Maine requests exemption from federal law, Southern Calif. hospital pays $5 million to resolve charges of false Medicare claims

Bloomberg: "Maine wants an exemption from the federal health-care law to keep a Wall Street-controlled insurer with a history of allegedly abusive practices from leaving the state. Mila Kofman, Maine's insurance superintendent, asked the U.S. Department of Health and Human Services for a three-year waiver from the law's requirement that insurers spend 80 percent of premium revenues on medical care." The insurer provides policies to about a third of Maine's individual market. But critics have suggested that allowing a troubled insurer to get a waiver goes against the hear of the law. "'If you grant a waiver to a junk health-insurance provider that is among the worst in America, then you might as well not have a health reform at all because you're never going to say no to anyone,' said Jamie Court, president of Consumer Watchdog" (Lawrence and Armstrong, 11/4).

Becker's Hospital Review: Blue Cross Blue Shield of Michigan is defending a demand it made to hospitals "to give it their lowest contracted rates, after a new lawsuit by the Justice Department challenged this practice, known as 'most favored nation,' according to a report by American Medical News. The lawsuit, filed Oct. 18, alleges Michigan Blue Cross' contracts with hospitals in the William Beaumont Health System, for example, require the hospitals to charge 'significant competitors' of Blue Cross at least 25 percent more" (Page, 11/3).

The Associated Press/San Francisco Chronicle: Simi Valley Hospital in Southern California "has paid the federal government more than $5 million to resolve allegations that it filed false Medicare claims," according to a statement from the Justice Department. "The case was originally a whistleblower lawsuit filed in 2001 by an employee who claimed the hospital submitted false claims to Medicare for chemical dependency and psychiatric treatments between 1991 and 1997" (11/3).

Lexington Herald Leader: "A group representing 29 small rural Kentucky hospitals has sued to try to stop the federal government from reducing payments to the facilities. The Kentucky Hospital Association filed the lawsuit in federal court in Covington on Wednesday. The lawsuit says the federal agency that oversees Medicare and Medicaid payments wants to cut a reimbursement that small hospitals have been getting"  (Estep, 11/3).

Kansas Health Institute: "Twenty companies have responded to the Kansas Health Policy Authority's call for ideas on how to hold down state Medicaid spending. … The companies' proposals are not available for public review" but Division of Purchases Director Chris Howe said the division "is in the process of forwarding the proposals to the health policy authority. Health policy authority officials have said they hope to use the proposals to generate cost-cutting initiatives for consideration during the 2011 legislative session" (Ranney, 11/3).