New York - Volume III, Number 3 - December, 1998


7 MANAGED CARE PLANS TO DROP MEDICARE IN NY COUNTIES

According to the federal Health Care Financing Administration (HCFA), seven managed care plans, including Oxford Health Plans, will cease coverage of Medicare beneficiaries in 17 counties of New York State. Oxford plans to pull its Medicare program out of Westchester, Orange, Putnam and Rockland Counties as of December 31, 1998, while continuing to operate in the five boroughs of New York City, as well as Nassau and Suffolk. Other carriers withdrawing from New York counties are Kaiser Permanente, NYLCare Health Plans of New York, Prudential Health Care Plans of New York, United Health Care of NY, Vytra Health Care of Long Island and Wellcare of New York. The more than 49,000 affected enrollees will face choosing a new Medicare HMO or returning to the traditional fee-for-service Medicare program.

 

MEDICAL LEADERS MEET TO STOP VIOLENCE

In the wake of the recent murder of New York obstetrician-gynecologist Barnett Slepian, M.D., representatives from the AMA, the Medical Society of the State of New York, and several medical specialties, met last month with top-level Justice Department and FBI officials to map strategies for protecting physicians and other health care workers from violence. One option discussed was adopting legislation that would prevent the state medical licensing board from publishing physicians’ home addresses and other personal information on its Web site. Additional meetings with federal law enforcement officials are planned.

 

HMO HEAD INDICTED FOR MEDICAID FRAUD

New York State Attorney General Dennis Vacco recently announced the indictment of Jay Fabrikant, CEO and owner of now defunct New York Health Plan, on charges of Medicaid fraud, alleging that Fabrikant cheated New York City and the State out of $300,000 in Medicaid funds. Fabrikant allegedly told his staff to drop 6,700 patients from the list of Medicaid recipients eligible for treatment by Plan physicians, after learning of NYC’s decision to terminate his multi-million dollar contract. The indictment marks the first time that the head of an HMO has been charged with criminally defrauding Medicaid.

 

PROPOSED LEGISLATION PROTECTS PATIENT PRIVACY

Sen. Robert Bennett (R-UT) has introduced legislation in Congress that would establish a federal confidentiality law to protect patients’ private health care information while recognizing the need for such information to be freely available to health care providers. Significantly, the legislation would allow patients access to their records; establish federal pre-emption of state confidentiality laws, with certain public health exceptions; set a national standard governing law enforcement officials’ access to confidential patient records; allow for confidential information to move appropriately and timely within groups and systems of providers without impeding the quality of care; and provide for federal sanctions against those who inappropriately disclose medical information.

 

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