to $40,000 electronically into his bank account - daily. Senator Charles Grassley (R, Iowa) recently found that Medicare administrators received 30 serious fraud warnings over three years, primarily during the Bush Administration, and simply ignored half of them. Medicare failed to investigate complaints that it reimbursed one company for injected drugs "at doses that were not medically feasible," one letter explained. Rather than the proper $74 per dose, Medicare sent this provider $4,464. Another recent report uncovered $18.1 billion in improper Medicaid payments, or 9.6 percent of that program's claims. Lacking the "evil and greedy" private insurers' profit motive, government managers have no incentive to uproot such malfeasance. Meanwhile, doctors routinely wait and wait to get paid less and less by Medicaid. According to Athena Health's PayerView report, North Carolina is the fastest state Medicaid system, paying doctors in 40.6 days. Still, it lags Coventry Health Care, the eighth-fastest national payer it measured, needing 38.5 days to issue checks. (Medicare Part B was ranked fifth at 33.4 days.) Among 14 Medicaid systems that Athena rated, six take 77.7 to 89.7 days to pay. Medicaid Doctors of New York is the biggest deadbeat, averaging 160.9 days (or nearly six months) before whipping out its checkbook. Medicaid systems also reject claims more than do private insurers. While Humana, the No. 1-ranked national payer, has a 5.3 percent denial rate, No. 7 Medicare Part B spurns 8.7 percent of claims. Among Medicaid systems, No. 1 Illinois denies 9.1 percent of its claims. Medicaid of California's refusal rate is 19.5 percent, while No. 12 New York's is 34.1 percent. Fourteenth-rated Florida denies 38.8 percent of Medicaid claims. Government reimbursements also trail inflation. In 1997, Medicare paid general surgeons $574 for each complex hemorrhoidectomy. In 2008, that procedure paid $390. This is barely half the $770 needed to equal inflation. "Physicians feel that increased government intervention in healthcare will force them to be even more indentured to Medicaid Doctors and Medicare which perpetually appear to be on the verge of collapse," says Dr. Soumi Eachempati, M.D., Associate Professor of Surgery and Public Health at Manhattan's Weill Cornell Medical College. The government option currently impedes distribution of the swine-flu vaccine. Washington has injected little more than confusion into this situation. According to early promises, 120 million doses were to be deployed by mid-October. Now, only 30 million doses will be on hand, but not until late November. "I think we led expectations of availability to be higher than they have been," Assistant Surgeon General Anne Schuchat told the Senate Homeland Security Committee on Tuesday. "That, I think, can lead to frustration." Senator Susan Collins (R, Maine) scolded Health and Human Services Secretary Kathleen Sebelius for offering senators "generalizations and non-answers" on this vital matter. The government option in medicine speeds taxpayer dollars into the hands of crooks, stalls payments to honest doctors, and stymies Americans desperate for swine-flu shots. Imagine how much more the government option could accomplish with a trillion dollars and an appetite for one-sixth of the U.S. economy.
1:00 pm	States Sue Over Overhaul That Will Bust State Budgets President Barack Obama faces a fight over the health-care overhaul from states that sued today because the legislation's expansion of Medicaid imposes a fiscal strain on their cash-strapped budgets. Florida, Texas and Pennsylvania are among 14 states that filed suit after the president signed the bill over the constitutionality of the burden imposed by the legislation. The health-care overhaul will make as many as 15 million more Americans eligible for Medicaid nationwide starting in 2014 and will cost the states billions to administer. States faced with unprecedented declines in tax collections are cutting benefits and payments to hospitals and doctors in Medicaid, the health program for the poor paid jointly by state and U.S. governments. The costs to hire staff and plan for the average 25 percent increase in Medicaid rolls may swamp budgets, said Toby Douglas, who manages the Medicaid Doctors program for California, which hasn't joined the lawsuits. "The states are coming through the worst fiscal period in the history of record keeping," said Vernon Smith, a former Medicaid director for Michigan and now a principal at the research and consulting firm Health Management Associates in Lansing, Michigan. "Medicaid is the most significant, most visible and most costly part of this expansion and states fully expect to see increases in their spending." California's Deficit For California, with a $20 billion budget deficit, the extra load will cost at least an additional $2 billion to $3 billion annually, said Douglas, chief deputy director for California's health care programs. He said the overhaul is currently projected to add 1.6 million people to the 7 million enrolled in his state's program. "We face enormous challenges just sustaining our existing program," said Douglas in a March 18 telephone interview. "I just don't see states having the capacity to move forward on these changes in this environment." The numbers of new enrollees because of the overhaul are based on current estimates and may be low, he said in an e-mail. The estimate doesn't incorporate the growth that the program, known in California as Medi-Cal, may experience even without the new federal legislation, he