Acadia Healthcare Under Scrutiny By VA Over Alleged Fraud Scheme
The psychiatric hospital chain is accused of extending stays of patients longer than medically necessary and profiting from U.S. insurance programs in the process. Other industry news covers a potential Cigna-Humana merger, elder care services, and more.
The New York Times:
Veterans Dept. Investigating Acadia Healthcare For Insurance Fraud
The Veterans Affairs Department is investigating whether Acadia Healthcare, one of the country’s largest chains of psychiatric hospitals, is defrauding government health insurance programs by holding patients longer than is medically necessary, according to three people with knowledge of the inquiry. The investigation, led by the agency’s inspector general, comes three weeks after Acadia told investors that it was facing scrutiny for its admissions practices from several other federal investigators, including prosecutors in Manhattan and a grand jury in Missouri. The company, which relies on government insurance programs like Medicare and Medicaid for much of its revenue, said it was also expecting to receive inquiries from the Securities and Exchange Commission and other agencies. (Silver-Greenberg and Thomas, 10/18)
Bloomberg:
Cigna Resumes Merger Discussions With Humana
Cigna Group has revived efforts to combine with its smaller rival Humana Inc. after merger talks fell apart late last year, according to people familiar with the matter. The two health insurance giants, with a combined market value of more than $125 billion, have held informal discussions recently about a potential deal, said the people who asked to not be identified because the talks aren’t public. The discussions are in early stages, they added. (Davis and Tozzi, 10/18)
Reuters:
Sanofi In Exclusive Talks With CD&R Over Sale Of $17 Bln Opella
French drugmaker Sanofi said on Monday it had entered exclusive talks to sell a 50% controlling stake in its consumer health business Opella to U.S. private equity firm Clayton Dubilier & Rice (CD&R). (Patton, 10/21)
Bloomberg:
Humana Sues To Reverse Cut To Medicare Ratings
Humana Inc. sued US health agencies seeking to reverse a cut to crucial Medicare quality ratings, linked to billions of dollars in revenue, that sent the company’s stock tumbling this month. The lawsuit argues that the US Medicare program was “arbitrary and capricious” in how it calculated the metrics for Humana’s health plans. The scores, known as star ratings, are linked to billions in bonus payments in future years. (Tozzi, 10/19)
KFF Health News:
Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More
When Pam McClure learned she’d save nearly $4,000 on her prescription drugs next year, she said, “it sounded too good to be true.” She and her husband are both retired and live on a “very strict” budget in central North Dakota. By the end of this year, she will have spent almost $6,000 for her medications, including a drug to control her diabetes. McClure, 70, is one of about 3.2 million people with Medicare prescription drug insurance whose out-of-pocket medication costs will be capped at $2,000 in 2025 because of the Biden administration’s 2022 Inflation Reduction Act, according to an Avalere/AARP study. (Jaffe, 10/21)
Axios:
MA Cash Cards Could Squeeze Other Senior Benefits
The popular debit cards that Medicare Advantage plans give older adults as a perk for signing up may be cutting off their access to some public assistance because of conflicting interpretations on what counts as income. (Goldman, 10/21)
Harvard Public Health:
U.S. Direct Care Worker Demand Outstrips Supply—Can Co-Ops Help?
Demand for home care workers is soaring, and the industry is struggling to keep up. Analysts project a steep care worker gap, with 4.6 million unfilled jobs by 2032. The industry is in turmoil over a combination of high turnover and low reimbursement rates from Medicare and Medicaid, which account for 73 percent of the industry’s $123.4 billion annual revenue, according to a 2023 analysis from PHI, an elder care services research and advocacy organization. But the shortage is driven by more than just billing. “There just aren’t enough workers entering or staying in the home care field, and that’s driven by poor job quality, low wages, and the lack of respect and recognition for the work they do,” says Katrina Kazda, vice president of home care innovations for the ICA Group, which provides home care cooperatives with technical assistance, coaching, and training. (Seegert, 10/16)
Modern Healthcare:
Providence CIO BJ Moore Departs
BJ Moore announced Friday his exit from Providence, where he has served as chief information officer for nearly six years. In a LinkedIn post, Moore, who also worked as executive vice president of real estate strategy and operations, said he planned to pursue other opportunities but did not elaborate. He joined Renton, Washington-based Providence in January 2019 after spending nearly 20 years at technology giant Microsoft. (Turner, 10/18)
