KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Investigation: Dangerous Caregivers Missing From Federal Database Of Disciplinary Records

News outlets report on health care fraud and legal issues, including missing disciplinary records in a federal database of dangerous caregivers and a new federal bill that would target fake Medicare claims for prescriptions and equipment.

An investigation by ProPublica, also published in the Los Angeles Times, found serious flaws in a national database intended to "to stop dangerous or incompetent caregivers from crossing state lines and landing in trouble again" by "allowing hospitals to check for disciplinary actions taken anywhere in the country against nurses, pharmacists, psychologists and other licensed health professionals." The database was ordered by Congress 22 years ago and will finally be accessible to hospitals March 1, "[b]ut the long-awaited repository is missing serious disciplinary actions against what are probably thousands of health providers. … Some of the missing cases involve providers who have harmed patients ..."

"The omissions took federal health officials by surprise, but "Friday, the head of the Health Resources and Services Administration (HRSA) acknowledged that records were missing. She said her agency had launched a 'full and complete' review to determine what is wrong and how to fix it… The new information will still go online as planned – but with a warning that it is incomplete, she said" (Weber and Ornstein, 2/15).

Hearst Newspapers/The St. Louis Post-Dispatch reports on new legislation, drafted by Rep. Scott Murphy, D-N.Y., "that would allow - and in some cases, force - the government to step up its oversight of pharmacies and companies selling wheelchairs, walkers and other medical equipment whenever there is a significant risk of [Medicare] fraud. The measure also would allow the government to temporarily halt payments to medical equipment suppliers suspected of fraud - getting rid of existing 'prompt pay' requirements in federal law that now force investigators to chase after swindlers long after they have been reimbursed" (Dlouhy, 2/14).

The Sun Sentinel reports that a new Medicare anti-fraud rule in Florida may be disrupting care for some seniors. "The new rule caps how much home-care companies can make from Medicare patients who need more than one visit a day. ... Medicare said some unscrupulous home health firms, many in Miami, abused the health system for seniors and disabled adults by creating fictitious patients and billing for multiple daily visits, because the government pays much more for them. Other firms took on large numbers of those patients to boost profits. As a result of the new rule, some firms are dropping a portion of their costly patients, and many other firms are reluctant to take them, according to officials at eight home care companies" (LaMendola, 2/15).

San Antonio Express-News: "A federal jury has convicted three people, one of them an orthotist from San Antonio, in a complex fraud and kickback scheme where they tried to defraud Medicaid and the Texas Medicare program out of nearly $1.2 million. The jury acquitted another orthotist from San Antonio during the two-week trial in Corpus Christi that ended Friday" (Contreras, 2/16).

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