Tag: Medicaid

Mass. Lab Settles W.Va. Health Care Fraud Case

  A Massachusetts clinical testing lab will pay the federal government more than $4 million to settle a health care fraud case in West Virginia.

U.S. Attorney Booth Goodwin announced the $4.67 million settlement with Calloway Laboratories, Inc. on Wednesday.

Goodwin says in a news release that an investigation found that Calloway Laboratories performed a medical review with urine drug screens that isn’t covered by Medicare or West Virginia’s Medicaid program. The company submitted claims for the review using a code for pathology services, which are covered.

Calloway Laboratories did not admit any liability in the settlement.

The company says in a statement that the settlement resolves a legacy issue that involved a disagreement about services that were ordered and performed, but weren’t covered. The issue dated back to previous management.

   

Health Care Glitch Affects 18,000 W.Va. Residents

  A state official says a glitch in the federal health insurance marketplace has affected about 18,000 West Virginians trying to sign up for coverage under the Affordable Care Act.

Jeremiah Samples of the state Department of Health and Human Resources tells the Charleston Gazette the federal exchange is having problems transferring account information to and from West Virginia’s system. He says some other states are having the same problem.

About 10,000 residents whose accounts should have been transferred because they’re eligible for Medicaid will have to sign up again, this time with the state. And about 8,000 residents who tried to sign up for Medicaid but were found to be ineligible now must go to the federal exchange if they want insurance because their information also was not transferred.

How Can You Protect Yourself from Medicare Fraud?

Open enrollment for Medicare ends Saturday, Dec. 7, and Kimberly Riddle with the WV Senior Medicare Patrol said that means an influx of scams directed toward seniors.

Whether they receive phones calls asking for personal information for fake Obamacare cards or banking information to bill them for their new Medicaid cards, Riddle said it’s important for seniors to know these are fraudulent calls and to report them.

At the West Virginia AARP’s “Consumer University” in Charleston, an educational seminar to reduce fraud among older West Virginians, Riddle presented easy steps for seniors to protect, detect and report possible healthcare fraud.

Protect:

Treat your Medicare, Medicaid and Social Security number like a credit card number, Never give these numbers to a stranger.

Remember, Medicare doesn’t call or visit to sell you anything,

Don’t carry your Medicare or Medicaid card unless you are going to a doctor’s appointment, visiting a hospital or clinic, or making a trip to the pharmacy.

Record your doctor visits, test and procedures in a personal health care journal or calendar.

Save your Medicare Summary Notices (MSN) and Part D Explanation of Benefits (EOB). Shred the documents when they are no longer useful.

Detect:

Always review your MSN and EOB for mistakes. You can access your current account 24 hours a day at www.MyMedicare.gov

Compare your MSN and EOB to your personal health care journal and prescription receipts.

Look for charges for something you didn’t get, billing for the same thing twice, or billings for services your doctor did not order.

Report:

If you have a question about the information on your MSN or EOB, call you provider or plan first.

If you are not comfortable calling your provider, call the Senior Medicare Patrol at 1-800-799-4638.

“If you do find a mistake you can call us and we’ll help you investigate that, answer your questions and see if we can’t get it resolved for you,” Riddle said.

For help reviewing your current Medicare plan and guidance on choosing the appropriate plan going into 2014, contact the West Virginia Bureau of Senior Services at 1-877-987-4463 or Medicare 24 hours a day at 1-800-633-4227.
 

60,000 More Residents Qualify for Medicaid

West Virginia Department of Health and Human Resources Cabinet Secretary Karen Bowling announced today that a second round of 61,000 auto-enrollment…

West Virginia Department of Health and Human Resources Cabinet Secretary Karen Bowling announced today that a second round of 61,000 auto-enrollment letters have been mailed to Supplemental Nutrition Assistance Program recipients and parents of children covered by Medicaid notifying them that they may automatically qualify for health insurance coverage.
 

To date, the DHHR has determined that 58,390 consumers are eligible for Medicaid expansion. 

The recipients of the second letter received a simple form asking if they wish to auto-enroll in Medicaid coverage.  A response is requested by December 18.
 
The Affordable Care Act of 2010 gave states, including West Virginia, the option to expand their Medicaid program to include individuals who were not previously eligible.  Governor Tomblin chose to expand Medicaid coverage.
 
Eligibility for Medicaid will depend on two factors: modified adjusted income and the size of the household.
 

