Officials Spotlight Abuses Of Medicare Advantage Coding
The coding process in private Medicare plan options need to be reformed, former and current officials have said, noting that health insurers' use of coding to get higher payments is a problem. Also: Cerebral replaces its CEO, patient risks from ransomware attacks, and more.
Stat:
Former Medicare Official Blasts The Medicare Advantage Coding Industry
Parts of the Medicare Advantage program — essentially, private Medicare plan options — are ripe for reform, former and current top Medicare officials said Wednesday. One of the most abused areas is risk coding, where health insurers document people’s illnesses and conditions as a way to get higher payments from the federal government, the officials said. (Herman, 5/18)
In other health care industry news —
The Wall Street Journal:
Cerebral Replaces CEO Kyle Robertson, A Move He Calls Illegal
Cerebral Inc. has replaced Chief Executive Kyle Robertson, according to a statement released by the company, a move Mr. Robertson called illegal after accusing board members of making him a scapegoat for the mental-health startup’s troubles. The board said in the statement that it has replaced Mr. Robertson with David Mou, the company’s president and chief medical officer. The leadership tumult comes as the company is facing a federal probe into its prescription practices and possible violations of the Controlled Substances Act. (Winkler, 5/18)
Indianapolis Star:
IU Health Forced Doctors To Reduce Patient Time, Lawsuit Says
The conflict between a long-time IU Health doctor and his former employer has spilled into the public with a lawsuit claiming the state’s largest health care system pressured physicians to spend less time with patients to increase revenues. Brian Leon, 57, began working as a doctor at IU Health and as a faculty member at the IU School of Medicine in 1997, according to the lawsuit. He was the site medical director at IU Health’s University primary care facility at 550 North University Blvd. before he was selected to be one of the five primary care regional medical directors in 2018. (Magdaleno, 5/18)
Stateline:
Ransomware Attacks On Hospitals Put Patients At Risk
A University of Vermont Medical Center employee accidentally opened an emailed file from her homeowners association, which had been hacked, in October 2020. That one mistake eventually led to the University of Vermont Health Network, which includes the state’s largest hospital in Burlington, having to cancel surgeries, put off mammogram appointments and delay some cancer patients’ treatments. The ensuing ransomware attack had forced officials to shut down all internet connections, including access to patients’ electronic health records, to prevent cybercriminals from doing any more damage. (Bergal, 5/18)
KHN:
The Private Sector Steps In To Protect Online Health Privacy, But Critics Say It Can’t Be Trusted
Most people have at least a vague sense that someone somewhere is doing mischief with the data footprints created by their online activities: Maybe their use of an app is allowing that company to build a profile of their habits, or maybe they keep getting followed by creepy ads. It’s more than a feeling. Many companies in the health tech sector — which provides services that range from mental health counseling to shipping attention-deficit/hyperactivity disorder pills through the mail — have shockingly leaky privacy practices. (Tahir, 5/19)
Modern Healthcare:
Bayada, Home Care Trade Groups Form Alliance To Tackle Workforce Challenges
A new home care industry coalition issued a call to action Wednesday for the country to address a what its members described as a staffing "crisis." Bayada Home Health Care, the National Association for Home Care and Hospice, and the Home Care Association of America are seeking partners to join their Home Care Workforce Action Alliance. They aim to catalyze action to resolve a severe workforce shortage the members say is leaving potential patients without care. "We all recognize this is a problem that needs to be addressed, but we all continue to work within our silos," National Association for Home Care and Hospice President Bill Dombi said during a webinar Wednesday. (Christ, 5/18)
Also —
Cincinnati Enquirer:
Health Sponsorships In Sports Are On The Rise. Are They Civic Minded?
When Major League Baseball's gross revenue cratered during the COVID-19 pandemic due to caps on fan attendance, one money-making sector skyrocketed. Sponsorships. The league's sponsorship revenue rose from $900 million in 2019 to $1 billion in 2020 before exploding by 70% to $1.7 billion in 2021. That number is expected to continue to grow. The increase in 2020 came even as the league's 30 teams combined for an estimated operating loss of $3 billion in a shortened season with no fans, according to league commissioner Rob Manfred. (Sutherland, 5/18)
