In Brief: CMS Approves Dual Eligibles Demonstration Project; UC Regents Settle Whistleblower Suit
CMS Approves Dual Eligibles Demonstration Project
The California Department of Health Care Services has entered into an agreement with the Centers for Medicare and Medicaid Services to begin a three-year demonstration project to better coordinate the care for 456,000 of the state's residents in eight counties who are enrolled in both Medicare and Medi-Cal.
The project, known as Cal MediConnect, will move the so-called dual-eligibles into managed care programs where their care will be managed by a single health plan, as opposed to navigating both the Medicare and Medi-Cal programs to obtain services.
“Currently, these patients must navigate a fragmented system to find the services they need. Through the Cal MediConnect program, Californians will receive coordinated care that helps prevent them from falling
through the cracks and ensures they have access to the right services at the right time,” said California Health and Human Services Secretary Diana Dooley.
The program will begin on Oct. 1 in Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara counties.
UC Regents Settle Whistleblower Suit
The University of California Board of Regents has agreed to pay the U.S. government $1.2 million to settle a whistleblower lawsuit regarding the improper use of anesthesiologists at UC Irvine Medical Center.
The suit, filed in 2008 against the hospital by a former anesthesiologist at the facility claimed that anesthesiology was regularly being administered by nurse anesthetists or residents when there was no supervisory anesthesiologist present, and that records were “pre-filled” to make it appear one was on site. The U.S. Justice Department later joined the suit, contending Medicare claims it filed connected with procedures where anesthesiology was improperly administered violated federal regulations.
The suit also claimed that residents were also performing post-operative evaluations unsupervised.
The anesthesiologist who filed the suit, Dennis O'Connor, M.D., received $120,000 from the settlement – a relator's share as a result of filing the suit and having it settled.
Two Join Payers & Providers Board
MemorialCare Health System Chief Operating Officer Tammie M. Brailsford and SCAN Health Plan Senior Vice President Sherry Stanislaw have been named to the Payers & Providers editorial board.
Brailsford is responsible for overseeing the clinical, quality, financial and operational performance of the Long Beach-based MemorialCare's four hospitals, retail medicine clinics and all shared services. Brailsford also oversees the MemorialCare Physician Society, performance improvement activities for the system and serves as the dean of the Memorial Leadership Academy.
Stanislaw is responsible for the overall performance of SCAN’s largest market with emphasis on provider contracting and network strategies. In addition, she leads SCAN’s marketing and communications, PR, product/market expansion, and community outreach functions.
“It is an honor to have both of these extraordinarily accomplished healthcare executives sitting on the editorial board,” said Payers & Providers Publisher Ron Shinkman.
