Aetna, Elevance, Humana May Be Sued In Alleged Kickback Scheme, Judge Says
The insurers are accused of paying to have customers directed to their Medicare Advantage plans and of paying brokers to limit sign-ups of people with disabilities. The companies deny any wrongdoing.
Modern Healthcare:
Aetna, Humana Medicare Advantage Marketing Lawsuit Moves Forward
CVS Health subsidiary Aetna, Elevance Health and Humana must face a civil lawsuit alleging they paid kickbacks to online brokerages for Medicare Advantage enrollments, a federal court ruled Wednesday. A whistleblower initiated the case in 2021, which the U.S. District Court for the District of Massachusetts unsealed last year after the Justice Department intervened. (Tepper, 3/25)
Modern Healthcare:
Provider-Insurer Contract Disputes Surge Amid Denials, Downcoding
Contract disputes between insurers and health system networks are reaching the breaking point more than ever. Burdened by cost inflation, labor shortages and uncompensated care, providers are demanding rate increases plus relief from prior authorizations and other red tape. Health insurance companies, clamoring to soothe apprehensive investors, are raising premiums and enacting strict utilization management policies to tamp down spending. (Tong, 3/25)
CBS News:
State Says Video Shows Denver Assisted Living Center Took 13 Minutes To Find, Begin CPR On Resident; 'He Didn't Have A Chance'
A state investigation has found that a Denver assisted living facility took 13 minutes to locate a resident who collapsed and begin CPR -- failures regulators say placed all residents in "immediate jeopardy." The Colorado Department of Public Health and Environment concluded that The Argyle assisted living facility violated multiple rules in connection with the January death of 73-year-old Robert Dutkevitch. The violations were classified at the CDPHE's most serious level, indicating 125 Argyle residents were at immediate risk of harm, according to the agency. (Maass, 3/25)
AP:
Why Some People Put Relatives Into Poverty To Pay For Nursing Homes
The U.S. Department of Health and Human Services estimates that more than half people over age 65 will need help with daily activities such as bathing, dressing or eating at some point, either for an extended period or the rest of their lives. Some research suggests that share may be as high as two-thirds. Yet relatively few older Americans have private long-term care coverage. AHIP, a trade association representing the U.S. health insurance industry, estimates that only 3% to 4% of Americans over 50 have an active policy that covers extended care. Medicare, the main health insurance program for older Americans, generally does not pay for continuing support services in a nursing home or assisted-living community. (Sweet, 3/25)
The Assembly:
N.C. Surgeon: Organ Donors Could Be Alive During Procedure
A North Carolina surgeon has raised concerns about an innovative procedure that reanimates a dead body to enable organ transplants. (Still, 3/25)
Also —
The Washington Post:
After A Decade As A Yale Hospital Janitor, She Is Now A Doctor There
For about a decade, Shay Taylor-Allen walked the halls of Yale New Haven Hospital pushing a janitor’s cart. She mopped patient rooms, disinfected surfaces and emptied the trash. Soon, she’ll walk the halls of the hospital again, this time wearing a white coat. Taylor-Allen, 32, recently matched into an anesthesiology residency at Yale New Haven Hospital — where she spent most of her adult life working as part of the cleaning staff. “I still can’t believe it,” she said. “It is surreal.” (Page, 3/26)
