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Medicare

Susie Fagan / KCUR 89.3

A former emergency room nurse at Lawrence Memorial Hospital has lost her whistleblower suit alleging the hospital falsified patient records to obtain higher Medicare and Medicaid reimbursements.

A federal judge on Tuesday ruled that Megen Duffy failed to prove an essential element of her claims, namely that the allegedly false data had an effect on how much the government paid the hospital.

Crysta Henthorne / Kansas News Service

MKGA

On the eve of the Kansas Republican primary for governor, President Donald Trump tweeted his endorsement of Secretary of State Kris Kobach.

Little more than a week later, when Kobach could finally claim victory, he stood at the foot of the state Capitol and promised to do for Topeka what Trump’s done for Washington. Trump, he promised, was coming to campaign for him.

This week, that campaign promise looks pretty strong.

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Sepsis hits nearly two million people in the U.S. a year and kills more than a quarter million. It’s a particular problem in nursing homes, where the aging, confused and immobile are especially susceptible.

In Kansas, scores of nursing homes have received federal citations since 2015 for practices that can put residents at a higher risk of sepsis.

File photo

The owner of four hospitals in the Kansas City area and its chief executive have agreed to pay the federal government $65 million to settle a whistleblower suit alleging the company defrauded Medicare.

Federal prosecutors alleged that Prime Healthcare Services falsely billed Medicare by unnecessarily admitting patients at 14 of its California hospitals when they should have been treated in an outpatient setting. Reimbursements are higher for admitted patients than for outpatients.

Prime will pay the bulk of the settlement; its CEO, Prem Reddy, will pay $3.25 million.

File Photo / Kansas News Service

Kansas officials are moving to protect more than 800 vulnerable residents of 15 financially troubled nursing homes across the state.

The Kansas Department for Aging and Disability Services is seeking court orders to put the facilities — currently operated by a New Jersey company — into receivership.

Heartland Community Health Center

This story was updated at 3:22 p.m. on March 15 to include Jon Stewart's statement.   

The CEO of a safety net clinic in Lawrence, Kansas, has been suspended pending completion of a review of the organization's finances.

In a release Wednesday evening, the board of Heartland Community Health Center said it had suspended Jon Stewart and appointed the clinic’s chief operating officer as interim CEO.

Via Christi Health

A whistleblower suit unsealed Thursday in federal court alleges Wichita-based Via Christi Health engaged in an illegal scheme to maximize Medicare reimbursements.

The lawsuit was filed in November 2016 but only unsealed after the government declined to intervene. It was brought by Mazen Shaheen, a cardiologist who formerly practiced in the Wichita area.

The suit, which seeks triple damages under the federal False Claims Act,  alleges Via Christi defrauded Medicare by performing  unnecessary cardiac tests and procedures, often on the same patient.

Dr. Warner / Creative Commons-Flickr

This story was updated at 4:24 p.m. to include comments from the CEO of McPherson Hospital.

Two Kansas hospitals have been selected to take part in a federal demonstration program aimed at ensuring access to health care in underserved areas.

The two, McPherson Hospital in McPherson and Morton County Health System in Elkhart, were among 13 nationwide chosen for the demonstration project being conducted by the Centers for Medicare and Medicaid Services (CMS).

Alex Smith / KCUR 89.3

President Trump has pledged to not make cuts to Medicare, the federal insurance program for seniors, but Seema Verma, administrator of the Centers for Medicare and Medicaid, acknowledges that changes are needed.

One of the program’s main funds, the Hospital Insurance Trust Fund, is expected to be depleted in 11 years.

On Monday, Verma was in Olathe, Kansas to talk with seniors about Medicare and encourage them to take part in Medicare open enrollment, which runs from October 15 through December 7.

Bryan Thompson / Kansas News Service

Doctors and nurses are obviously essential to any primary care medical team. But when it comes to managing a chronic health condition, a social worker could be the most valuable player from the patient’s perspective.

That’s what some Medicare patients in and around the small northwest Kansas town of Plainville have been discovering since January of last year.

This week, Missouri transferred the state-run health coverage of about 240,000 low-income adults and children to managed care plans run by three companies: WellCare, Centene Corporation and United Health Group.

The move is part of an increasing privatization of Missouri’s Medicaid program, MO HealthNet. Legislators call it a cost-saving measure that improves efficiency in health care. Critics say the transfer happened too quickly, putting patient health at risk.

www.weisspaarz.com

The owner of a medical imaging company allegedly defrauded Medicare and Medicaid of more than $1.5 million, according to a criminal complaint filed Monday in Topeka.

Cody Lee West, 38, did business as C&S Imaging Inc., a mobile diagnostic testing facility based in Paragould, Arkansas. The facility provided ultrasound services to chiropractors and other medical providers in Kansas.

According to the complaint, West told chiropractors he would provide them with ultrasound equipment and a technician at no charge. The chiropractors would bill for the services.

Aaron Pellish / KCUR 89.3

It's been 40 years since Missouri voters have sent two Democrats to represent them in the U.S. Senate. If Jason Kander has his way, that will soon change.

A recent poll released by Monmouth University indicates Kander, the state's Secretary of State since 2013, has narrowed incumbent Roy Blunt's lead to within the margin of error.

Aaron Pellish / KCUR 89.3

Missouri hasn't had two Democratic U.S. Senators in 40 years, but Jason Kander is looking to change that. Today, we speak with the current Missouri Secretary of State about his run to defeat incumbent Sen. Roy Blunt in what has become a very competitive race.

American Hospital Association/Health Research and Educational Trust

As part of a federal quality improvement effort, Kansas hospitals are reducing the odds that patients will get certain types of infections.

And while that effort provides information on hospital quality throughout the state, finding information about the quality of care at individual hospitals remains a challenge.

