Morning Briefing
Summaries of health policy coverage from major news organizations
Medicare Advantage Audit Uncovers Rampant Overcharging
NPR/Center For Public Integrity: Audits Of Some Medicare Advantage Plans Reveal Pervasive Overcharging
More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression. The Center for Public Integrity recently obtained, through a Freedom of Information Act lawsuit, the federal audits of 37 Medicare Advantage programs. These audits have never before been made public, and though they reveal overpayments from 2007 — money that has since been paid back — many plans are still appealing the findings. (Schulte, 8/29)
Meanwhile, Kaiser Health News and California Healthline offer a look on what exactly observation care is —
California Healthline: Protecting California’s Seniors From Surprise Hospital, Nursing Home Bills
Californians with Medicare coverage would no longer be surprised by huge medical bills stemming from “observation care” in hospitals under legislation that state lawmakers approved overwhelmingly last week and sent to Gov. Jerry Brown to sign into law.The sticker-shock can happen when people go to the hospital but health care providers are not sure what’s wrong. If the patient is not sick enough to be formally admitted, but still not healthy enough to go home, they can stay in the hospital for “observation care,” which Medicare considers an outpatient service. That can mean higher out-of-pocket expenses for the patient. (Jaffe, 8/29)
Kaiser Health News: Hospital Surprise: Medicare’s Observation Care
Hospitals provide observation care for patients who are not well enough to go home but not sick enough to be admitted. The care may seem just like what an admitted patient receives — they are in a hospital room, nurses check on them and doctors order treatments. But surprises can arise over billing because Medicare considers this outpatient care. So instead of Medicare picking up most of the bill, patients usually also have copayments for doctors’ fees and each hospital service, and they have to pay whatever the hospital charges for any routine drugs the hospital provides that they take at home for chronic conditions. (Ying, Nguyen and Shallcross, 8/29)
Kaiser Health News: FAQ: Hospital Observation Care Can Be Costly For Medicare Patients
Here are some common questions and answers about observation care and the coverage gap that can result. (Seniors enrolled in Medicare Advantage should ask their plans about their observation care rules since they can vary.) (Jaffe, 8/29)
