Charleston’s Post and Courier reported the investigation into South Carolina doctors who have billed millions of dollars in prescriptions to the financially struggling, taxpayer-funded Medi-caid program.  U.S. Sen. Charles Grassley, an Iowa Republican, requested data from each state this year listing which doctors write the most prescriptions for eight common drugs covered by Medicaid, the federal health program for the poor. The reports were intended to "ensure that taxpayer dollars are appropriately spent," Grassley wrote in a letter to state officials.

The report detailed the top prescribers of the following drugs:Abilify; Geodon; Oxycontin; Risperdal; Roxicodone; Seroquel; Xanax; and Zyprexa.

The Palmetto State’s report, released to The Post and Courier, identifies a handful of doctors who have written thousands of prescriptions for painkillers and anti- psychotics over the past two years.  State Department of Health and Human Services officials confirmed this week that some doctors on the list are under investigation for fraud.

Kathleen Snider, the state agency’s compliance chief, declined to say which doctors are under review because their cases are open. State health departments are responsible for monitoring Medicaid prescription rates and billing irregularities.

Among the doctors getting the most reimbursements were a Columbia psychiatrist, who wrote about 3,900 prescriptions for the drugs in question in 2008 and 2009. The doctor billed about $1.3 million to Medicaid, according to a Post and Courier review of the data.

A family doctor in Summerville billed about $635,000 for writing nearly 2,400 prescriptions for antipsychotics and painkillers during that time.

A psychiatrist with an Augusta, Ga., address wrote more than 1,300 prescriptions, billing nearly $720,000 over the two years.

A Sumter family doctor billed more than $500,000 for writing about 860 prescriptions.

Grassley also noted that the top prescriber for a particular drug often writes several times more prescriptions than the 10th highest prescriber. This was the case for several of South Carolina’s lists. For example, a Greenville area neurologist wrote 100 prescriptions for Oxycontin in 2009 — 10 times more prescriptions that the No. 10 prescriber on the list.

The No. 1 prescriber of Xanax, a Greenville psychiatrist, wrote 1,073 prescriptions in 2009, while the No. 10 prescriber wrote 63, according to the data.

While prescription drug abuse strains the system, Snider said other examples of fraud — billing for duplicate tests, extra hours or phantom patients — cause even more wasteful payouts because they can be harder to detect.

 

The Clarion-Ledger had an interesting article about Mississippi Republican Governor and presidential hopeful Haley Barbour trying to lower Medicaid payouts. Gov. Haley Barbour is pushing to cut Medicaid payments to hospitals, nursing homes and other providers in a sweeping proposal that critics say could curtail access to health care.

 

 

Barbour built a large part of his 2012 fiscal budget on a proposal to lower rates for providers, excluding physicians, to fiscal 2010 levels, a move the Division of Medicaid says could cost about $60 million.  Medicaid is a federal-state program that provides medical coverage for qualified low-income families or individuals as well as elderly, disabled individuals, children, and those who are pregnant.  There are about 629,000 people on Medicaid. Fifty-eight percent of those on Medicaid in Mississippi are under the age of 21, mostly children.

What Barbour proposes would amount to a 4 percent cut for nursing homes and an 8 percent cut for hospitals and other providers, the governor’s office reports.

The Obama Administration bolstered the Medicaid budget with stimulus money – the feds putting up about 85 cents for every 15 cents the state contributed. That rate resets next year to roughly a 75-25 split.

A report by the agency showing the top 27 highest-paid executives overseeing Mississippi hospitals. Baptist Memorial Health Care CEO Stephen Reynolds topped the list at $1.5 million followed by Mississippi Baptist Health Systems Inc. CEO Kurt Metzner, who earned $1.3 million in salary and benefits in 2009. Fourteen other executives earned at least half a million dollars last year.

Payments to hospitals have increased on average $88.6 million annually since 2005.
 

Dallas Business Journal had an article about NewCare Health Corp., which through a subsidiary tried to gain control of Tri-City Hospital.  However, executives have been charged with Medicaid fraud, racketeering, grand theft and abuse of the elderly.

Chris Brogdon, 50, chairman of NewCare Health, and Darrell Tucker, 40, president, turned themselves in on Feb. 3 to authorities in Gainesville, Fla.  NewCare Health is an Atlanta-based nursing home operator.

