Investigation Finds Medicare Insurers Drew $9.2B From Controversial Billing Practices

The Wall Street Journal: Most Of $9.2 Billion In Questionable Medicare Payments Went To 20 Insurers, Federal Investigators Say
Medicare insurers drew $9.2 billion in federal payments in one year through controversial billing practices, with 20 companies benefiting disproportionately and together accounting for more than half of the total, according to federal health investigators. The findings by the Office of Inspector General of the Department of Health and Human Services are the latest sign of growing scrutiny of Medicare Advantage insurers, which offer private plans under the federal benefit program. The inspector general’s report focuses on certain procedures used by insurers to document health conditions, which helps determine how much they are paid. The investigators said the findings raise concerns that insurers might be gaming the process to improperly boost federal payments. (Wilde Mathews, 9/22)

Modern Healthcare: CMS To Retool Medicare Advantage To Better Serve Dual-Eligibles
The Centers for Medicare and Medicaid Services plans to retool the Medicare Advantage program to improve the patient experience for people eligible for both Medicare and Medicaid, an agency official said during AHIP's National Conference on Medicare, Medicaid and Dual Eligibles Online Tuesday. The agency wants to build on the lessons learned from Medicare-Medicaid Plans participating in its Financial Alignment Initiative by incorporating them into the Medicare Advantage program, said Tim Engelhardt, director of CMS' Medicare-Medicaid Coordination Office. CMS could announce the changes as soon as this fall, he said. "It's really time for us to focus on bringing more of the successful elements to greater scale through Medicare Advantage," Engelhardt said. "Stay tuned." (Brady, 9/21)

AP: Consumers Get Online Tool To Check Nursing Home Vaccine Data
Families and patients have a new online tool to compare COVID-19 vaccination rates among nursing homes, Medicare announced Tuesday, addressing complaints from consumer groups and lawmakers that the critical data had been too difficult to find. The information is now being made available through the “ Care Compare ” feature at Medicare.gov, the online tool for basic research on quality and safety issues at nursing homes. Consumers will be able to compare up to three nursing homes at the same time, and the webpage shows vaccination rates for residents and staff, as well as national and state averages. (Alonso-Zaldivar, 9/21)

Bloomberg Law: Long-Term Care Providers Get New Look At Medicare Bad Debt Pay
Eight long-term care providers will recover more Medicare money to satisfy bad debts because the federal government wrongfully reduced payments for years they weren’t enrolled in state Medicaid programs, a federal court said. The Centers for Medicare and Medicaid Services, a part of the U.S. Health and Human Services Department, must reevaluate nearly $2 million in claims filed by providers operated by Select Medical Corp. in Alabama, Arkansas, Mississippi, Nebraska, and Wisconsin, the U.S. District Court for the District of Columbia said. (Pazanowski, 9/21)

North Carolina Health News: NC Restores SHIIP For Seniors Choosing Medicare Plans 
The state’s popular NC senior health insurance information program, or SHIIP, decided Monday to bring back online, state-compiled Medicare information that, until a change this year, consumers had used to choose among different Medigap plans. It’s a reversal of a decision earlier this year when the state’s Department of Insurance, which runs SHIIP, had switched to a database created by a commercial vendor that has potential financial interest in the valuable health-care data that seniors enter into the system. (Goldsmith, 9/22)

In Medicaid news —

Yahoo Finance: Closing The 'Medicaid Gap' Would Save Lives And $2 Billion In Medical Debt, Study Finds
All U.S. states adopting Medicaid expansion would save an estimated 7,000 lives each year, shave off $2 billion of medical debt in collection, and lead to 48,640 fewer evictions on an annual basis, according to a new report from the Center for American Progress (CAP). Health insurance is “about far more than just coverage,” Emily Gee, co-author of the report and senior economist for health policy at CAP, told Yahoo Finance. “It can improve so many facets of people’s well-being, whether that’s health-related or financial, or even just peace of mind. My goal was to quantify the benefits of closing the coverage gap. The number of lives saved, reductions in evictions, and the reductions in medical debt is staggering.” (Belmonte, 9/21)

Fierce Healthcare: OIG: Most States Not Doing Enough To Monitor Medicaid Telehealth Fraud For Behavioral Health Services
Many states don’t monitor for telehealth fraud and fail to evaluate how telehealth has impacted patient access and care, a Department of Health and Human Services watchdog found. The agency’s Office of Inspector General (OIG) released a report Tuesday that explored how states are evaluating the use of telehealth to treat behavioral health in Medicaid. While states have increasingly turned to telehealth during the COVID-19 pandemic, OIG found that a few don’t even know what services are offered virtually. (King, 9/21)

Mississippi Today: Congress Considers Medicaid Expansion Workaround To Aid Poor Mississippians
Democrats in the U.S. Congress are considering a way to offer health care insurance for low income Mississippians who have been denied coverage because of the refusal of the state’s political leadership to expand Medicaid. The proposal would provide health care coverage to people who are below the federal poverty level (an individual making $12,880 per year or less) in the 12 primarily Southern states — including Mississippi — that have not expanded Medicaid under the Affordable Care Act. Two million Americans could access health care coverage through the plan, with the bulk of those being in Texas, Florida, Georgia and North Carolina, according to an analysis by Judith Solomon, a health policy analyst with the Washington-based Center for Budget and Policy Priorities. (Harrison, 9/21)

In other insurance news related to high medical bills —

The New York Times: Their Baby Died In The Hospital. Then Came The $257,000 Hospital Bill
Brittany Giroux Lane gave birth to her daughter, Alexandra, a few days before Christmas in 2018. The baby had dark eyes and longish legs. She had also arrived about 13 weeks early, and weighed just two pounds. Alexandra initially thrived in the neonatal intensive care unit at Mount Sinai West. Ms. Lane, 35, recalls the nurses describing her daughter as a “rock star” because she grew so quickly. But her condition rapidly worsened after an infection, and Alexandra died early on the morning of Jan. 15 at 25 days old. ... Last summer, Ms. Lane started receiving debt collection notices. The letters, sent by the health plan Cigna, said she owed the insurer over $257,000 for the bills it accidentally covered for Alexandra’s care after Ms. Lane switched health insurers. (Kliff, 9/21)