‘Big 3’ Medicare Advantage Insurer Algorithms Deny 1 in 4 Post-Acute Care Requests: Probe
A Senate investigation found the three largest Medicare Advantage insurers have been increasingly denying seniors claims since adopting AI and algorithms to help streamline the approval process, reaching a nearly 1 in 4 denial rate since 2022.
Stat:
Medicare Advantage Insurers Used Tech To Help Deny Claims: Senate Report
The nation’s three largest Medicare Advantage insurers increasingly refused to pay for rehabilitative care for seniors in the years after adopting sophisticated technologies to aid in their coverage decisions, a Senate investigation found. (Herman and Ross, 10/17)
In other health industry developments —
The Boston Globe:
Newton-Wellesley Hospital Nurses Plan Strike Authorization Vote
Nurses at Newton-Wellesley Hospital plan to picket and hold a strike authorization vote next week, amid labor contract negotiations with the hospital’s parent organization, Mass General Brigham. The Oct. 22 vote could allow the nurses’ union bargaining committee to schedule a strike in the future, provided the union gives the hospital the required 10-day notice, according to a news release from the Massachusetts Nurses Association, the union representing the nurses. (Tannenbaum, 10/16)
Houston Chronicle:
Texas Children's Pediatrics Awarded For Fighting Physician Burnout
Texas Children’s Pediatrics earned national recognition for its efforts to improve its physicians’ well-being by reducing the prevalence of burnout — a persistent problem in the health care industry. Texas Children’s Hospital’s pediatric primary care network is among 62 health systems, hospitals and medical groups across the U.S. recognized as Joy in Medicine health organizations by the American Medical Association. The program recognizes organizations that are working to alleviate physician burnout, which skyrocketed during the COVID-19 pandemic and remains higher among health care workers than other professions. (MacDonald, 10/16)
The Texas Tribune:
Texas Hospitals’ Citizenship Count Renews Focus On Uninsured
When Gov. Greg Abbott ordered hospitals this summer to start asking patients for their citizenship status, the intent was clear: to take the cost of caring for undocumented immigrants to the Biden administration and demand Texas taxpayers be reimbursed. Beginning Nov. 1, hospital patients will be asked their citizenship status. Abbott’s order does not say patients are legally bound to answer the question. However, the care of patients who answer this question, or don’t, will not be interrupted, according to the Texas Hospital Association (THA). (Langford, 10/17)
The Boston Globe:
Steward Health Care Lawyers Seeking $36 Million
Lawyers for Steward Health Care were awarded more than $36 million — or more than $420,000 per day in fees — for their work on the first three months of the company’s bankruptcy case. New York-based law firm Weil, Gotshal & Manges filed a request Tuesday for reimbursement of $36,255,939.14 for fees and expenses, which included rates for attorneys billing as much as $2,350 per hour. Other rates included $750 per hour for a law clerk, and up to $595 per hour for paralegals. (Pressman, 10/16)
Reuters:
Sanofi Workers In France To Strike Over Sale Of Consumer Health Unit, Union Official Says
French unions have called on workers at Sanofi to strike from Thursday to protest a planned sale of the pharmaceutical group's consumer health arm, adding to complications around a deal estimated at about $16 billion. ... Sanofi said last week it had entered into talks to sell a controlling 50% stake in its consumer health business Opella to U.S. private equity firm Clayton Dubilier & Rice, a year after flagging that it was looking at options for the business. (10/16)
KFF Health News:
Patients Are Relying On Lyft, Uber To Travel Far Distances To Medical Care
When Lyft driver Tramaine Carr transports seniors and sick patients to hospitals in Atlanta, she feels like both a friend and a social worker. “When the ride is an hour or an hour and a half of mostly freeway driving, people tend to tell you what they’re going through,” she said. Drivers such as Carr have become a critical part of the medical transportation system in Georgia, as well as in Washington, D.C., Mississippi, Arizona, and elsewhere. (Scaturro, 10/17)
On veterans' health care —
Military.com:
Supreme Court Weighs Arguments In Lawsuit Over Veterans Getting 'Benefit Of Doubt' In Claims Decisions
The Supreme Court heard arguments Wednesday in a case that could determine how the U.S. Court of Appeals for Veterans Claims considers decisions on veterans' requests for disability compensation. For more than an hour Wednesday, the justices peppered attorneys for the plaintiffs and the federal government on whether the Veterans Court is obligated to determine whether the Veterans Board of Appeals -- the VA's deciding panel on denied claims -- must always consider, when there is equal evidence supporting and against a claim, the VA decided in favor of the veteran. (Kime, 10/16)
