Alleged Medicare Overpayments Cost Seniors $13.4B In Premium Increases
The Joint Economic Committee found that last year, the average American senior’s Medicare premiums were about 10% higher, or more than $200 annually, because of the alleged overpayments. Also: a CBS News analysis of alleged fraud among hospices in Los Angeles.
The Wall Street Journal:
Seniors Paid Billions In Extra Premiums Due To Alleged Medicare Overpayments
The average American senior’s Medicare premiums last year were about 10% higher, or more than $200 annually, because of alleged overpayments to private Medicare Advantage plans, congressional investigators found. Medicare Part B premiums that most seniors pay were partly pushed up by controversial health-insurer practices such as adding diagnoses to trigger higher payments, according to the Joint Economic Committee, a bipartisan group of lawmakers that advises Congress on financial matters. (Weaver and Wilde Mathews, 3/10)
In other Medicare news —
CBS News:
CBS News Investigation: Hundreds Of LA Hospices Have Multiple Indicators Of Fraud
At age 69, Lynn Ianni is a pickleball whiz, zipping from dinks to drives energetically. When she suffered an injury on the court two years ago, she sought physical therapy, and was surprised to learn her Medicare insurance wouldn’t cover it. She was, according to Medicare records, dying and in hospice. “They said, ‘you're in hospice.’ And I said, ‘what? What are you talking about?” Ianni said. “‘Are you kidding me? Do I look like I’m in hospice?’” (Gold, Geller, Yamaguchi and Kates, 3/10)
More on the high cost of health care and private equity investments —
Modern Healthcare:
Elevance Health Expands Out-Of-Network Provider Billing Policy
Elevance Health is expanding a policy to deduct pay from hospitals that refer some members to out-of-network providers. Beginning June 1, the Blue Cross Blue Shield licensee may reduce California hospitals’ pay by 10% or terminate facilities from its network if hospitals refer commercial members to inpatient or outpatient providers without a contract, according to a notice sent to providers last month. Hospitals must not pass on the financial penalty to patients, the notice said. (Tepper, 3/10)
Bloomberg:
Surgery Center Of Oklahoma Posts Up-Front Prices To Cut Health-Care Costs
By 6:30 a.m. on a chilly Wednesday last year, the Surgery Center of Oklahoma is bustling. Six miles north of the state Capitol, beside a stretch of Route 77 lined with medical facilities, spouses waiting in the lobby scroll through their phones and slurp coffee from foam cups. A toddler in a Tigger-print medical gown and pajamas is on the way toward the operating room for his tonsillectomy, a doctor leading him by the hand. Those waiting include a young man in for a sinus operation and a middle-aged woman getting a hysterectomy. It’s a diverse caseload by the standards of your average surgery center—most SCs focus on just one branch of surgery, such as thoracic or orthopedic. But what really separates SCO is its price transparency. (Moore Gerety, 3/10)
Fierce Healthcare:
NYU Report Outlines PE Impact On Care Quality, Calls For Reform
Private equity’s influence over healthcare companies’ quality of care warrants new reforms for the firm's investing practices, a new report says. The report, published by NYU Stern’s Center for Business & Human Rights, aimed to document the problems observed in recent years stemming from PE ownership in healthcare, including hospital closures, reduced staffing and compromised healthcare services. (Gliadkovskaya, 3/10)
Becker's Hospital Review:
Private Equity Invested $1T In Healthcare In 10 Years: Report
Private equity firms have become a major force in healthcare, investing more than $1 trillion over the last ten years, according to a recent report from New York University’s Stern Center for Business and Human Rights. The report, published March 10 and authored by Michael Goldhaber, examines how private equity’s investments have impacted patient care, hospital finances and medical access. (Scheetz, 3/10)
Other health care industry updates —
Chicago Tribune:
Northwestern Memorial Gets Approval For ICU Bed Expansion
Northwestern Memorial Hospital may move forward with a $96 million project to add more intensive care unit beds, a state board decided Tuesday — a plan that’s part of a larger growth strategy for the hospital. (Schencker, 3/10)
Modern Healthcare:
WellSpan Launches AI-Powered Robotic Kitchen Fresh Take Eatery
WellSpan Health is testing artificial intelligence — and a robot — to improve staff and visitors’ access to food options, particularly after-hours. The 400-square-foot kitchen, named Fresh Take Eatery, at WellSpan York Hospital in Pennsylvania features a robotic arm that prepares fresh meals 24/7. It is not designed for inpatient use. (DeSilva, 3/10)
Fierce Healthcare:
How CVS Is Using 'Agentic Twins' In Developing Consumer Tools
CVS Health is making investments in digital health and patient engagement tech across the enterprise, including a partnership with Simile to lean on "agentic twins" to test and pilot new programs. The company has built these digital twins on 2.9 million consented responses from a group of more than 400,000 individuals, representing answers across more than 200 behavioral scenarios. This allows the AI versions to act as accurate stand-ins for the people they're based upon. (Minemyer, 3/10)
KFF Health News:
Primary Care Is In Trouble. So Doctors Band Together To Boost Their Market Power
Western Massachusetts, a patchwork of rural communities and low-income cities, is a difficult place to find a primary care doctor if you don’t already have one. Frustrated patients often turn to online forums, asking for leads or advice on how to find a practice that is accepting new patients. One name repeatedly crops up in these discussions: Valley Medical Group. (Brown, 3/11)
KFF Health News:
Cosmetic Surgery Investigation Prompts Warnings For Patients, And A Push For Tighter Safety Standards
An investigation into cosmetic surgery chains by KFF Health News and NBC News has prompted consumer warnings from industry groups representing plastic surgeons and a call for more transparency around physician disciplinary actions in California. The American Society of Plastic Surgeons, which represents 12,000 doctors, is now warning patients to “do their homework” before getting liposuction, a Brazilian butt lift, a “Mommy Makeover,” or other cosmetic procedures. (Schulte, 3/11)
