Coventry agrees to keep covering ARH patients until June 30

After a two-hour hearing in federal court, managed-care firm CoventryCares agreed yesterday to keep paying Appalachian Regional Healthcare for treating Medicaid patients at its hospitals through at least June 30 while negotiations continue.

"Coventry officials said the state allowed another managed-care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry," the Lexington Herald-Leader reports. "Blaming the state, Coventry had notified ARH that it was going to terminate its contract Friday. About 25,000 Medicaid recipients in the ARH service area would have been affected."

ARH then sued Coventry in U.S. District Court and asked for an injunction to continue coverage, which Coventry had said it would end yesterday. The state ordered it to maintain coverage for 30 days, and Senior Judge Karl Forester ordered ARH and Coventry to negotiate.

After yesterday's hearing, the adversaries and the state "all said the goal was for patients to continue receiving care through Appalachian Regional Healthcare's hospitals in Eastern Kentucky on a long-term basis," the Herald-Leader reports. "If the health care chain and Coventry reach an impasse, cabinet officials said procedures could be expedited with Coventry's cooperation. That would allow Coventry members to switch to another insurance provider and continue receiving services at ARH, considered the largest health care chain in Eastern Kentucky." (Read more)

ARH has hospitals in Harlan, Hazard, Hindman, McDowell, Middlesboro, West Liberty and Whitesburg, as well as three in West Virginia, including Williamson, on the Kentucky border.

State tells Coventry Cares to keep covering ARH patients; managed-care firm says it will drop Ashland hospital

The state has ordered Medicaid managed-care firm Coventry Cares to keep paying for its members to be treated at Appalachian Regional Healthcare hospitals for at least 30 days, rather than stopping tomorrow -- when a federal judge will hold a hearing in ARH's lawsuit against Coventry, after having ordered negotiations between the parties. For more from ARH, click here.

Meanwhile, the Lexington Herald-Leader reports that Coventry plans to stop paying for services at King's Daughters Memorial Hospital in Ashland, one of the largest health-care facilities in the region. Hospital spokesman Tom Dearing told the newspaper, "Coventry's obvious lack of commitment to the people of Eastern Kentucky, putting profits ahead of lives, will potentially leave thousands of Medicaid recipients without adequate health care options." He said the hospital had 29,000 cases covered by Coventry from Nov. 1 to March 31. (Read more)

Read more here: http://www.kentucky.com/2012/05/02/2172494/judge-orders-hospital-chain-medicaid.html#storylink=cpy

Managed-care firm blames state for problems leading to impending end of contract with ARH hospitals

In the face of a lawsuit that alleges it did not pay claims promptly, Coventry Health and Life Insurance Co. blamed the state for problems that have surfaced since managed care was implemented. Coventry has canceled its contract with Appalachian Regional Healthcare, which has sued the company as well as Kentucky Spirit Health Plan Inc., reports Nola Sizemore for the Harlan Daily Enterprise.

"The current crisis would have never occurred except for the commonwealth's failure to make timely and reasonable decisions on three major issues," Coventry Executive Vice President Timothy Nolan said in a letter to ARH President Jerry W. Haynes. The issues are "a failure to implement a risk adjustment methodology, failure to find a solution to the supplemental hospital payment issue and errors in the original data book and failure to ensure all MCOs meet the same robust standards for network adequacy," Sizemore reports. MCOs are managed-care organizations.

Conventry Health and Kentucky Spirit are two of three MCOs chosen to manage the state's Medicaid program. Since they took over Nov. 1, there have been repeated complaints about delayed payments, as well as burdensome rules requiring doctors to get pre-authorization from the companies before they can provide care.

ARH treats about 25,000 Medicaid patients at its eight hospitals. In the past six months, nearly 11,000 Medicaid visits have been made at the Harlan facility alone, with 7,800 of them covered by Coventry, said Mark Bell, community and patient advocate. This will "present a complex and serious crisis for everyone," he said. (Read more)

What will high court do on health law? 4 most possible scenarios

Last week, U.S. Supreme Court justices heard arguments about the constitutionality of the federal health-care reform law. At the center of the debate is whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. There are four likely scenarios that will be the outcome of the justices' decisions, asserts Jennifer Haberkorn for Politico, all of which come with their own problems.

