Quest Diagnostics announced a $241 million settlement with California's Medicaid program, Medi-Cal, to settle a civil lawsuit that alleged overbilling of the program.
The lawsuit was originally brought by a Quest competitor that alleged Quest did not comply with "comparable charge" regulations resulting in overbilling the state health plan for its services. Quest, which denied any wrong doing in announcing the settlement, contends the state's comparable charge regulations are unclear. The company said it intends to push for reform of the regulation to provide clearer guidelines. The California office of the Attorney General said the settlement was the largest in the history of the state's False Claims Act.
Sen. Tom Coburn (R.-Okla.) introduced a Medicaid reform bill that stops short of the House plan to reform Medicaid into block grants for states, but would allow states to alter their eligibility standards. The bill would leave intact some features of the current federal match Medicaid funding mechanism for some hospitalizations and short-term care for seniors and the disabled – groups healthcare advocates said would be especially hard hit under the House plan due to their high costs of care. The bill, however, would give states the power to limit payments for long-term care for those populations. It would also allow states to lower eligibility requirements for the program which aims to allow states to trim their rolls to save money -- a move that is in direct opposition to the current "maintenance of effort" requirements in health reform aimed at maintaining coverage for people currently receiving Medicaid benefits.
The Washington state Senate passed legislation designed at cracking down on Medicaid fraud and the bill now moves to House for further action. The law, modeled on federal law that provides incentives and protections for whistleblowers who witness and report fraud in their workplace. Washington is one of only a handful of states not to have such a law on the books. The federal law allows individuals to sue entities that have defrauded the government through the false claims act. If the lawsuit is successful, the individual shares a portion of the recovered sum. Supporters of the measure say the law, if passed, would save the state hundreds of millions of dollars in false Medicaid payments.