Medicare Paid $2B On Thousands Of Unessential Back Surgeries: Analysis
In other news, University of Illinois nurses strike; Baystate Health makes leadership cuts; St. Louis University tackles a lack of palliative care; and more.
Axios:
Medicare Spent $2B On Unneeded Back Surgeries
Hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries in the U.S. over three years, according to a new analysis. Roughly $2 billion was spent on the "low value" procedures while patients were put at risk of poor outcomes, researchers from the Lown Institute wrote. (Reed, 11/14)
Modern Healthcare:
Aetna, Cigna, Elevance Cut Medicare Advantage Commissions
Aetna, Cigna and Elevance Health sell Medicare Advantage plans. But that doesn't necessarily mean they want people to buy them. Partway through the Medicare annual enrollment period for 2025, which started Oct. 15 and ends Dec. 7, those three insurers stopped offering commissions to brokers and other third-party marketers who steer new customers toward some of their Medicare Advantage products. Sam Melamed, CEO of the dental and vision insurer NCD and founder of a social media platform for brokers and agents called Insurance Forums, has never seen anything like it. (Tepper, 11/13)
ProPublica:
Lincare Made Billions While Repeatedly Defrauding Medicare. Feds Did Little To Rein It In.
For Lincare, paying multimillion-dollar legal settlements is an integral part of doing business. The company, the largest distributor of home oxygen equipment in the United States, admitted billing Medicare for ventilators it knew customers weren’t using (2024) and overcharging Medicare and thousands of elderly patients (2023). It settled allegations of violating a law against kickbacks (2018) and charging Medicare for patients who had died (2017). The company resolved lawsuits alleging a “nationwide scheme to pay physicians kickbacks to refer their patients to Lincare” (2006) and that it falsified claims that its customers needed oxygen (2001). (Lincare admitted wrongdoing in only the two most recent settlements.) (Elkind, 11/13)
Becker's Hospital Review:
'We're Going To Have To Fix This Ourselves': 4 CFOs On Navigating Medicare Advantage
Medicare Advantage now provides health coverage to around 55% of the nation’s seniors, but some hospitals and health systems are choosing to end contracts with some MA plans due to administrative hurdles. The most frequently cited challenges include high prior authorization denial rates and delayed payments from insurers. Becker's connected with four health system CFOs at our 12th Annual CEO-CFO Roundtable on Nov. 11 to understand how hospital finance leaders are navigating Medicare Advantage today. (Emerson, 11/11)
In other health industry news —
Chicago Tribune:
Nurses At University Of Illinois Hospital & Clinics Strike
Nurses at University of Illinois Hospital & Clinics walked off the job Wednesday morning, with plans to strike for an indefinite length of time. The nurses are seeking better security to prevent patients from attacking them at the hospital, are concerned about potential staffing changes, and they’re asking for higher pay. (Schencker, 11/13)
Modern Healthcare:
Baystate Health Cuts Hit 134 Leadership Positions
Baystate Health has eliminated 134 leadership positions as part of a larger cost-saving effort amid financial challenges. The cuts will affect less than 1% of the system's workforce, the system said in a statement Wednesday. Some of the affected positions are vacant roles that will not be filled. (Desilva, 11/13)
Modern Healthcare:
Ex-MetroHealth CEO's Bonuses Did Not Break The Law, Auditor Says
The Ohio Auditor of State’s office has released the findings of its criminal investigation and special audit of the allegations that ex-MetroHealth president and CEO Dr. Akram Boutros paid himself $1.9 million in unauthorized bonuses. The report, published Tuesday, Nov. 12, on the state auditor’s website, says the office concluded Boutros’ actions were not criminal, and it was not able to determine whether he had proper authorization to receive supplemental performance-based variable compensation (SPBVC). (Bennett, 11/13)
St. Louis Public Radio:
SLU Studies Outline Lack Of Palliative Care Treatment
Although palliative care has been shown to improve quality of life for patients with severe illnesses, two studies from St. Louis University researchers indicate it’s not offered frequently to patients who may benefit from the treatment. Palliative care is treatment that helps manage side effects, symptoms and mental health issues for people with cancer and other severe illnesses. (Fentem, 11/14)
