Overpayments To Medicare Advantage Insurers Now Top $75 Billion Yearly

Axios: Medicare Advantage Overpayments Higher Than Estimated: Study
Overpayments to insurers administering Medicare Advantage plans now exceed $75 billion a year due to aggressive coding of patients' health conditions and easily-achieved bonus payments tied to quality, researchers with the USC Schaeffer Center for Health Policy & Economics found. (Bettelheim, 6/14)

In news about health care personnel —

St. Louis Public Radio: Nurses Ask For Better Working Conditions At SLU Hospital
As a nurse at St. Louis University Hospital, Jessica Tulk expects physical and verbal assault by patients on any given day. Violence against nurses is one of the many problems union officials and staff called attention to at a protest Tuesday outside the hospital, which is part of the SSM Health system. (Halloran, 6/13)

Boston 25 News: Prosecutor: NH Man Stabbed Mass. Hospital Nurse In Neck As She Tried To Adjust His Oxygen Tube 
A New Hampshire man has been ordered held on high bail after he allegedly stabbed a nurse at a hospital in Massachusetts on Monday night. ... The victim, Sharon Siew, was taken to UMass Memorial Medical Center in Worcester. She is expected to be OK. ... The attack did not surprise Karen Coughlin, RN, a psychiatric nurse for 34 years and chair of the Workplace Violence Task Force at the Massachusetts Nurses Association. MNA is the largest union in the state representing nurses. Its membership includes nurses at Heywood Hospital. “We are seeing an increase in workplace violence across the spectrum,” Coughlin said. “Nurses are more likely to be assaulted — seven times more likely to be assaulted — than police officers.” (Morelli and O'Laughlin, 6/13)

Modern Healthcare: Home Health Nursing Programs Grow As Demand Increases
Duke University launched a four-year program this spring with a $3.9 million federal training grant aimed at helping better prepare nurses for a growing trend in healthcare: treating patients where they live. “In the hospital, nurses really have all the power and the patients are literally stripped of their clothing,” said Donna Biederman, associate clinical professor at Duke University School of Nursing. “In the community, the nurse really needs to understand the dynamics. It can be very humbling when you are in a place where you’re not necessarily able to call all of the shots.” (Eastabrook, 6/13)

In other health care industry news —

Stat: AMA Asks Doctors To De-Emphasize Use Of BMI In Gauging Health
The American Medical Association on Tuesday strongly criticized the body mass index, urging doctors to de-emphasize its use in assessing health and obesity and acknowledging that the measurement has been used for “racist exclusion” and has caused “historical harm.” (Trang and Chen, 6/13)

Stat: Infighting Leads Chapters To Break Away From Leading ALS Group
After a bitter dispute, the ALS Association has settled a lawsuit filed by 15 chapters that chafed at managerial moves by the national organization and will now break away to form an alternative organization for patients and their families combating the debilitating disease. (Silverman, 6/13)

Stat: Vindicated MIT Professor Says Probe Into His Lab Did Lasting Damage
For three years, nine months, and one week, Ram Sasisekharan lived under a gag order. In 2019, some of the Massachusetts Institute of Technology professor’s peers publicly accused his lab of falsifying research, setting in motion a lengthy internal investigation that sidelined his work, decimated his team, and barred him from speaking out in his own defense. (Garde, 6/14)

KFF Health News: At Least 1.7M Americans Use Health Sharing Arrangements, Despite Lack Of Protections 
A new report has provided the first national count of Americans who rely on health care sharing plans — arrangements through which people agree to pay one another’s medical bills — and the number is higher than previously realized. The report from the Colorado Division of Insurance found that more than 1.7 million Americans rely on sharing plans and that many of the plans require members to ask for charity care before submitting their bills. (Hawryluk, 6/14)

Modern Healthcare: How Health Insurers Did During The First Quarter
Publicly traded health insurance companies enjoyed a profitable first quarter in 2023. But uncertainty looms about how the year will shake out for the insurance industry, which experienced strong performances during the COVID-19 pandemic. Investors are concerned about how regulatory updates will impact Medicare Advantage plans and risk-bearing providers, how Medicaid redeterminations will shake out, and how legislation targeting pharmacy benefit managers would impact operations and profits. (Tepper, 6/13)