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July 1, 2024

Healthcare World Panicking Over Chevron Deference Being Struck By Supreme Court

With the Supreme Court striking down the Chevron deference as the backbone of promulgating regulations, the healthcare world is officially in panic.  Most argue it will grind rule-making to a halt, create court backlogs and inconsistent rulings, and jeopardize health.  I touch upon many of these points in my Thursday blog.  I have mixed views on the ruling. I am not sure the world comes to an end as many think, but it will have vast implications.

#chevrondeference #cms #hhs #regulations #healthcare

https://kffhealthnews.org/news/article/supreme-court-chevron-deference-doctrine-health-care-policy-shockwaves/

House GOP Wants Fraud Investigation Of Exchanges

Based on tens of thousands of Americans being illegally switched in the Exchange program and estimates that five million may wrongly be receiving premium subsidies, House GOP leaders are calling for the Department of Health and Human Services Office of Inspector General (HHS OIG) and the Government Accountability office (GAO) to commence a fraud investigation.

#hhs #oig #gao #fwa exchanges #aca

https://www.washingtonpost.com/health/2024/06/29/aca-fraudulent-enrollment-congress-investiation

Humana Has New CEO

Humana President and CEO Jim Rechtin officially took the helm at Humana today, replacing legendary healthcare executive Bruce Broussard.  Broussard did a tremendous job building the Medicare Advantage-focused company over more than a decade of service.

#humana #medicareadvantage #broussard

https://www.beckerspayer.com/executive-moves/humanas-new-ceo-takes-the-reins.html

Polite Tit-For-Tat In Health Affairs Forefront On Medicare Advantage

Health Affairs Forefront Blog has been publishing a periodic tit-for-tat between academics and researchers on the issue of overpayment calculations in Medicare Advantage (MA). Some argue that those who say overpayments are in the tens of billions annually are telling tall tales.  This article counters an earlier one that sought to shoot holes in such arguments.

To be clear, I tend to fall closer to those who believe the huge overpayment estimates are largely wrong and could be politically motivated to hurt MA’s growth.  At the same time, research around a few areas would tend to support the idea that there are some overpayment concerns, including related to health risk assessment and chart reviews as well as the impact of a small number of players abusing the risk adjustment system.  

The article is worth the read because this is what is resonating on Capitol Hill and the Centers for Medicare and Medicaid Services (CMS).

(Article may require a subscription.)

#medicareadvantage #overpayments #cms

https://www.healthaffairs.org/content/forefront/estimating-overpayments-ma-plans-medpac-critics-get-wrong

— Marc S. Ryan

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