The charges follow a two-year investigation by Florida’s Medicaid fraud unit. That inquiry centered on University Nursing Care Center, which, until last year, was run by a Brogdon company, Retirement Care Associates Inc.

The board of privately held Tri-City Hospital struggled to retain control of the beleaguered facility as the 137-bed hospital was hit by lawsuits from its bondholders and from NewCare.

Tri-City is a key source of medical care for residents in southeastern Dallas, treating many people whose health care is covered by the state Medicaid program for the poor and the federal Medicare program for the elderly.

At the Florida hospital, things got so bad that by December paychecks started bouncing, the hospital found itself short on drugs, X-ray film and food — and employees were being told to bring their own toilet paper. Shortly before Christmas, the entire senior management team of the hospital quit. And last month, Princeton filed for Chapter 11 protection in U.S. Bankruptcy Court.

 

Some facts about US nursing homes from the Nursing Home Complaint Center.

Nursing facility providers in the United States 1,813,665 total nursing facility beds; 16,995 total nursing facilities; 13 percent of facilities are hospital-based; 52 percent of facilities are part of a chain ("Chain" facilities are owned or leased by a multi-facility organization. The remaining facilities are individually owned and operated);  66 percent for profit; 27 percent not-for-profit; 7 percent government. 107 facility bed size (average); 83 percent nursing facility occupancy rate 

The elderly population, ages 65-74 is 7 percent (18,759,000 people) of the total population; The elderly population, ages 75-84 is 4 percent (11,145,000 people) of the total population; The elderly 85 and older are 1 percent (3,625,000 people) of the total population; and The total elderly population, aged 65 and older is 13 percent of the total population. 

 

The Chicago Tribune had an article about a recent jury verdict against Friendship Manor Care Center. The estate of retired farmer, Wilbur Jackson, who died after an accident has been awarded more than $546,000 from the home and an ambulance service.  Jackson was being taken on a gurney to an ambulance for tests at a nearby hospital when one of its wheels dropped into a crack in a walkway outside the home. The gurney flipped over and his head struck the pavement. He lapsed into a coma and died within days.

The jury found Friendship Manor was 90 percent at fault, and Midwest Ambulance Service of Iowa was 10 percent.

The San Francisco Chronicle recently had an article about pressure ulcers.  There are over 16,000 nursing homes in the country with an estimated 1.7 million elderly people occupying beds, according to the Center for Disease Control and Prevention (CDC).

The article discusses why some residents require more care than others such as those that are not ambulatory. Immobile elderly residents need to be consistently moved and turned around in order to prevent bedsores from developing. Unfortunately, this is rarely done in most nursing homes.

Pressure ulcers or bedsores are lesions ulcers that develop in the body. The severity of bedsores ranges from a simple abrasion-like wound to a deep puncture wound. Often bedsores appear as a pink discoloration on the skin that develops when there is consistent pressure on that one area, but when that pressure is relieved the bedsore often disappears. However, for more severe bedsores a deep puncture wound can develop that cuts through the skin to the bone, or sometimes may even pierce through the skin to an organ. The more serious bedsores can leave a deep hole in the body and look fleshy and raw.

Simply leaving someone lying in a bed isn’t the sole cause of bedsores. There are several other factors that contribute to the injury, including:  Nutrition; Force – such as friction or pressure on an area; Changing temperature and humidity; Sitting in a wet or dirty brief.

Several areas are more susceptible to bedsores, such as: the buttocks and sacrum, on the lower legs in the thighs and calves areas, and on joints such as the elbows, knees and ankles.

Preventing bedsores can be as simple as constantly keeping an eye on the person and not neglecting their needs. Since you cannot always be with your elderly loved one, it is important to make sure that nursing home staff or in-home caretakers are constantly monitor the elderly patient and removing any pressure points that may cause a bedsore. According to the Braden Scale of Predicting Pressure Sores, a caretaker should, on a daily basis, monitor causes of bedsores, especially mobility and friction. With proper monitoring and rotating of a resident, bedsore wounds can be prevented.

If this is not properly done, an elderly resident can develop bedsores, the more serious of which can usually be fatal.