Plans Launch New Ad Campaign On NSA Disputes
A new health plan ad campaign takes aim at the No Surprises Act (NSA) law and its arbitration component. It says that the dispute processes “create a ‘fox guarding the hen house’ dynamic.”
Data show that providers are far more likely to win (87% of the time) and earn significantly higher payouts than payments before the law. It is driving overall healthcare costs up.
Further, it is subject to abuse, with five organizations accounting for 63% of disputes in the first half of 2024: Team Health, SCP Health, Radiology Partners, AGS Health and HaloMD.
Plans have sued but it will take the courage of Congress to fix his problem.
#nosurprisesact #transparency
Administration Attacks Fraud
The Centers for Medicare and Medicaid Services (CMS) announced two fraud initiatives. First, CMS and the Department of Health and Human Services (HHS) issued an ultimatum to state officials to ramp up fraud enforcement or face consequences that could include a halt to all federal Medicaid funding. It will withhold Medicaid money from all 50 states if they do not follow federal anti-fraud statutes.
Specifically, Vice President and new fraud czar JD Vance said CMS will withhold $1.3 billion in Medicaid funding from California as officials have “not taken fraud very seriously.” CMS Administrator Dr. Mehmet Oz said California’s Medicaid records “generated major red flags.” He says California needs to clarify $630 million in billing, $500 million in home health service and $200 million linked to coverage for undocumented immigrants.
Second, HHS is placing a moratorium on new Medicare enrollments from home health care and hospice providers. The six-month freeze will prevent these providers from signing up to receive reimbursements from Medicare and help combat fraud and these areas a ripe for fraud. Earlier this year, it placed a moratorium on durable medical equipment, prosthetics, orthotics and supplies companies. CMS says the moves are data-driven and will help identify and investigate bad actors by deploying advanced analytics.
Additional articles: https://www.fiercehealthcare.com/regulatory/cms-withhold-13b-medicaid-funds-california-puts-state-officials-notice-about-fraud and https://www.fiercehealthcare.com/regulatory/cms-pauses-hospice-home-health-medicare-enrollments-fraud-crackdown and https://www.modernhealthcare.com/politics-regulation/mh-hhs-medicaid-funding-fraud-jd-vance/ and https://thehill.com/policy/healthcare/5876361-trump-administration-freeze-medicare-enrollments-hospice/?tbref=hp and https://www.healthcaredive.com/news/cms-suspends-new-medicare-enrollment-hospice-home-health-six-months/820137/ and https://www.beckershospitalreview.com/legal-regulatory-issues/white-house-freezes-1-3b-in-medicaid-payments-to-california/ and https://www.cms.gov/newsroom/press-releases/cms-announces-aggressive-nationwide-crackdown-fraud-six-month-hospice-home-health-agency-enrollment and https://thehill.com/homenews/administration/5876707-states-face-medicaid-fraud-crackdown/
(Some articles may require a subscription.)
#fwa #cms #medicare #medicaid
— Marc S. Ryan