Scenario 1: The individual mandate is struck down, as well as insurance reforms: If these parts of the Affordable Care Act are scrapped, "Insurance companies will still be able to deny coverage based on customers' costly pre-existing conditions and charge more to older and sicker — or female patients," Haberkorn reports.

If that happens, the Obama administration and Democrats would likely blame Republicans for promoting a lawsuit that puts insurance companies in charge again. If reaction from the public is strong, Republicans may feel obligated to enact insurance reforms without an individual mandate. Ideas for doing this include "charging more if a person buys insurance at the last minute, tax incentives and a promise that if a person buys coverage, that person wouldn't lose it if he or she were to get sick and need it," Haberkorn reports.

Scenario 2: The mandate is struck down, but insurance reforms stay intact: Part of the reason why insurance companies agreed to stop denying coverage based on pre-existing conditions is they could offset the losses because the law would enlarge their insurance pool by 30 million people — the number of Americans who lack coverage.

If insurance companies are still required to stop denying coverage based on pre-existing conditions but the individual mandate is struck down "They could start a mini revolt over having to cover expensive patients without the mandate," Haberkorn reports.

Scenario 3: The entire law, or the majority of it, is axed: That would mean unpopular parts of the law would be trashed, but so would popular ones, including the pre-existing conditions piece as well as a provision that allows young adults to stay on their parents' health insurance until the age of 26.

In 2010, 26 provisions took effect and another 17 did last year. Nine new provisions are taking place this year. "Lawmakers designed the phase-in, in part, with the thought that the public would become more supportive of the law once certain provisions began to take hold," report Michael Doyle and David Lightman for McClatchy Newspapers.

Scrapping the law entirely could cause the most political fallout. "Republicans would try to move quickly to enact a small-scale health reform legislation aimed at restoring some of the popular pieces of the health law," Haberkorn reports. "But Democrats won't want to support something far less comprehensive than the Affordable Care Act, not with some 50 million Americans uninsured."

Scenario 4: The law stands: Though this is the hope of the Obama administration, "The mandate is considered relatively weak: The penalty for not obeying it starts at $95 in 2014 — that's nothing compared with the cost of insurance premiums," Haberkorn reports. The amount increases to $695 by 2016.

As for what the justices will do, "at least some of the court's conservatives seem prepared to kill the whole bill," report Doyle and Lightman. "My approach would be, if you take the heart out of the statue, the statute is gone," Justice Antonin Scalia said.

Justice Elena Kagan countered, "Half a loaf is better than no loaf," while Justice Ruth Bader Ginsburg suggested, "It's a question between a wrecking operation and a salvage job."

Some justices said the whole bill should be sacked, "on the theory that members of Congress would not have voted for it without the mandate," Adam Liptak reports for The New York Times. But Justice Sonia Sotomayor said killing the whole law "would be too broad an assertion of judicial power," Liptak notes. Justice Anthony Kennedy, the likely swing vote, said "We would be exercising the judicial power, if one provision was stricken and the others remained, to impose a risk on insurance companies that Congress had never intended."

The justices probably decided the future of the law Friday morning, reports Mark Sherman for The Associated Press. Typically, an initial vote is "followed soon after by the assignment of a single justice to write a majority opinion, or in a case this complex, perhaps two or more justices to tackle different issues. That's where the hard work begins, with the clock ticking toward the end of the court's work in early summer," Sherman writes.

In Kentucky, health advocates and officials are watching closely to see what happens. "I think the entire health-care sector and insurance sector are watching this closely because it has significant implications on both industries," said Stephen Williams, chief executive officer of Norton Healthcare. "This is very far-reaching."

In Kentucky, the law extends coverage for 35,000 young adults, reports Laura Ungar for The Courier-Journal. (Read more)

Cabinet files appeal to prevent releasing full child abuse records; Beshear backs decision

On the day the state was supposed to release unadulterated records on deaths and near deaths from child abuse, under a court order, it filed an appeal to stop the process. And though Gov. Steve Beshear had ordered the Cabinet for Health and Family Services to release the records, yesterday he sided with its officials, saying in an op-ed piece sent to Kentucky newspapers he did not "think the judge's order was protective enough" of informants who often want to remain secret, such as relatives, health-care providers, teachers and law-enforcement officials. (Getty Images photo)

“You teach in a small community and suspect a student is being abused,” Beshear wrote. “Can you come forward without the newspaper naming you as the accuser?" Jon Fleischaker, attorney for The Courier-Journal and the Kentucky Press Association, said Beshear was “fear-mongering,” and noted that Shepherd’s order to release records applies only in cases in which children were killed or nearly killed from abuse or neglect, following a state law designed to hold the cabinet accountable for its child protective services.

