News in brief - Oct. 6, 2008

Whistle-blower activity on the rise for health care fraud

Increased efforts by the U.S. Dept. of Justice to combat health care fraud were accompanied by an uptick in whistle-blower actions, according to a recent study documenting a decade of Medicare and Medicaid fraud cases.

The government closed 379 cases that recovered $9.3 billion between 1996 and 2005, said the report, published in the September Annals of Internal Medicine.

By 2005, 90% of new actions were initiated by whistle-blowers, who each received an average of $3.6 million.

Whistle-blowers were most commonly health care executives and physicians, while the most common targets of accusations were hospitals and physician practices.

Billing fraud, particularly for unnecessary medical services, was the top alleged violation.

Although pharmaceutical manufacturers were defendants in only 4% of fraud cases over the decade, they accounted for 39%, or $3.6 billion, of total judgments and settlements.

Back to top

Kentucky leaders seek higher SCHIP enrollment

Thousands more children would be enrolled in the Kentucky State Children's Health Insurance Program, or KCHIP, by 2010 under a plan unveiled Sept. 3 by Kentucky Gov. Steve Beshear and Lt. Gov. Dan Mongiardo, MD.

Starting Nov. 1, the state will attempt to expand enrollment and improve enrollee retention by implementing several initiatives. For example, the state no longer will require face-to-face interviews to sign up, will allow those denied coverage 30 days to contest the rejection, will send a postcard to the parents of every newborn in Kentucky informing them of KCHIP, and will contact families by phone and mail if they fail to renew their coverage.

KCHIP covers about 53,000 children while Kentucky's Medicaid program covers about 350,000 kids. Roughly 67,000 children are uninsured but eligible for KCHIP or Medicaid, according to Vikki Franklin, spokeswoman for Kentucky's Cabinet for Health and Family Services.

Back to top