When you make the jump into retirement, what will catch you? On this edition of Up to Date, the Smart Money Experts discuss the long-term prospects of Social Security and Medicare and how to prepare for an uncertain future. We also take a look at cyber-security and protecting your personal information in the digital era.

Guests:

Courtesy Kansas Department for Aging and Disability Services

Editor’s note: Heartland Health Monitor partner KHI News Service conducted a months-long investigation into what led federal officials to deem Osawatomie State Hospital as a facility too dangerous for Medicare patients and whether officials can rebuild the hospital for a successful future. This is the fifth and final story of the series.

Pat Hook

NPR, Harvard University and the Robert Wood Johnson Foundation partnered to survey Americans last year about their perceptions of health care.

Jessica Hill / AP

Missouri became the first state to go on record opposing a proposed merger of insurance giants Humana and Aetna, saying the combination would create an anticompetitive market in the state for various lines of insurance.

A ruling late Tuesday by the Missouri Department of Insurance gives the two companies 30 days to address the department’s concerns. Otherwise, it said it would block them from offering individual, small-group and group Medicare Advantage plans in Missouri if the merger goes through.

Susie Fagan / Heartland Health Monitor

Lawrence Memorial Hospital is forcefully denying fraud allegations made in a whistleblower lawsuit filed by a former employee.

The lawsuit was originally filed under seal in May 2014 by former emergency room nurse Megen Duffy and unsealed this summer. It charged that the hospital defrauded the federal government by submitting falsified Medicare and Medicaid claims.

In its response last week, the hospital charged that Duffy’s lawsuit and her failure to disclose it violated the terms of a settlement it reached with her after she was fired.

Susie Fagan / Heartland Health Monitor

Editor's note: This story was updated on Sept. 1 to include the response of the CEO of Lawrence Memorial Hospital.

A former emergency room nurse at Lawrence Memorial Hospital has filed a federal “whistleblower” lawsuit alleging that the hospital falsified patient records to obtain higher Medicare and Medicaid payments.

The lawsuit filed in U.S. District Court in Kansas City, Kan. on behalf of Megen Duffy alleges that top hospital officials knew about the fraud, which began in 2007, and threatened to fire employees who objected.

iStock/Getty Images

A bill headed to President Barack Obama’s desk will require hospitals to notify Medicare patients if they were admitted or only kept under observation.

But advocates for hospitals and nursing homes say there’s more work to be done on Medicare regulations that tie patients’ hospitalization status to reimbursements for skilled nursing care afterward.

The bill that unanimously passed both houses of Congress mandates that hospitals must inform Medicare patients within 36 hours whether they were admitted or kept under observation.

Executive Office of the President of the United States

Advocates of government-sponsored health care gathered Thursday at the Harry S. Truman Library and Museum in Independence, Missouri, to mark the anniversary of legislation that’s both a local story and a milestone for medical care in the United States.

Fifty years ago, on the same stage where speakers sat, President Lyndon Johnson signed the law establishing Medicare and Medicaid, vastly expanding insurance protections for the elderly and for low-income Americans.

Courtesy photo / U.S. Department of Justice

Kansas Secretary of State Kris Kobach is urging members of Congress to ratify a controversial health compact that would give Kansas and eight other states control over Medicare and other federal health care programs within their borders.

University of Kansas Medical Center

Note: KCUR will run a series of stories Friday on end-of-life issues and the policy changes needed to give people more control over what happens to them in their final days. 

This week’s announcement that the federal government is proposing Medicare reimbursements for doctors who discuss end-of-life plans with their patients was one Christian Sinclair has been waiting for.

Rural Kansas Hospitals Search For Ways To Survive

Jun 29, 2015
Bryan Thompson / Heartland Health Monitor

A lot of the hospitals in rural Kansas are called “Critical Access Hospitals.” It’s an important designation, because Critical Access Hospitals were created by the federal government to maintain access to health care in rural areas.

But Many Kansas Critical Access Hospitals are in financial trouble. Medicare requires them to offer 24-hour emergency services. But most don’t have enough ER patients to justify the cost of 24-7 service, says Melissa Hungerford, senior vice president for health care leadership at the Kansas Hospital Association.

A whistleblower lawsuit alleging a Kansas oncologist provided medically unnecessary services is the second suit to question his practices, according to The Wichita Eagle.

The newspaper reported on Sunday that Viran Roger Holden, the former chair of the Mercy Clinic oncology department in Springfield, Missouri, claims he was fired after raising questions about Greg Nanney, a cancer doctor who now works for Central Care Cancer Center in Newton and Great Bend, Kansas, and in Bolivar, Missouri.

This story was updated at 5:14 p.m. to include comments from a spokeswoman for Cox Medical Center.

Cox Medical Center in Branson, Missouri, is the latest hospital to come under scrutiny for billing Medicare for a rare form of malnutrition usually seen in third-world countries.

In a report released Wednesday, the Department of Health and Human Services’ Office of Inspector General (OIG) said not one of the hospital’s 59 claims for the treatment of Kwashiorkor that the OIG reviewed was legitimate.

Story updated at 12:26 p.m.

Saint Luke’s Hospital of Kansas City overbilled Medicare $581,000 over a two-year period, a federal report concludes.

The report by the Department of Health and Human Services’ Office of Inspector General (OIG) says the hospital failed to comply with Medicare requirements for 80 of 294 inpatient and outpatient claims reviewed by OIG.

AP Photo

The public should expect to see significant evolutions in Medicare and Medicaid in coming years, a national health care expert told a Kansas City audience Friday.

Genevieve M. Kenney of the Urban Institute said an inevitable component of Medicare’s need to save money will be talk about raising the eligibility age. The current age of eligibility is 65, but life expectancy has increased since enactment of the program 50 years ago.

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