Beshear wrote, “The cabinet has been accused of 'operating under a veil of secrecy' in a supposed attempt to protect inept workers and a poorly designed system. But this is not about shielding the system from scrutiny. We understand the need to be more transparent than in years past.” In December, the cabinet handed over 353 pages of records, but the names of at least eight children who died from abuse or neglect had been redacted, along with all the names of children who had been seriously injured, as well as much other information. The Courier-Journal, the Lexington Herald-Leader and the Todd County Standard had sued the cabinet for refusing to release the records. Twice before, Franklin Circuit Judge Phillip Shepherd ordered the cabinet to turn them over. Last week, Shepherd fined the agency $16,000 for its secretive treatment and delays. He also found the cabinet should pay more than $57,000 in legal fees for the newspapers. (Read more)

Yesterday, the cabinet filed its motion with the state Court of Appeals and "asked the court to block Shepherd's Jan. 19 order to release records, starting today, with limited redactions," reports the C-J's Deborah Yetter. In the meantime, the cabinet released about 90 internal reviews of child deaths and serious injuries incurred by abuse but with deletions it feels is necessary "to protect the best interests of the state's child welfare system," its motion read. (Read more)

Kentucky court hearing more than 100 cases about drug that caused heart arrhythmia

More than 100 lawsuits filed by people who say they or their family members were hurt by Darvon, Darvocet or other drugs that contain the ingredient propoxyphene have been heard in U.S. District Court of the Eastern District of Kentucky since August. So far, none of the cases originated in Kentucky, but stem from people living in other parts of the country.

The effort is the result of U.S. District Judge Danny Reeves being selected by a federal panel to handle all cases pertaining to the subject, reports Jennifer Hewlett of the Lexington Herald-Leader. "It's basically in the interest of judicial economy so that multiple judges aren't handling the same issue," said deputy U.S. District Clerk Susan Baker.

Last last year, the U.S. Food and Drug Administration asked Xanodyne Pharmaceuticals to withdraw Darvon and Darvocet from the market after receiving evidence propoxyphene can cause serious or fatal heart rhythm abnormalities. Now, thousands of suits are being filed by people who took the drug. "Our issue is people took a bad drug that hurt people and they want to have their day in court," said attorney Richard Schulte of Dayton, Ohio, whose firm is dealing with 2,000 cases or potential cases. "We're looking for justice for our clients. You're not supposed to die when you take a pill for mild pain." (Read more)

PIkeville Medical Center agrees to pay $36,000 to settle claim that it improperly billed Medicare

Pikeville Medical Center has agreed to pay more than $36,000, but does not have to admit any wrongdoing, to settle a lawsuit that accused it of improperly billing Medicare.

The suit was brought by Dr. Michael Fletcher, director of the pain management clinic from May 2005 to July 2007. "The hospital used improper billing codes for the pain management clinic, which indicated services were provided in a private physician's office, rather than a clinic," reports Brett Barrouquere of The Associated Press.

Fletcher alleged the same was being done at the hospital's radiation oncology and medical oncology units and told hospital administration as much, but nothing was done. Fletcher will receive $7,228 as part of the settlement of the suit, filed under the federal False Claims Act. (Read more)

Jury tells nursing home to pay $1 million to former resident

A Fayette County jury has decided that Lexington's Cambridge Place Nursing Home will have to pay more than $1 million in damages to a former resident who fell and was found in an equipment storage room with broken bones in her face.

In January 2009, Irene Hendrix, who has Alzheimer's disease, was reportedly walking up and down a hall using a Merry Walker, which is a walker that has a seat. At some point, Hendrix, right, fell and was found with bleeding in her brain, a 4-centimeter cut on her forehead and the broken bones, the Lexington Herald-Leader's Valarie Honeycutt Spears reports. Hendrix's daughter and guardian filed a lawsuit against the facility later that year, alleging negligence.

