Cancer Care Giant Faces Medicare Billing Probe
The Justice Department is investigating whether 21st Century Oncology “knowingly billed for services that were not medically necessary," reports The Wall Street Journal. Other stories look at the government's withdrawal of a rule regarding the 340B drug discount program, double-digit increases in the prices hospitals pay for technology and the increase in plans covering gender reassignment surgery.
The Wall Street Journal:
Cancer-Care Giant Is Investigated Over Medicare Billing
The Justice Department is investigating whether a cancer-care giant improperly billed Medicare for a procedure when it administered radiation therapy to patients—the second time the company has faced federal scrutiny this year. Federal prosecutors have requested an array of documents from 21st Century Oncology Holdings Inc. “concerning allegations” that it “knowingly billed for services that were not medically necessary and for services not rendered,” the company disclosed in a regulatory filing. (Carreyrou, 11/13)
CQ Healthbeat:
HRSA To Withdraw Pending Discount Drug Program Rule
The federal agency that oversees the 340B drug discount program is abandoning an attempt to create a sweeping set of rules for the effort and instead will try to resolve disputes about the program through a guidance document. Krista Pedley, director of the Office of Pharmacy Affairs at the Health Resources and Services Administration, said the Department of Health and Human Services will at midnight withdraw a proposed regulation that had advanced to the final clearance step before public release, submission to the Office of Management and Budget. HRSA intends to issue guidance early next year to address many of the same issues. (Young, 11/13)
Modern Healthcare:
Hospitals Paying More For Some High-End Tech
Three products among the most expensive equipment tracked in the Modern Healthcare/ECRI Institute Technology Price Index saw double-digit increases in the prices that hospitals were paying. The Technology Price Index provides a monthly snapshot of prices based on three-month rolling averages. The average price paid for radiosurgery equipment such as stereotactic systems was $2.4 million, up 49.1% from the previous month's data but down 38.7% from a year earlier. (11/13)
St. Louis Public Radio:
Growing Number Of Insurance Plans Cover Gender Reassignment
Andre Wilson lived as a woman for the first 43 years of his life. It was excruciating, he said. When Wilson began hormone therapy to transition into becoming a man, everything changed. “The third day on testosterone for me was the first un-depressed day of my life,” Wilson said. That feeling of severe discomfort with one’s biological sex is called "gender dysphoria" by physicians. The treatment is often gender reassignment therapies or surgeries. But in many cases, the treatments are not considered medically necessary by health insurance plans and are therefore not covered, leaving people to pay the bills out-of-pocket. (Bouscaren, 11/13)
Meanwhile, the CBO forecasts rising deficits for the rest of the decade as baby boomers retire and Social Security and Medicare costs rise -
The Associated Press:
October Budget Deficit Rises To $121.7 Billion
But the CBO is forecasting the deficits will start rising for the rest of the decade as baby boomers retire and Social Security and Medicare costs rise. The CBO and other budget experts have warned that the current trajectory for the deficit is unsustainable and eventually could lead to a fiscal crisis. ... The improved deficit picture for 2014 reflected slower growth in spending due to lower-than-expected health care costs as well as a 2011 budget pact with Republicans that sharply curbed agencies’ operating budgets. (11/13)
