News in brief >Posted Sept. 5, 2011.< 2011

Arkansas prioritizes Medicaid pay bundling

Arkansas has identified nine priority illnesses and services for which to bundle Medicaid pay, according to a letter Gov. Mike Beebe sent to federal Health and Human Services Secretary Kathleen Sebelius on Aug. 10. They are: pregnancy and neonatal care; attention-deficit/hyperactivity disorder; type 2 diabetes; back pain; cardiovascular disease; upper respiratory infections; developmental disabilities; long-term care; and prevention.

State Medicaid officials are working on a plan -- the Arkansas Health Care Payment Improvement Initiative -- to pay teams of physicians and other health professionals based on episodes of care and to allow doctors to keep any savings they generate. These partnerships would be similar to the health system reform law's accountable care organizations but would not be defined as specifically as ACOs. Payment levels would be based on a study of both public and private health care spending in the state.

The priority list represents a more modest goal than the complete transformation of Medicaid payment initially outlined by Arkansas Medicaid Director Eugene Gessow. The state, however, still is aiming for a July 2012 implementation for the revised program.

The Arkansas Medical Society is pleased that the state recognized its full reform plan was impractical given the short time frame, said David Wroten, the society's executive vice president. "However, we still have concerns over the practicality of utilizing a bundled payment approach in a state that is primarily rural," he said. "We also remain concerned that there are no current plans to pilot the bundled payment methodology prior to statewide implementation."

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HHS approves 106 more waivers to health reform law

As of Aug. 19, the Dept. of Health and Human Services had approved an additional 106 waivers that will exempt health plans, unions and employers from annual coverage requirements imposed by the health system reform law through 2014. The approval affects more than 100,000 plan enrollees and increases the total number of waivers granted to 1,578, although that figure includes some multiple waivers granted to the same applicants.

The new waivers allow health plans, unions and employers to continue imposing benefits coverage limits lower than $750,000 through 2014. The minimum coverage requirements mandated by the reform law will increase twice more until the law ends nearly all coverage limits starting in 2014. Federal health officials announced in June that they no longer will accept waiver applications after Sept. 22. The full list of approved waivers is available online (cciio.cms.gov/resources/files/approved_applications_for_waiver.html).

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Ophthalmologist convicted of 150 fraud counts

A federal jury on Aug. 22 convicted a former Temple University physician of 150 counts of health care fraud, wire fraud and making false statements, officials said.

Joseph J. Kubacki, MD, 62, submitted thousands of false claims to health insurers while he was the chair of the Ophthalmology Dept. at the Temple University School of Medicine in Philadelphia from 2002 to 2007, attorneys for the Dept. of Justice said.

Prosecutors said Dr. Kubacki directed staff employees to stack patient charts outside his door at the main campus of the university hospital. The patients had been treated by other physicians, but Dr. Kubacki would make notes on charts to indicate he saw the patients. The submitted claims totaled $4.5 million.

Dr. Kubacki, who had left Temple to live in Florida, will be sentenced by an Eastern District of Pennsylvania judge at a later date. He faces more than seven years in prison and $36 million in fines.

Judson A. Aaron, an attorney for Dr. Kubacki with Conrad O'Brien PC in Philadelphia, said a decision to appeal the conviction would be made at the time of sentencing. Aaron declined to comment further on the case.

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