Morning Briefing
Summaries of health policy coverage from major news organizations
Lawsuits: Medicare Advantage Plans Boost Payments By Claiming Sicker Patients
Modern Healthcare: Were Patients Really Sicker? Lawsuits Say Medicare Advantage Plans Inflated Diagnoses To Boost Payments
For an 82-year-old man with diabetes and rheumatoid arthritis, the CMS will pay a Medicare Advantage plan a certain amount of money each month. Add renal failure and hemiplegia to the list of maladies, and the CMS' monthly payment to his plan skyrockets. It could mean $2,282 a month versus $1,149, experts say.The CMS pays private Medicare Advantage plans under a severity-adjusted model designed to give insurers a financial incentive to take sicker enrollees. But critics, including HHS' Office of the Inspector General, say the severity-adjusted payment model is being abused by some plans and providers, costing taxpayers billions annually. (Schencker, 11/22)
Milwaukee Journal-Sentinel: Large Companies Moving Retirees Off Health Care Plans
Relatively few companies have opted to stop offering health benefits to retirees completely. But as health care costs have steadily risen and as people live longer, more firms have taken steps to limit the benefits. Among large employers — those with 1,000 or more workers — 60% have instituted caps on benefits for retirees eligible for Medicare, according to an annual survey by Towers Watson and the National Business Group on Health. (Boulton, 11/22)
The Washington Post: Alzheimer’s Risk Is Higher In African Americans, But Many Fear Clinical Studies
Studies show that older African Americans are almost twice as likely as whites to develop Alzheimer’s disease for genetic, biological and socioeconomic reasons. ... Yet relatively few African Americans want to talk about Alzheimer’s, which is the leading cause of dementia. For historical reasons, even fewer want to participate in clinical research trials that could deliver benefits to themselves and future generations. ... The effort to engage African Americans on Alzheimer’s comes as the U.S. population ages and becomes more diverse. (Kunkle, 11/23)
