Reimbursement

California nursing homes bolstered their bottom lines with much of the $590 million that state lawmakers provided them to better tend to the poor, while patient care declined by several key measures, according to a study to be released today. A law boosting reimbursements from Medi-Cal, the state's healthcare program for the poor, passed in 2004.

A little-known Los Angeles police union program that reimburses officers for wages lost as a result of misconduct suspensions has been roundly criticized by law enforcement and management experts, who say the practice seriously undermines officer discipline. "It tends to make the discipline process somewhat meaningless," said Merrick Bobb, executive director of the Police Assessment Resource Center.

Insurance companies often fail to properly reimburse doctors, needlessly adding more than $200 billion a year to the nation's healthcare tab, the American Medical Assn. said Monday. An analysis of 3 million medical claims over a six-month period beginning in October also found that doctors in the U.S. spend 14% of the fees they receive from insurers and Medicare on the process of collecting those fees, the AMA said in a report issued at its annual meeting in Chicago.

Doctors across California and in two other Western states are owed millions of dollars in backlogged Medicare reimbursements, leading some physicians to turn away elderly patients and pushing others to the brink of bankruptcy. In the most extreme cases, doctors have not been paid since February. Others are owed hundreds of thousands of dollars. Doctors who serve high numbers of Medicare patients say they are defaulting on rent, laying off staff and begging drug suppliers not to stop shipments.

A proposal to divert funds from a federal program that reimburses hospitals for the cost of treating illegal immigrants has angered lawmakers in California and other border states. Under the proposal the House Appropriations Committee planned to consider today, some of those funds would be shifted to help states cover shortfalls in a children's health insurance program.

The U.S. Medicare agency said Monday that, unless it received new evidence, it would not reverse a decision to cut reimbursement for bestselling anemia drugs such as Amgen Inc.'s Aranesp. The U.S. Centers for Medicare and Medicaid Services, or CMS, the biggest purchaser of prescription drugs, made its position clear in a letter sent to physicians and others who sought to persuade the agency to reverse its stance.

Thousand Oaks biotech giant Amgen's summer doldrums are stretching into the fall. This month Aetna Inc., one of the nation's largest insurers, quietly changed its reimbursement guidelines for the company's anemia drugs, echoing Medicare's new tighter reimbursement policy for the medicines. Aetna is the largest private insurer to do so, and analysts expect others to follow soon.

HealthSouth Corp.'s ousted chief executive, Richard Scrushy, must repay more than $47 million in bonuses he received while running the medical rehabilitation chain amid a huge fraud, despite being acquitted in the scheme, a judge ruled. Combined with as much as $265 million in refunds the company is seeking from the federal government for taxes it paid on overstated income during the fraud, the court-ordered repayment could help shore up the finances of HealthSouth. Scrushy plans to appeal.

A San Diego County insurance broker accused of taking kickbacks from insurance companies agreed Thursday to return as much as $2 million to former clients. Universal Life Resources of Del Mar was hired by large employers such as Intel Corp. to negotiate group life and disability coverage for their workers. Authorities say Universal steered these clients to insurers who had secretly pledged to pay it kickbacks. Universal owner Douglas P.

A federal appeals court gave a boost Tuesday to California Atty. Gen. Bill Lockyer's attempt to force PG&E Corp. to return as much as $5 billion to customers of its utility subsidiary. Judges at the U.S. 9th Circuit Court of Appeals voted 2-1 to allow Lockyer to pursue a lawsuit in state court that seeks restitution of profits allegedly transferred illegally by San Francisco-based Pacific Gas & Electric Co. to its corporate parent before seeking bankruptcy protection in 2001.