After two hours of deliberation, the jury awarded Hendrix $1 million for physical pain, suffering and mental anguish. It also awarded Hendrix more than $27,000 for her medical bills. "A jury spoke today regarding the level of care they expect for their loved ones in nursing homes in Fayette County," plaintiff's lawyer Scott Owens said.

The Cabinet for Health and Family Services and the Office of the Kentucky Attorney General previously investigated Hendrix's case and a state adult-protection worker "determined that Hendrix was a victim of caretaker neglect and had been exposed to an extreme safety risk," Spears reports. "The protection worker told the attorney general's office that she thought Hendrix's injuries were the result of an accident." The attorney general's office closed the case in March 2009. (Read more)

Ex-boss of defunct Jenkins personal-care home accepts federal plea deal; he and relatives still face state charges

"The former administrator of a Letcher County personal-care home that was recently shut down by the state pleaded guilty Thursday in federal court to a charge that he took thousands of dollars from residents," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

James F. "Chum" Tackett of Jenkins accepted a prison sentence of two years and two days in prison, and agreed to repay $113,547 that he admitted embezzeling from the federal benefits of residents at the Golden Years Nursing Home. He still faces state charges, including felony theft. His daughter has been charged with failure to make required disposition of property, in relation to the home, and his grandson, who succeeded him as administrator, has been charged with bribing a witness and other felonies. (Read more) 

U of L physicians' group drops open-records appeal, but C-J may still not get records

An organization representing University of Louisville doctors who were trying to keep their financial records private dropped its lawsuit appealing an adverse open-records decision Tuesday. In April, Attorney General Jack Conway ruled that University of Louisville Physicians Inc. is a public agency and, as such, is subject to the Kentucky Open Records Act. Conway's opinion was requested by The Courier-Journal.



Last November, state auditor Crit Luallen released a scathing audit against Passport, which provides managed care for 165,000 Medicaid patients in Jefferson and 15 surrounding counties. The audit accused the organization of "wasteful spending, conflicts of interest and the questionable transfer of $30 million in Medicaid funds to organizations represented on Passport's board, including University Physician Associates," The Courier-Journal's Tom Loftus reports. Because of the audit, the newspaper asked for financial records from University Physicians Associates and University of Louisville Physicians Inc., which is the successor to University Physicians Associates. They refused to hand over the records, and Conway's decision followed.



Though the attorney general determined the organization should be subject to the open-records law, and the doctors' lawsuit has been dismissed, giving Conway's opinion the force of law, The Courier-Journal may not receive the records it has asked for. In its notice of dismissal, University of Louisville Physicians stated it could change "its structure and function in the future which it believes may alter its status as a public agency."



"We are still forming our final structure and function," Diane Patridge, ULP's vice president for marketing and communications, told Loftus. "Once we're up and fully established we may appeal this current determination." Curiously, "Partridge also said that ULP has no records to release to the newspaper as a result of the dismissal of the case," because it has no employees -- even though it was incorporated in March 2010. "She said University Physicians Associates . . . has handled all financial matters and paperwork for ULP to date," Loftus reports.



“This case is another piece of a puzzle,” Courier-Journal attorney Jon Fleischaker said. “It’s another step to try to make sure there’s more transparency at the University of Louisville School of Medicine and University Medical Center.” (Read more) "Sounds like a shell game with shell corporations," said Al Cross, director of the Institute for Rural Journalism and Community Issues and associate extension professor of journalism at the University of Kentucky.

Former boss of troubled personal-care home is indicted

"Another former administrator of a troubled Letcher County personal care home has been indicted on charges of witness tampering and theft," Beth Musgrave reports for the Lexington Herald-Leader.

A county grand jury indicted Jonah Tackett, former administrator of Golden Years Rest Home, on two charges of bribing a witness, two of tampering with a witness, and three of theft by failure to make required disposition, all felonies punishable by one to five years in prison.

A spokeswoman for Attorney General Jack Conway, whose office is prosecuting the case, declined to tell the Herald-Leader whether the charges "relate to ongoing criminal and civil cases involving the Jenkins home that houses more than 34 people," Musgrave reports. A circuit judge barred the Tackett family and members of the home's board of directors from having contact with the facility.

The indictment was "the latest in a history of legal troubles at the facility and for the Tackett family," Musgrave reports. "Conway’s office has said that the office would like to keep Golden Years open but its primary concern is the safety of the residents at the facility." (Read more)