Medicaid Program

Martin P. Wasserman, state health secretary, has named a committee to begin studying how to reform the most costly aspect of the Medicaid program -- long-term care. Recipients are disabled and chronically ill, and many are in nursing homes.The 15-member advisory group, chaired by Richard Bennett, executive director of long-term care at Johns Hopkins Bayview Medical Center, will hold several public hearings. The group is scheduled to issue a report in the fall.The effort is similar to the strategy used to draft a plan for the state's first phase of Medicaid reform, which calls for moving about 200,000 women and children into health maintenance organizations next year.

A Rosedale man pleaded guilty Monday in Baltimore County Circuit Court to submitting more than $245,000 in false claims to the Medicaid program, the state attorney general's office said yesterday. Stanley Junious Benn, 42, of Arrowood Court operated Resolutions Unlimited Inc., which provided counseling services to Medicaid recipients from 2002 until 2004. According to the statement of facts, from May 2002 through Nov. 18, 2003, Benn billed for more than 5,000 counseling services, for which Medicaid paid him more than $340,000.

WASHINGTON -- When Maryland tried to boost its federal Medicaid funds by millions of dollars through a doctors' "tax," the Bush administration cried foul, calling it a "sleight of hand" trick.Yesterday, the administration had a different term for it: OK.Gov. William Donald Schaefer was told by a top administration budget official that the so-called doctors' tax was legal and that, therefore, the state would be receiving some $30 million in January that had been withheld by the federal government.

WASHINGTON - A federal appeals court has upheld methods used by more than half of the states to control the cost of prescription medicines bought for Medicaid recipients and other low-income people. In its ruling Friday, the court rejected a challenge by the pharmaceutical industry, which had attacked Michigan's strategy for encouraging low-income patients to use lower-cost medicines. The decision is significant because a rapidly growing number of states have adopted "preferred drug lists" like Michigan's as a way to control soaring drug costs.

Cuts in payments to HMOs and doctors for Medicaid patients could cause some health care providers to drop out of the program, legislators were told at a hearing yesterday.The hearing left members of two state Senate committees in a dilemma -- not wanting to pay rates that are too high, but not wanting to drive HMOs and other providers out of the program.Dr. Martin P. Wasserman, the state health secretary, is seeking a 7.5 percent cut in rates beginning in April, after a consultant concluded that the state was paying too much for the roughly 300,000 Medicaid enrollees who were switched to managed care in 1997.

A Towson doctor pleaded guilty Monday to bilking Medicaid of $115,646 by falsely claiming he had delivered babies for 121 indigent women, the state attorney general's office reported.Dr. Carter J. Williams, 42, an obstetrician and gynecologist, reported to Medicaid that he had delivered the babies at the Greater Baltimore Medical Center in Towson, even though the Timonium resident was frequently nowhere near the hospital or Baltimore during the births."On one occasion, Williams billed for the delivery of a baby at [GBMC]

WASHINGTON -- President Clinton and Senate Republican leader Bob Dole will offer competing proposals tomorrow to overcome a political impasse that has stalled welfare legislation for two months.The two are scheduled to outline their proposals in speeches to the National Governors' Association, meeting in Burlington, Vt. Gov. Tommy G. Thompson of Wisconsin, a Republican who is the group's incoming chairman, said he would work to line up support for Mr. Dole's plan.Administration officials said yesterday that Mr. Clinton, in an effort to recapture the initiative on welfare, would announce steps to encourage states to move more of their welfare recipients into jobs.

An Ellicott City doctor practicing in Baltimore has been given an 11-month suspended prison sentence after entering a plea agreement on charges he collected Medicaid payments without fully examining patients.Dr. Ha Yong Jung, of the 8500 block of Harvest View Court, VTC entered an Alford plea, which means he did not admit guilt but acknowledged that prosecutors had enough evidence for a conviction.Dr. Jung, 42, entered the agreement for one count of Medicaid fraud before Judge Ellen Hollender in Baltimore Circuit Court on Tuesday.

A Towson doctor pleaded guilty yesterday to bilking Medicaid of $115,646 by falsely claiming he had delivered babies for 121 indigent women, the state attorney general's office reported.Dr. Carter J. Williams, 42, an obstetrician and gynecologist, reported to Medicaid that he had delivered the babies at the Greater Baltimore Medical Center in Towson, even though the Timonium resident was frequently nowhere near the hospital or Baltimore during the births."On one occasion, Williams billed for the delivery of a baby at [GBMC]

In a time when 37 million Americans do not have health insurance, and as a consequence often get no health care at all, the state of Oregon has embarked on an innovative, albeit radical, course of action: It wants to ration health care for the poor.Oregon, like most other states, faces the daunting problem of escalating health care costs for its Medicaid program, the joint state-federal health insurance program for the poor. For years Medicaid has been so underfunded that only a portion of eligible people are served.