FBI Investigating Alleged $2 Billion In Fraudulent Medicare Charges
The Washington Post reports that fraudulent insurance claims were submitted to Medicare by seven companies, according to health care groups that have analyzed billing data. And sources say they've been approached by FBI investigators.
The Washington Post:
U.S. Investigates Alleged Medicare Fraud Scheme Estimated At $2 Billion
The first angry calls to the Pretty in Pink Boutique began last August, confusing staff at the Franklin, Tenn., provider of wigs, mastectomy bras and other accessories for cancer patients. Medicare recipients from around the country claimed that a company called Pretty in Pink had charged their health insurance companies thousands of dollars for urinary catheters that they never ordered or received. Flooded by dozens of complaints, the boutique launched a webpage in September to explain that its leaders were dumbfounded, too. (Diamond, Weber and Keating, 2/9)
Modern Healthcare:
CMS Proposed Rule To Increase Accrediting Organization Oversight
The Centers for Medicare and Medicaid Services proposed Thursday to crack down on accrediting organizations following concerns of biased, inconsistent survey results and conflicts of interest. The proposed rule would strengthen CMS’ oversight of accrediting bodies and mandate the organizations reduce conflicts of interest with healthcare facilities, including by limiting fee-based consulting services. The proposal also would standardize accrediting organizations' survey processes. (Devereaux, 2/9)
On prior authorizations —
Modern Healthcare:
Prior Authorization Legislation Proliferates In States
A growing number of states is imposing new limitations on prior authorization requirements to address provider and patient complaints that health insurance companies are delaying and denying care. Some of these legislative efforts go further than what the Centers for Medicare and Medicaid Services proposed last month for insurers participating in federal programs such as Medicare, Medicaid and the health insurance exchanges. (McAuliff, 2/9)
KFF Health News:
States Target Health Insurers’ ‘Prior Authorization’ Red Tape
Christopher Marks noticed an immediate improvement when his doctor prescribed him the Type 2 diabetes medication Mounjaro last year. The 40-year-old truck driver from Kansas City, Missouri, said his average blood sugar reading decreased significantly and that keeping it within target range took less insulin than before. But when his doctor followed the typical prescribing pattern and increased his dose of Mounjaro — a drug with a wholesale list price of more than $1,000 a month — Marks’ health insurer declined to pay for it. (Sable-Smith, 2/12)
In other health news from the federal government —
Bloomberg:
Lloyd Austin In Critical Care Unit, Hospitalized For Second Time In A Month
US Defense Secretary Lloyd Austin was admitted into care late Sunday with an apparent bladder issue, after being hospitalized for the second time in a month. His security detail brought him to Walter Reed National Military Medical Center outside Washington with “symptoms suggesting an emergent bladder issue,” Pentagon spokesman Pat Ryder said in a statement. Austin, who in January had been in for treatment for complications from prostate cancer, was moved “for supportive care and close monitoring,” according to a statement from Walter Reed physicians. (Diaz and Wadhams, 2/11)
Stat:
A Neuropsychologist Clarifies Science On Aging And Memory In Wake Of Biden Special Counsel Report
What is the relationship between aging, memory loss, and overall cognition? That’s a matter of hot debate in the wake of special counsel Robert Hur’s report on President Biden’s alleged mishandling of classified documents. (Merelli, 2/9)
