20 Medicare Advantage Insurers Took Lion’s Share Of Payments, Probe Finds
A Wednesday report from the HHS's Office of Inspector General said the 20 accounted for more than half of the $9.2 billion the federal government paid for care that beneficiaries may not have needed or received in 2016, Modern Healthcare reports.
Modern Healthcare:
Some Medicare Advantage Insurers To Blame For Half Of Undiagnosed Claims
Twenty Medicare Advantage insurers accounted for more than half of the $9.2 billion the federal government paid for care that beneficiaries may not have needed or received in 2016, according to a Wednesday report by federal investigators. Among these 20 companies, one large insurer stood out for the share of payments it received for diagnoses that were listed on patients' chart reviews and health risk assessment services, but nowhere else. Both of these techniques "may be particularly vulnerable to misuse by Medicare Advantage companies," since they are often performed by the health plan or by vendors hired by the health plan, the Health and Human Services Department's Office of Inspector General report said. (Tepper, 9/22)
In health technology news —
Crain's New York Business:
NYC Startups Bring Digital Health Tech To Pregnancy And Postpartum Care
A crop of new startups is capitalizing on the pandemic-era digital health boom to take aim at the maternal mortality crisis and improve pregnancy outcomes in the U.S. The latest example, Chelsea–based Seven Starling, publicly launched its pregnancy and postpartum peer-support platform Tuesday with $2.9 million in seed funding led by Pear VC, Expa and Magnify Ventures. (9/22)
Stat:
The ‘Great Resignation’ Could Be Health Tech’s Next Big Sales Pitch
Innovative health companies hoping to boost sales are playing into one of the biggest fears of employers everywhere: their workers are on the verge of quitting. There’s been much public hand-wringing about the so-called “great resignation,” a trend in which an unprecedented wave of dissatisfied workers are abandoning their jobs. The solution, if you ask a company selling employee health benefits, is unsurprisingly to offer more and better benefits. (Aguilar, 9/23)
Stat:
Health Tech Leaders Look To Design To Make Care More Equitable
At the opening of each of her clinics, there’s a moment when Carolyn Witte, the founder and chief executive officer of women’s health startup Tia, holds her breath. “We call it the ‘shoulder-drop moment,’” Witte told STAT. During those few seconds, as a patient is opening the doors to one of Tia’s offices, Witte watches for them to turn from apprehension — about the idea of a rushed meeting with a new doctor or the notion of changing into a papery gown in a cold, industrially-lit room — to comfort. Witte hopes that during that moment, when patients see the colorful, sunlit environment, they feel welcomed instead of alienated. (Brodwin, 9/23)
In other health care industry news —
Modern Healthcare:
Prime-UnitedHealthcare Spat Shows Price Transparency Data Will Color Contract Talks
In demanding more money from insurance giant UnitedHealthcare, Prime Healthcare's New Jersey hospitals came armed with a new negotiating tool: price transparency data. A federal rule has since Jan. 1 required hospitals to publicly disclose the prices they charge for medical care, including negotiated rates with insurers. Even though compliance has been dismal, Prime said it was still able to see that it was getting paid far less than many of its local peers. That's led to a tussle that threatens in-network coverage for thousands of patients. (Bannow, 9/23)
Modern Healthcare:
Ballad Health, Tennessee Physician Group Reach $83 Million Settlement
Ballad Health will pay $83 million to Highlands Physicians to settle allegations that the health system undermined the physician practice. Then-Wellmont Health System, which merged with Mountain States Health Alliance in 2018 to form Ballad, allegedly depressed reimbursement rates, diverted resources and sabotaged contracts for the 1,500 physicians across Tennessee and Virginia. A Tennessee jury awarded Highlands Physicians $58 million in 2018, which Ballad unsuccessfully appealed. (Kacik, 9/22)
Modern Healthcare:
Whistleblower Claims That Aetna Inflated Provider Network In 13 States
Modern Healthcare Hospital Operations Reporter Alex Kacik and Insurance Reporter Nona Tepper talk about a lawsuit that was unsealed recently alleging that Aetna operated a shadow network of pediatric primary care doctors. (9/23)
