Morning Briefing
Summaries of health policy coverage from major news organizations
Uninsured Numbers Held Flat Even With Pandemic: Census Bureau
Axios: Pandemic Didn't Lead To Spike In Uninsured
Roughly 8.6% of Americans didn't have health insurance in 2020, a figure that has stayed consistent since 2018, according to the latest U.S. Census Bureau data. Government assistance, in the form of beefed-up Medicaid eligibility and heavily subsidized plans in the Affordable Care Act markets, kept people insured despite the pandemic-fueled recession. (Herman, 9/15)
KHN: Census: Insured Population Holds Steady, With A Slight Shift From Private To Public Coverage
Despite a pandemic-fueled recession, the number of uninsured Americans has increased only slightly since 2018, according to Census Bureau health insurance data released Tuesday. Twenty-eight million people, or 8.6% of Americans, were uninsured for all of 2020. In 2019, 8% of people were uninsured during the full year; in 2018, it was 8.5%. (Knight and Appleby, 9/14)
In Medicaid news —
Modern Healthcare: Aetna Lied About Provider Network To Win Medicaid Contracts, Suit Alleges
Aetna illegally secured contracts with Pennsylvania's Medicaid program by misrepresenting the number of pediatric providers in its network, according to a federal whistleblower lawsuit unsealed Tuesday. The insurer benefited from this alleged fraud because the lack of providers limited access to care, saving Aetna money. Aetna Better Health of Pennsylvania CEO Jason Rottman and Alice Jefferson, director of the company's quality management division, are named as defendants along with the company in the lawsuit, which was filed in the Western District of Pennsylvania. (Tepper, 9/14)
In Medicare news —
Modern Healthcare: DOJ Intervenes In False Claims Act Suit Against Medicare Advantage Insurer
The federal government is suing a New York Medicare Advantage insurer under the False Claims Act, accusing it of bilking the government for millions of dollars by making its members appear sicker than they were. The Justice Department is intervening in a whistleblower lawsuit against Buffalo-based Independent Health, its now-defunct risk adjustment subsidiary, DxID, and DxID's former CEO. The government won a $6.4 million settlement against Seattle-based Group Health Cooperative, another defendant in the original case, last year. Kaiser Permanente acquired the company in 2017, five years after prosecutors began their case against Group Health Cooperative. (Bannow, 9/14)
KHN: Justice Department Targets Data Mining In Medicare Advantage Fraud Case
The Justice Department has accused an upstate New York health insurance plan for seniors and its medical analytics company of cheating the government out of tens of millions of dollars. The civil complaint of fraud, filed late Monday, is the first by the federal government to target a data mining company for allegedly helping a Medicare Advantage program game federal billing regulations to overcharge for patient treatment. (Schulte, 9/14 )
Modern Healthcare: Providers Push For Medicare Pay Boost
Doctors oppose looming Medicare cuts as they continue to grapple with the COVID-19 pandemic. The 2022 Medicare physician fee schedule would level an across-the-board 3.75% pay raise implemented in the 2021 fiscal year. Typically, increases for certain provider groups would come at the expense of other specialties to balance the budget. But Congress temporarily recalibrated the budget-neutral framework considering the pandemic. CMS should reconsider budget neutrality and the associated pay cuts, the American Medical Association recommended. (Kacik, 9/14)
