July 09, 2018

The Readmissions Quagmire: Medicaid Work Requirements Pose Audit Risks

30 minutes

The state of Kentucky has introduced Medicaid work requirements. And the trend seems to be proceeding fast and furiously in other states looking to cut health and behavioral health benefits of Medicaid enrollees, with officials saying the costs can’t be met otherwise. Kentucky eliminated vision and dental benefits to 500,000 Medicaid enrollees within 36 hours of the federal decision.

Imagine the impact to the readmissions quagmire if benefits continue to be cut for the most vulnerable and disenfranchised members of society, or those most impacted by the social determinants of health (SdoH).

These costs are already eye-raising: $1.7 trillion is being spent annually on 5 percent of the population. Readmission penalties are barely being managed across all hospitals, especially the safety net facilities.

What will the continued impact of forcing shifts in Medicaid benefits be for the patients who need them most? Reporting on this latest development during the next edition of Monitor Mondays is nationally recognized SDoH expert Ellen Fink-Samnick, author, consultant, and founder of EFS Supervision Strategies, LLC.

The broadcast rundown also will include:

Monday Focus: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, has an update on the largest-ever healthcare bust, involving more than $2 billion in fraudulent billings. According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided.

Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey.

Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.

Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage.

Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

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