Medicare Advantage Plans May Be Exaggerating Sicknesses, CMS Worries

Modern Healthcare: CMS Official Questions Future Of Medicare Advantage Payments
A top official with the Centers for Medicare and Medicaid Services questioned the future of Medicare Advantage payments Thursday, pointing to studies from government watchdogs and experts. The Office of Inspector General for the Health and Human Services Department suggested Medicare Advantage plans may be making their beneficiaries look sicker than they really are to maximize payments from the federal government. "We too are very concerned with the overall trend lines for code growth in the MA program versus the overall fee-for-service program," said Jonathan Blum, principal deputy administrator of CMS, at an event in Washington, D.C. Thursday. (Hellmann, 10/21)

In other developments —

Modern Healthcare: Tennessee Claimed $1B In Improper Uncompensated Care, Audit Finds
Tennessee's Medicaid program did not comply with federal requirements for claiming uncompensated care at public hospitals as certified public expenditures, exceeding the allowed claim amount by $1.1 billion, according to a recent audit. The Health and Human Services Department's Office of Inspector General report found that for state fiscal years between 2009 and 2014, Tennessee claimed a total of $2 billion in certified public expenditures. Of this amount, only $909.4 million was allowable and supported. TennCare claimed $482.1 million in excess certified public expenditures that it did not return after calculating the actual care costs for Medicaid enrollees and uninsured patients at public hospitals. (Devereaux, 10/21)

Stat: FDA Warns A Hospital And Two Physicians For Putting Patients At Risk In Trials
In harsh tones, U.S. regulators warned a Minnesota hospital and two of its physicians for violating regulations on human research in studies that tested antipsychotics and the potent anesthetic ketamine on patients in emergency rooms or prior to their arrival. The warnings were issued by the Food and Drug Administration after its inspectors found Hennepin County Medical Center and the physicians failed to obtain consent from subjects for trials that involved testing the safety and effectiveness of the medications for managing agitation. The inspections took place in April 2019 and the FDA letters were sent last May, but only became publicly available this week. (Silverman, 10/21)

Modern Healthcare: UNC Hospitals' Patients At Risk For Identity Theft
UNC Hospitals on Wednesday said 719 patients might be at risk for identity theft after an employee misused their personal information. The Chapel Hill, North Carolina-based system said it mailed letters to affected patients after finding out a now former employee was using patients' demographic and financial information to illegally obtain goods and services. UNC Hospitals learned of the misconduct Sept. 10, and its police department has launched a criminal investigation, the system said. (Christ, 10/21)

Stat: Athira Chief Executive Resigns As Company Confirms She Altered Research
The chief executive of biotech Athira Pharma has permanently left the company after papers she published as a graduate student were found to contain altered research. Leen Kawas was suspended in June, after STAT asked the Alzheimer’s research company to comment on the allegations, and Athira announced her resignation as president, chief executive, and member of the board of directors today. (Goldhill, 10/21)

KHN: ‘No Mercy’ Bonus Episodes: More From Fort Scott, Kansas
Host Sarah Jane Tribble sets out on a mission to learn more about the Sisters of Mercy, the nuns who founded Fort Scott’s Mercy Hospital and were once prominent leaders of the community. Tribble’s first glimpse into their lives takes her to an old convent. To learn more about the founding of Fort Scott’s hospital, listen to Episode Four. (Tribble, 10/22)

In corporate news —

Philadelphia Inquirer: Crozer Health Put Up For Sale By Prospect Medical
Prospect Medical Holdings Inc., the for-profit owner of Crozer Health’s four hospitals in Delaware County since 2016, has put them up for sale, according to four industry sources. The Los Angeles company and its former controlling owner, private-equity firm Leonard Green & Partners, have come under criticism for buying struggling hospitals — usually hospitals that few others want to buy — and then extracting money from them for investors. Officials at Prospect did not respond to a request for comment about the letters sent Wednesday to potential buyers. Peter Adamo, chief executive officer of Crozer Health, did not respond to a text seeking comment. (Brubaker, 10/21)

Chicago Tribune: Amita Health Splitting Up, As Organizations Decide To Go Separate Ways
The organizations behind Amita Health, one of the largest hospital systems in Illinois, have decided to go their separate ways, splitting the system. AdventHealth and Ascension have decided to unwind the partnership under which they’ve been operating Amita Health, which has 19 hospitals in Illinois. Some of the hospitals will operate under AdventHealth and others under Ascension. (Schencker, 10/21)

Milwaukee Journal Sentinel: Texas Firm Proposes Micro-Hospital For Site Where Hotel Was Rejected
A Texas company that develops micro-hospitals is proposing a $13 million project on Milwaukee's far south side. Houston-based Nutex Health Inc. wants to develop a 22,073-square-foot hospital at 1801 W. Layton Ave., just west of I-94. That's according to information filed with the Milwaukee Department of Neighborhood Services, which oversees building inspections. Nutex is seeking a preliminary plan review to determine if the hospital would meet the site's zoning requirements, according to department records. It would have six to eight inpatient beds and eight to 10 emergency room beds, according to a separate filing with the Board of Zoning Appeals. (Daykin, 10/21)

Modern Healthcare: Tenet Healthcare's Q3 Boosted By High-Acuity Surgeries
Leaders at Tenet Healthcare Corp. chalked up their strong third quarter performance in part to an uptick in high-acuity surgeries, a major focus area the for-profit hospital chain. Dr. Saum Sutaria, Tenet's new CEO as of September 1, told investors on a call Thursday that cardiac interventions are recovering to 2019 levels. Orthopedic cases across the company's ambulatory surgery centers grew 22% year-over-year, and ambulatory joint replacements have more than doubled from 2020. (Bannow, 10/21)

CNBC: Google Is 'All In' On Health Care, Again
Alphabet’s Google is “still all in on health,” according to its chief health officer, despite the demise of its recent attempt at a formalized business unit for the health-care sector. The tech giant founded Google Health in 2018 and at one point grew it to 500 employees, but dissolved the unit in August. The department was established to head the tech company’s health strategy but Google faced backlash in recent years over the intersection of Google, AI and health data. (Doniger, 10/21)