said. Medi-Cal recipients are projected to increase 4.3 percent to 7.3 million in fiscal 2011, which begins July 1, spokesman Norman Williams said. Court Challenge Douglas's state is battling in court over Medicaid spending cuts it tried to make this fiscal year. The Ninth U.S. Circuit Court of Appeals on March 3 barred California from reducing payments to doctors and hospitals, saying federal law required states to maintain "equal access to basic health care" for the poor. California is appealing the decision to the U.S. Supreme Court. The federal government mandates that states provide health coverage under Medicaid to children, pregnant women, and the elderly and disabled poor. States set the rules on eligibility and decide which benefits to provide, making for a complex hodge-podge of coverage standards across the nation. The health- care overhaul simplifies the system by setting a minimum national floor and requires that all states cover childless adults, who will make up almost all of the expansion enrollees. Medicaid Spending Medicaid spent more than $344 billion in 2008, about 15 percent of total national health-care expenditures that year, according to the Centers for Medicare & Medicaid Services, which administers the program. It currently covers 60 million, about the same as Medicare, the federal program for the elderly and disabled, according to the Kaiser Family Foundation in Menlo Park, California. The U.S. government covered about 57 percent of Medicaid's cost in 2008, the foundation said. Florida will have to spend an additional $1.6 billion for Medicaid Doctors and hire 1,000 new workers to accommodate the overhaul, the state's Attorney General Bill McCollum said yesterday in Orlando, Florida. "This is a bad bill," he said. "That's a political determination and a practical one." The states that sued are Alabama, Colorado, Florida, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Virginia and Washington, McCollum said in a statement on his office's Web site. The complaint posted on the Florida attorney general's Web site called the legislation an "encroachment on the sovereignty of states," and said Florida will be asked to "broaden its Medicaid eligibility standards to accommodate upwards of 50 percent more enrollees." Insurance Mandate Besides the added Medicaid costs, the states are also challenging the right of the federal government to impose a mandate requiring individuals to buy health insurance . Virginia Attorney General Ken Cuccinelli, whose state filed a separate lawsuit today challenging the law, called the health legislation an "unconstitutional overreach" of the federal government's authority. Nancy-Ann DeParle, director of the White House Office of Health Reform, said the president isn't "concerned" about the potential legal challenges. Congress has the "inherent authority" to mandate coverage under the commerce clause that allows the federal government to regulate interstate commerce, she told Bloomberg Television yesterday. The historic health-care bill, which the House passed March 21 after 13 months of debate and discord, marks the biggest expansion of health coverage since enactment of Medicaid and Medicare in 1965. Obama signed it into law today. Legislation Amendments The House on March 21 also passed legislation amending the overhaul, expanding the number of those who will be covered by insurance and raising the total cost to $940 billion. The Senate is scheduled to take up these amendments this week. The package of bills would increase the number of Americans insured by 32 million, raising the portion of people under the age of 64 with insurance to about 94 percent. The bills raise the threshold for people to qualify for Medicaid to 133 percent of the federal poverty level, which was $22,050 for a family of four and $10,830 for an individual for the 48 contiguous states in 2009, according to guidelines set by the Department of Health and Human Services. The biggest challenge states face is dealing with a program where the growth in annual spending regularly exceeds the growth in state revenue, said Smith of Health Management Associates. "It has been a very, very difficult period for the states," Smith said. "They had to cut spending at a time when significantly more people needed it." Falling State Revenue Most states have confronted drops in revenue since the beginning of the recession in late 2007 as tax collections fell for an unprecedented fifth straight quarter by the end of December last year, according to the Nelson A. Rockefeller Institute of Government in Albany, New York. In the first nine months of 2009, states suffered the biggest decline in revenue ever recorded. In fiscal 2009, Medicaid enrollment increased a record 3.29 million nationally, with another rise of 1.29 million the year before, based on reports compiled for the Kaiser foundation. Medicaid spending accounts for about 22 percent of state spending, according to the National Governors Association, which said it doesn't expect revenue to return to pre-recession levels until at least 2014. Budget directors estimate the fiscal 2011 budget gap could expand to $102 billion and may even reach $180 billion, the Kaiser study said. States by law, unlike Washington, must balance their budgets. "In the past, Medicaid was only as strong as its weakest link," said Stephen Somers, president of the health-policy nonprofit Center for Health Care Strategies Inc. in Hamilton, New Jersey. " Now, there is the first universal floor and it will form the foundation for universal coverage."