HRSA Policy Change Could Mean Some Outpatient Clinics Lose 340B Discounts
The Health Resources and Services Administration reversed a policy change which could hit some hospital outpatient clinics' eligibility for the 340B drug discount program. The change was made in 2020 to expedite the certification process, and hospitals had expected it to remain permanent.
Modern Healthcare:
340B Drug Pricing Program Offsite Clinic Policy Reversed By HRSA
Some hospital outpatient clinics are likely to lose 340B drug discount program eligibility under a policy the Health Resources and Services Administration issued Thursday. Hospitals participating in the drug pricing program now must register offsite clinics with HRSA and list them on Medicare cost reports to qualify for 340B, the agency announced in a Federal Register notice. This reverses a 2020 HRSA policy that aimed to streamline 340B certifications during the height of the COVID-19 pandemic. (Kacik, 10/26)
Stat:
Hospitals Warn Medicare's Drug Payment Fix Is ‘Unlawful’
Hospitals are telling government officials it would be illegal to claw back $7.8 billion as part of a remedy that is making hospitals whole over underpaid drug discounts — and they may sue if that plan goes into effect. (Herman, 10/26)
Modern Healthcare:
Medicare Should Reform Primary Care Physician Pay: AMA
Medical societies and allied healthcare organizations are lobbying policymakers to focus on primary care amid a worsening physician shortage. The American Medical Association and the Primary Care Collaborative are among those urging Congress to pass legislation to increase Medicare reimbursement for physicians and boost graduate medical education funding for primary care providers. (Kacik, 10/26)
Reuters:
Former HealthSun Exec Accused Of Medicare Fraud Resulting In $53 Mln Overpayment
A former executive of Florida health insurance company HealthSun Health Plans Inc, which offers privately managed but publicly funded Medicare Advantage plans, has been charged with orchestrating a scheme that resulted in the federal government being overbilled by $53 million, prosecutors announced Thursday. According to an indictment filed in Miami federal court, Kenia Valle Boza, who served as Director of Medicare Risk Adjustment Analytics at HealthSun from 2017 to 2020, fraudulently told the federal government that beneficiaries of HealthSun Medicare Advantage plans had chronic conditions that they did not really have. (Pierson, 10/26)
San Diego Union-Tribune:
Out-Of-Network Access Should Be Allowed In Scripps Medicare Advantage Split, Expert Says
The recent decision by Scripps Health to stop its clinic and coastal medical groups from participating in Medicare Advantage plans created uncertainty for thousands of seniors. But there might be one bit of good news. Research performed by San Diego’s widely-respected Health Insurance Counseling & Advocacy Program indicates that patients with preferred provider organization Medicare Advantage plans will retain their ability to visit affected Scripps Health doctors after their groups no longer accept such coverage starting in 2024. (Sisson, 10/26)
The Motley Fool:
The Little-Known Downsides Of Medicare Advantage Plans
Medicare Advantage plans are more popular than ever -- for very good reasons. Fully 51% of the eligible Medicare population is enrolled in one this year, per the folks at health information organization KFF. They also report that "The average Medicare beneficiary in 2023 has access to 43 Medicare Advantage plans, the largest number of options ever." Still, Medicare Advantage plans are not perfect. Here's a look at why you might consider them and why you might not. (Maranjian, 10/27)
