Two new proposed rules that would give states a wider berth to tailor their Medicaid plans to better fit their patient population drew fire from at least one member of CongressRep. Frank Pallone Jr. (D-N.J.), chairman of the House Energy and Commerce Health Subcommitteewho said it would result in increased costs for low-income families. Under the proposed rules, states would be allowed to open their Medicaid programs to a broader base of health insurance plans, and providers would be allowed to collect payment upfront from all but the poorest Medicaid recipients before care is provided. Also, hospitals would be allowed to charge Medicaid recipients if they receive care through the emergency department for problems that are otherwise not deemed critical or could have been treated elsewhere.
Community Health Systems, Franklin, Tenn., said the U.S. Justice Department has now put a price tag on its allegation that three of the companys hospitals submitted improper claims to a New Mexico program for indigent care: $27.5 million. The government alleges that the improper claims caused the state to submit false claims to the federal government, according to Communitys previous disclosure of the investigation. The company still maintains that it did not submit any false claims and continues to discuss the case with the government, said Wayne Smith, chairman, president and chief executive officer of Community, during an earnings conference call. In Communitys first full quarter of results since it completed its acquisition of Triad Hospitals in July 2007, the company reported a loss of $88.3 million for the quarter, on revenue of $2.53 billion. For the fourth quarter of 2006, Community reported a profit of $53.6 million on $1.1 billion in revenue.
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