Part-time neCompany helps
Its a time of great uncertainty for almost 3 million Floridians who receive their health, home and nursing home care through the states Medicaid program.
Part-time neCompany helps fight Medicaid fraud one visit at a time,The Florida Legislature has passed a top-to-bottom overhaul of the $18 billion entitlement program, one that would require most Medicaid beneficiaries to go through private insurers or hospital networks for their care. The states reform plan wont automatically come to pass, however. More than half of each Medicaid claim is paid by the U.S. government, and,Part-time netimestranscri. hence, the U.S. Department of Health and Human Services will have final say over whether to allow the states privatPart-time network money projecization experiment to proceed. What is certain is that on July 1, people on Medicaid will experience other changes, ones initiated about two years ago, when the Florida Agency for Health Care Administration put out a request to hire a quality improvement firm to help it control its costs.
Louisiana-based nonprofit eQHealth Solutions won that three-year, $50 million contract, and CEO Gary Curtis said his firm will focus on the Medicaid patients who will continue to be on the states traditional fee-for-service program.
Curtis said he has several key charges from the state:
To speak with patients doctors and do a review before hospital stays and home health services are OKd.
To develop a care monitoring pilot project in Miami-Dade County to reduce fraud related to home health visits.
Curtis recently completed a tour of Florida and discussed his plans to set up offices in Tampa and Miami-Dade County, where he will hire about 135 people, mostly in nursing and information technology.
Hell also hire a panel of part-time physician reviewers.
Curtis believes he will save state taxpayers significant amounts of money, while maintaining or even improving quality.
Q What is a &34;quality improvement firm&34; and what do you do?
A We help hospitals, physicians, home health agencies 小吃加盟, nursing services - we help them to better understand appropriate utilization of health care services. Medicare and Medicaid pay a per unit cost. If completely unbridled, people might deliver more services than necessary. So we require they authorize or certify care prior to delivery. Were a federally recognized quality improvement organization.
There are about 40 across the nation. We provide services to Medicare in Louisiana. Thats our beginning. Weve been doing that since 1986. We have also added the states of Mississippi, Illinois and now Florida.
Q How do you begin to tackle the kind of endemic, widespread fraud in Medicaid that Florida is known for?
A I just spent six weeks in Florida. I have traveled to Tallahassee,The most proOhio.com. Jacksonville, Orlando, Tampa and Miami. I spent a full two weeks in Miami.
I have been meeting with the health providers, and I have been asking them the tough questions: Are you aware of fraudulent conditions? The answer is usually yes. Can you tell the good guys from the bad guys? The answer is usually yes.
Let me give you an example of what I saw. For instance, a home heath provider has been providing services for 10 years to a certain individual, and they say that service keeps the individual from deteriorating to the point they need to go to the nursing home.
I say 胸部下垂怎么办, &34;What have you been doing?&34;
They say, &34;Bathing the client twice a week, but not on Thursdays because the client goes to work that day.&34;
It would be very hard to make the case that this is a medically necessary service.&34;
Q Do you think theres a lot of that going on? Theres money to be saved?
A Oh yes, there is a whole lot of money to be saved. Its something I dont see much in other states - in Florida they pay for an aide visit provided by a home-health provider - the bathing situation, where we are not delivering an acute-care substitute.
Thats absolutely a good benefit, and one Florida wants to protect, but those cases are much harder to justify. There are legitimate cases of that - a person who is blind and cant give themselves a shot, a diabetic on insulin. There are conditions where it is medically necessary for somebody to assist someone so they can stay at home. But those cases are rare.