More than 400 doctors opt to leave Tufts network

Physicians at Southcoast Health System have opted to leave the physician network of Tufts Medical Center in Boston after merger plans with another system fell through. About 425 doctors from the New Bedford, Mass.-based system will exit the New England Quality Care Alliance and create their own physician network called the Southcoast Health Network. The announcement to leave Tufts' physician network comes a few weeks after Southcoast halted merger plans with Care New England Health System, based in Providence, R.I. The merger would have created the third-largest health system in Massachusetts. Southcoast operates four hospitals and outpatient centers throughout the state. The New England Quality Care Alliance includes a network of nearly 1,800 physicians in Massachusetts. Southcoast physicians were part of the network for six years.

—Maria Castellucci

A federal appeals court ordered a group of Maine hospitals to return $17 million in Medicare overpayments to HHS, ruling the agency had the right to reclaim the funds. In a reversal of a lower federal court, the 1st U.S. Circuit Court of Appeals determined that HHS appropriately reopened several years' worth of disproportionate-share hospital payments for the affected hospitals and was entitled to claw back millions in overpayments. HHS alleged that the hospitals inappropriately included stays for patients who were eligible for Medicare Part A and Medicaid but not supplemental security income in their DSH calculations, leading to $22 million in overpayments dating as far back as 1993. But the hospitals claimed it was absurd for HHS to exclude some low-income patients from a calculation meant to reimburse them for increased charity-care costs.

—Erica Teichert

New York wants to use federal Medicaid funds to cover the care of prison inmates. States currently either terminate or suspend Medicaid coverage upon incarceration as law prohibits people in prison from receiving Medicaid federal funds. There is a provision that covers inpatient treatment provided by a medical facility not associated with the prison. This scenario occurs when a prison inmate goes to a hospital and remains there for over 24 hours. Under a waiver request, New York state's Health Department wants federal Medicaid matching funds to provide care management and other supportive services to incarcerated individuals in the 30 days prior to their release. Eligible individuals would receive care management, clinical consultation services, and coverage of certain medications, including those treating behavioral health and substance use disorders.

—Virgil Dickson