The federal government will prosecute hospitals and physicians that use electronic medical records to engage in upcoding or cloning of medical records to enhance their Medicare revenue.

This is the message that Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder sent in a letter to five major hospital groups:  the American Hospital Association, the Federation of American Hospitals, the Association of Academic Health Centers, the Association of American Medical Colleges, and the National Association of Public Hospitals and Health Systems.

According to the September 24 letter, hospitals are taking advantage of opportunities offered by electronic health records to seek payments to which they are not entitled.

Through the American Recovery and Reinvestment Act of 2009, the federal government has given hospitals billions of dollars to invest in electronic health record technology.

Learn more about the letter from Secretary Sebelius and Attorney General Holder in this New York Times article and read the letter itself here.…

Pennsylvania is not engaging in extensive planning on the development of key components of the Affordable Care Act and will not do so until it receives additional information from the federal government.

So explained state Insurance Commissioner Michael Consedine in an August letter to U.S. Health and Human Services Secretary Kathleen Sebelius. Mr. Consedine reinforced this message in a statement he submitted to the U.S. House Ways and Means Committee on September 12.

According to Mr. Consedine, Pennsylvania lacks the information it needs on two important aspects of the 2010 health care reform law: the creation of health insurance exchanges and the development of the essential benefits packages that insurers will be required to offer Pennsylvanians.

Read more about the state’s position on this issue in this Central Penn Business Journal article. In addition, read Mr. Consedine’s letter to Secretary Sebelius here and his statement to the House Ways and Means Committee here.…

The nation’s state Medicaid programs are collectively developing and implementing a variety of changes in their payment and delivery systems – changes designed to improve care and make it more economical.

These innovations can generally be divided into five types:  payment adjustment policies, managed fee-for-service, bundled payments, managed care initiatives, and health homes.

Learn more about how state Medicaid programs are pursuing their own health care innovations in this Commonwealth Fund report.…

The number of uninsured Pennsylvanians is not growing.  According to data released by the U.S. Census Bureau, about one out of every eight Pennsylvanians under the age of 65 was uninsured in 2010-2011, roughly the same number as in 2008-2009.  16.2 percent under the age of 65 were covered by Medicaid in 2010-2011, the same as 2008-2009 but up sharply over previous years.

Find more data about the uninsured in Pennsylvania, those living below the federal poverty level, and those covered by Medicaid in this Central Penn Business Journal article.…

The U.S. Government Accountability Office (GAO) has released a report describing how the various states use managed care in their Medicaid programs.  Find a summary of the report, and a link to the entire document, here.…