State Medicaid numbers up since expansion

While state officials say they’re not sure how many West Virginians have signed up for private health insurance under the Affordable Care Act last week, more than 50,000 are now covered by Medicaid under the state’s expansion of the program.Those numbers come from just the first week of enrollment under the ACA’s health care exchange.

Department of Health and Human Resources Assistant Secretary Jeremiah Samples said the state does not yet have access to the number of West Virginians who have signed up for health coverage through the federal exchange, but 1,932 people have signed up for Medicaid through the state internet portal called inRoads.

Another 47,752 West Virginians found they were eligible for Medicaid by visiting their county DHHR offices and signing up in person.

Samples said last week more than 45,000 people were enrolled in the state’s Medicaid program before the exchange opened through auto enrollment letters sent out and returned to the DHHR.

That puts the number of West Virginians newly enrolled in Medcaid at nearly 100,000, Samples said exceeding the state’s expectations for the first week.
 

State falling short in revenue collections for FY 2014

Newly appointed Secretary of Revenue Bob Kiss and members of his department presented an overview of last year’s budget to lawmakers. Legislators…

Newly appointed Secretary of Revenue Bob Kiss and members of his department presented an overview of last year’s budget to lawmakers. Legislators scrutinized the governor’s last minute decision to cut almost $18 million from Medicaid to balance the budget at the end of the last fiscal year, but they were also given some crucial insight into the revenue numbers for this year.
To fulfill his Constitutional duties in balancing the state budget, Governor Tomblin cut the state’s Medicaid program by nearly $18 million at the end of the Fiscal Year 2013.

But where that money went is still in question by some lawmakers, including House Minority Whip Daryl Cowles. He questioned Secretary Kiss during a Joint Committee on Finance.

“What was that money spent on? If we appropriated it to Medicaid, what was that money spent on?” Cowles asked.

“It wasn’t spent on anything. It didn’t exist so to speak. So, the budget had to be cut to make sure you finished the year with a balanced budget,” Kiss responded. “That $17 million didn’t go any place.”

So, it wasn’t spent. Kiss explained the governor made the total Medicaid budget smaller than what the legislature had appropriated for that year in order to keep West Virginia out of the red.

But that last minute cut wasn’t the only time Medicaid had been shorted in Fiscal Year 2013.

The fiscal year ended before a funding bill passed by the legislature for the program could take effect. That bill would have taken $67 million out of excess lottery funds and put them toward Medicaid.

Regular lottery funds were down last year as well. Of the $50 million dollars from that fund that is dedicated to Medicaid, only $29 million actually came in, adding another $21 million to the program’s deficit.

In total, Medicaid was shorted about $109 million in Fiscal Year 2013.

Director of the State Budget Office Mike McKown said for now, the program is financially stable.

“Medicaid’s cash flow is pretty good right now, but by the middle of probably March if we don’t appropriate some money to Medicaid, there’s going to be some cash flow problems,” McKowan said.

“On the last day of the fiscal year we didn’t really have many options to balance the budget. If we had not cut them the last day, nothing would have gotten re-appropriated which would have caused some major problems for some of the agencies and we felt that the cash flow was strong in the Medicaid program for a few months so that was the reasoning behind that.”

Secretary Kiss reassured the committee the emergency $18 million cut to the program’s funding is not a permanent one. The legislature will be able to restore those funds and the $67 million dollars appropriated from lottery funds is still in the state accounts to be put toward the program.

But Medicaid isn’t the only state funded program feeling financial woes. A letter in early August from Kiss and Tomblin asked state agencies to prepare its budgets as if it were taking a 7.5 percent cut. For the second year in a row.

Tomblin stressed this was a precautionary measure, but three months into the Fiscal Year, McKown said revenues are already below estimates.
 
“At the end of August, after two months into this fiscal year, we were down $32 million for estimate,” he told the committee. “So, this year started off not strong, but we’re keeping a close eye on that.”

McKown did bring some good news to the committee. He said budget cuts have been made without having to furlough or lay off any workers, the state has kept up with retirement contributions and the bond rating is still very good because of a strong Rainy Day Fund, ranked one of the top five in the nation.

Currently holding about $907 million, McKown added that fund, however, is not enough to fall back on. If the state lost all sources of revenue, the Rainy Day Fund could only sustain state spending for an additional two and a half months.
 

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