News Headlines

News Headlines
Health care news from around the state and nation

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State budget boosts Medi-Cal by $1.2B, but still no relief from fee cuts
Sacramento Business Journal

Gov. Jerry Brown’s proposed May revision of the state budget plugs a big jump in Medi-Cal enrollment — and $1.2 billion in higher spending to provide care to these people — but leaves fee cuts to the program in place.

California signed up 1.4 million new Medi-Cal members who are part of a mandatory expansion under the Affordable Care Act. The cost for these people is paid through a combination of state and federal matching funds. The additional caseload brings state costs to $193 million in 2013-14 and $918 million in 2014-15, or $1.2 billion, state officials say.

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Feds Bust 90 Linked to Medicare Fraud Schemes Totaling $260M
Health Leaders Media

Federal prosecutors on Tuesday unveiled charges against 90 people in six cities for their alleged roles in Medicare frauds that resulted in $260 million in false billings.

The defendants include 16 physicians and 11 other people identified as “medical professionals,” according to a joint media release from the Departments of Justice and Health and Human Services.

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Health Insurance Giants To Unveil Price Information In 2015

The elusive goal to provide consumers more transparency about prices may soon be achieved by a collaborative effort of health insurance giants Aetna AET -0.05% (AET), Humana HUM -0.75% (HUM) and UnitedHealth Group UNH -0.49% (UNH), the three confirmed today.

A nonprofit organization the three work with known as Health Care Cost Institute, a nonpartisan research organization, said the insurance companies will develop and provide consumers “free access to an online tool that will offer consumers the most comprehensive information about the price and quality of health care services.”

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Medicare Pays Billions for Wasteful Care
Health Leaders Media

Two measures developed by Boston-area medical researchers to quantify the extent of needless care have been used to estimate that 25% to 42% of patients over age 65 received at least one low-value, potentially unnecessary healthcare service during the study period, and many received several.

The study examined just 26 types of procedures, such as stress testing for stable coronary disease, or CT imaging for patients with headache.

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Gov. Brown’s revised budget proposal boosts spending for Medi-Cal
Los Angeles Times

Enrollment in the state’s healthcare program for the poor has soared past expectations as a result of President Obama’s federal overhaul, Gov. Jerry Brown said Tuesday, and by next year about a third of Californians will be covered, costing hundreds of millions of dollars more than anticipated.

The expansion is “a huge social commitment on the part of the taxpayers of California,” Brown said as he released his revised, $156-billion budget proposal. “I’m proud we did it.

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Jerry Brown urges budget restraint amid massive Medi-Cal expansion
Sacramento Bee

Gov. Jerry Brown, moving to blunt calls for increased spending ahead of budget talks this spring, warned Tuesday that the state faces $1.2 billion in unanticipated costs from California’s vastly expanding roll of Medi-Cal recipients.

The Democratic governor appealed for “restraint and prudence,” even as he released a budget revision that reflects $2.4 billion more than expected in revenue through June 2015.

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California Governor Jerry Brown 2014 May Budget Revision Expands Health Care Coverage, Pays Down Debt and Shores Up Teachers’ Pensions
Sierra Sun Times

Governor Edmund G. Brown Jr. released a revised state budget today that provides health care to millions more Californians, pays down $11 billion in debt and fully funds the teachers’ retirement system over time.

“This May Revision is good news for California,” said Governor Brown. “It shows that California can afford to provide health care to many more people, while at the same time paying its debts and shoring up the long-troubled teachers’ retirement system.”

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How Obamacare Rules Triggered $1.6 Billion in Insurance Rebates

One of the less discussed pieces of the Affordable Care Act is a measure to control insurance premiums by limiting how much companies can spend on stuff other than medical claims. Expenses for marketing, fees to brokers, administrative costs, profits, and the like can’t take up more than 20¢ of each premium dollar (or 15¢ for large-group plans). Any amount collected above that threshold must be returned to customers.

This rule is known as the medical-loss ratio, and it has resulted in rebates of $1.6 billion to individuals and businesses over the last two years, according to a new tally of federal data from the Commonwealth Fund, a health research foundation. In 2012, the second year the rule was in effect, insurers returned $513 million, about half as much as the year before. That means the insurance companies got better at setting premium prices closer to the medical costs they actually paid out.

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Most Americans want Obamacare to stay, but tweaked: poll

They may not love all of it, but most Americans want the president’s signature health reform policy to stay.

A significant majority (61%) of Americans want the Affordable Care Act kept as-is or improved with changes, while a little more than a third (38%) want the law fully repealed or replaced, according to new polling released Sunday.

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Obamacare brings expanded coverage and higher costs to California
Los Angeles Times

Enrollment in California’s healthcare program for the poor has soared as the state implements President Obama’s federal overhaul, pleasing advocates who have sought expanded coverage but also presenting new costs for the state.

Nearly one-third of California’s total population — roughly 11.5 million people — will be enrolled in Medi-Cal next year, according to Gov. Jerry Brown’s administration.

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Poll: Should health law be kept or repealed?
KESQ News Channel 3

A majority of Americans want to keep the federal health care law as is, or make some changes to improve it, according to a new national poll. But a CNN/ORC International survey released Sunday also indicates public attitudes have been largely unaffected by news that 8 million people have enrolled in health insurance plans under the Affordable Care Act.

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L.A. doctors nabbed in nationwide Medicare fraud sweep
Los Angeles Daily News

Nearly 100 doctors, nurses and other medical staff from across the nation, including Los Angeles County, were charged with scamming Medicare out of $260 million, officials with the U.S. Department of Justice announced Tuesday.

Investigators with various federal agencies said this latest fraud takedown showed the government was billed for everything from medical procedures that went undone to the purchase of thousands of high-powered wheelchairs that went unused.

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Medicare pays billions of dollars for wasteful procedures – study

As many as 42 percent of U.S. Medicare patients were subjected to procedures providing little if any medical benefit, costing the government program up to $8.5 billion in wasteful spending, according to a study published on Monday. The research, reported in JAMA Internal Medicine, is the first large-scale analysis of what Medicare spends on procedures widely viewed as unnecessary, from advanced imaging for simple lower back pain to pre-operative chest X-rays and putting stents in patients with stable heart disease.

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Statins just part of maintaining a healthy heart
San Francisco Chronicle

Coronary artery disease that results in heart attacks, sudden death or heart failure remains a leading cause of death in the Western world despite more than 25 years of effort by medical organizations and doctors to persuade people to adopt healthy lifestyles, quit smoking and lower cholesterol levels.

Late last year, the American College of Cardiology/American Heart Association developed updated guidelines for cholesterol management. The guidelines highlight lowering cholesterol with medications commonly referred to as statins.

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Local Exec to Lead Hospital Trade Group
Los Angeles Business Journal

The chief executive of Olympia Medical Center in Mid-City Los Angeles has been named chairman of the Hospital Association of Southern California.

John A. Calderone will serve as leader of the trade group for the rest of this year. The association represents 175 hospitals in Los Angeles, Orange, San Bernardino and Riverside Counties and also operates a for-profit subsidiary, AllHealth, a consultancy that works with hospitals.