Insurers Collected Billions In Dubious Medicare Advantage Payments: Watchdog Report
A HHS watchdog reports that insurers like UnitedHealth, Humana were paid an estimated $7.5 billion last year from health risk assessments that diagnosed serious health conditions for which patients had no follow-up care. The Centers for Medicare and Medicaid Services declined to crack down on the practice though.
Stat:
Questionable Medicare Payments To UnitedHealth, Humana: Federal Watchdog
A federal watchdog found that Medicare Advantage insurers led by UnitedHealth Group collected billions of dollars in dubious payments from Medicare by using home visits and medical chart reviews to diagnose patients with conditions for which they received no follow-up care. (Ross, Bannow, Lawrence and Herman, 10/24)
Modern Healthcare:
CMS Rejects HHS OIG's Call To Limit Risk-Adjusted MA Pay
The Centers for Medicare and Medicaid Services declined to crack down on certain Medicare Advantage payments a federal watchdog said are based on improper diagnoses. Insurers have been embroiled in controversy around using health risk assessments to drive up diagnoses among Medicare Advantage enrollees for years. The Health and Human Services Department Office of Inspector General has said the practice led to billions in payments for which patients receive no corresponding follow-up visits, procedures, tests or supplies. Those payments hit $7.5 billion in 2023, the OIG says in a new report issued Thursday. (Early, 10/24)
Newsweek:
US Government Shares New Pandemic Plan
U.S. government officials, together with counterparts in Canada and Mexico, have unveiled their latest plans to strengthen regional health security and pandemic preparedness. ... The collaboration, called the North American Preparedness for Animal and Human Pandemics Initiative, or NAPAHPI, has been described as a "flexible, scalable, cross-sectoral" platform which aims to strengthen regional capacities for disease control, built on lessons learned from COVID-19 and other healthy security events. (Dewan, 10/24)
Roll Call:
Medicaid Limits Access To Life-Saving Doses Of Addiction Care
Consensus is growing around the idea that for some patients higher doses of a gold-standard opioid addiction treatment drug may be better than lower doses at keeping patients healthy and in treatment, especially for those who use fentanyl. But whether someone can access higher doses of buprenorphine — which works by curbing cravings and withdrawal from opioids — depends on where they live. (Hellmann, 10/24)
Stat:
Eli Lilly Weight Loss Drug Shortage Underscores Issues With FDA Oversight
A turbulent series of events surrounding the supply of Eli Lilly’s blockbuster weight loss treatment has raised concerns around how the Food and Drug Administration maintains its list of drug shortages and which sources it relies on, an issue that affects a growing number of Americans. (Lawrence, Chen and Silverman, 10/25)
Stat:
Disability Benefits Should Not End Because Of Marriage, Activists Say
When Chelsea Smith met Jason Martin she knew right away that he was the one — so she refused to get his phone number. That’s because getting married would make Smith ineligible for Social Security benefits and Medicaid — financial support that she and many others with disabilities need to survive. Smith didn’t want to risk falling in love knowing she couldn’t get married. (Zamora and Srikanth, 10/25)
The Hill:
Most Say Not Enough Being Done To Ensure Affordable Mental Health Care: Survey
Nearly three-fourths of U.S. adults said the government is not doing enough to ensure access to affordable mental health care, a new West Health-Gallup Healthcare survey found. The survey revealed that 73 percent of Americans said that the government was not doing enough to ensure affordable access to mental health care, compared to 12 percent who said that it was doing about the right amount. Seven percent said the government was doing too much, while another 7 percent said they didn’t know. (Ventura, 10/24)
And in election news —
KFF Health News:
Presidential Election Puts Affordable Care Act Back In The Bull’s-Eye
Health care is suddenly front and center in the final sprint to the presidential election, and the outcome will shape the Affordable Care Act and the coverage it gives to more than 40 million people. Besides reproductive rights, health care for most of the campaign has been an in-the-shadows issue. However, recent comments from former President Donald Trump and his running mate, Ohio Sen. JD Vance, about possible changes to the ACA have opened Republicans up to heavier scrutiny. (Armour, 10/25)
