Pushback At Medicare Plan To Limit Hospital Medical Complication Reports
Consumer groups and employers, USA Today reports, are resisting a plan by Medicare to limit public reporting of certain often-preventable complications that happen during hospital stays. Separately, Medicare Advantage insurance firms are accused of data mining patient records to make false bills.
USA Today:
Medicare Seeks To Hide Reports Of Medical Complications At Hospitals
Consumer groups and employers are pushing back against a Medicare proposal to limit public reports of medical complications such as bedsores and falls that occur during hospital stays. The proposed rule from the Centers for Medicare and Medicaid Services, now open for public comment through June 17, would suppress reporting next year for 10 types of medical harm at hospitals that are often preventable. The agency also would halt a program to dock the pay of the worst performers on a list of safety measures, pausing a years-long effort that links hospitals' skill in preventing such complications to reimbursement. (Alltucker, 6/6)
The Washington Post:
Medicare Advantage Insurance Firms Accused Of Data-Mining Patient Records And Submitting False Bills
Kathy Ormsby’s work auditing medical case files uncovered an alleged scheme to defraud the federal government: The California health system that employed her was scouring health histories of thousands of elderly Medicare patients, then pressuring doctors to add false diagnoses it found to their current medical records. The point of larding the medical records with outdated and irrelevant diagnoses such as cancer and stroke — often without the knowledge of the patients themselves — was not providing better care, according to a lawsuit from the Justice Department, which investigated a whistleblower complaint Ormsby filed. It was to make patients appear sicker than they were. (Rowland, 6/5)
In Medicaid news —
Modern Healthcare:
CMS Offers Extra Year To Spend Enhanced Medicaid Home Care Funding
States will get an extra year to use enhanced Medicaid home- and community-based services funding, the Centers for Medicare and Medicaid Services announced Friday. The dollars will now be available through March 31, 2025, for states that want the additional time, CMS wrote in a letter to Medicaid directors. Congress provided states with a 10-percentage-point increase in federal Medicaid matching funds for home- and community-based services spending as part of COVID-19 relief legislation last year. States were originally required to spend the money by March 31, 2024. (Goldman, 6/3)
Politico:
Florida Medicaid Regulator Sides Against Including Gender-Affirming Care
Florida’s Medicaid regulator has determined that taxpayer-subsidized health coverage should not include transition-related medical care for the treatment of gender dysphoria, or the feeling of discomfort or distress some transgender people experience when their bodies don’t align with their gender. Tom Wallace, the deputy secretary for Medicaid at the Florida Agency for Health Care Administration, submitted a report on Thursday that claims there was no evidence showing that gender-affirming care is a safe and effective way to treat gender dysphoria. (Sarkissian, 6/3)
Springfield News-Leader:
Medicaid Expansion: Wait Times Should Lower Soon, Official Says
Missouri took an average of 101 days to process applications to join the state's low-income health care program in April — more than twice as long as is allowed under federal law. A top official in the department overseeing that program pledged Wednesday that by the end of July, wait times would be down to 45 days, in compliance with federal law. Kim Evans, the director of the Family Services Division that oversees MO HealthNet (Missouri's Medicaid program), told lawmakers Wednesday that the application processing time should be down to 30 days by the end of August. (Bacharier, 6/6)
Villages-News.Com:
Medicare Issuing New Cards To Residents Of The Villages After Data Breach
Medicare has issued new cards and numbers to some people in The Villages due to a data breach. The new numbers are effective Monday and a letter advises those who received them to destroy their old cards. It is not clear how many people were affected. Due to the large number of Medicare recipients, The Villages is a focal point for possible fraud. (6/4)
In related news —
KHN:
AARP’s Billion-Dollar Bounty
In September, AARP, the giant organization for older Americans, agreed to promote a burgeoning chain of medical clinics called Oak Street Health, which has opened more than 100 primary care outlets in nearly two dozen states. The deal gave Oak Street exclusive rights to use the trusted AARP brand in its marketing — for which the company pays AARP an undisclosed fee. AARP doesn’t detail how this business relationship works or how companies are vetted to determine they are worthy of the group’s coveted seal of approval. But its financial reports to the IRS show that AARP collects a total of about $1 billion annually in these fees — mostly from health care-related businesses, which are eager to sell their wares to the group’s nearly 38 million dues-paying members. (Schulte, 6/6)
