March 27, 2024

Improper Payments Huge In Federal Programs

A new Government Accountability Office analysis finds that the federal government made nearly $236 billion in improper payments in 2023. The payments were largely in Medicare, Medicaid, Pandemic Unemployment Assistance, the Earned Income Tax Credit and Paycheck Protection Program loan forgiveness.

Medicare had the largest improper payments at $51.1 billion.  Medicaid had $50.3 billion.

GAO Report here: https://www.gao.gov/products/gao-24-106927

#fwa #medicare #medicaid

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New Rule Simplifies Medicaid and Children’s Insurance Enrollment

A new Centers for Medicare & Medicaid Services (CMS) final rule will help enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) coverage. Among changes include transfer from Medicaid and CHIP if Medicaid is lost, renewals no sooner than every 12 months, no waiting periods, and sufficient time to respond to state inquiries on coverage.

Federal press release and fact sheet: https://www.cms.gov/newsroom/press-releases/biden-harris-administration-builds-success-affordable-care-act-streamlining-enrollment-medicaid-and and https://www.cms.gov/newsroom/fact-sheets/streamlining-medicaid-childrens-health-insurance-program-and-basic-health-program-application

Additional articles: https://www.modernhealthcare.com/government/cms-medicaid-chip-enrollment-renewal-rule and https://insidehealthpolicy.com/daily-news/cms-finalizes-rule-overhauling-medicaid-enrollment-eligibility-processes

(Some articles may require a subscription.)

#medicaid #chip #coverage

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Optum Buys Physician Group; Walgreens Continues Clinic Closures

Optum has bought Steward Health’s multi-state physician group while Walgreens continues closures of VillageMD clinics.  Optum already owns over 90,000 physicians.

Walgreens article: https://www.modernhealthcare.com/providers/walgreens-villagemd-nevada-clinics-closing

Additional article on Optum: https://www.fiercehealthcare.com/providers/optum-buy-struggling-steward-health-cares-physician-group-under-proposed-deal

(Some articles may require a subscription.)

#united #optum #walgreens

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Healthcare Center Stage In the Presidential Campaign

At a campaign stop in North Carolina, President Biden promised to expand coverage while former President Trump claimed he does not want to take the Affordable Care Act (ACA) away but make it better.

Biden is smartly going after the former president on his previous muddled statements.  I think the former president’s ongoing clarifications are losers for him. 

Trump has taken on a lot of water on social service issues, including his position on the ACA as well as comments on Medicare and Social Security.

(Article may require a subscription.)

#aca #obamacare #medicare

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Biden Budget Does Not Tackle Many Big Health Care Issues Looming In Congress

President Biden’s FFY 2025 budget proposal does not tackle Medicare physician payment reform, site-neutral hospital policies, and Medicare Advantage spending.

(Article may require a subscription.)

#ffy2025budget #spending

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HHS Publishes Provider Resources In Wake Of Change Cyberattack

The Department of Health and Human Services released resources providers can use in the wake of the ongoing fallout from the Change Healthcare cyberattack.

(Article may require a subscription.)

#changehealthcare #hhs #cyberattacks #providers

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CMS Says Plans Can Use Prior Authorization, Step Therapy, And Quantity Limits With GLP-1s; Sanders Says Weight-Loss Drugs Overpriced

In light of Food and Drug Administration (FDA) approval of GLP-1s for certain disease states (but not general use for obesity), the Centers for Medicare and Medicaid Services said that Part D and Medicaid plans can use prior authorization (PA), step therapy and quantity limits on the drugs.  This is a major declaration in light of CMS’ terrible 2024 rule limiting PA overall on Part C (A and B) services.

At the same time, Sen. Bernie Sanders, Chairman of the HELP Committee, is pressing drug maker Novo Nordisk to reduce the price of two such drugs when production costs are said to be under $5 per weekly prescription. Sanders says Novo Nordisk charges Americans nearly $1,000 a month for the drug, while the same exact product can be purchased for $155 a month in Canada and just $59 in Germany.

Costs of such drugs are skyrocketing in Medicare despite their limited use so far.

Sanders article: https://thehill.com/policy/healthcare/4560323-sanders-calls-for-novo-nordisk-slash-ozempic-wegovy-prices/

(Some articles may require a subscription.)

#drugpricing #branddrugmakers #weightlossdrugs

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No Surprises Act Is Boon For Providers

As I have long argued, the No Surprises Act has been a boon for providers at the expense of health plans.  Despite this, providers continue to fight the law in an effort to slant results even more toward providers. State laws that had baseball style arbitration had stats that showed this, yet Congress passed a similar law anyway.  Tragic. It shows the ugly influence of lobbying dollars on Capitol Hill. This will lead to significant increases in costs despite the original projections.

See my blog tomorrow on this topic and study.

#nsa #nosurprisesact #surprisebilling

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Rebate Laws May Be Leading To Lower Prices From Brand Drug Makers

Good article on how rebate laws in Medicaid and Medicare may be leading to lower drug prices and concessions on cost-sharing from brand drug makers.  Drug lobbies deny it and at least part of it could be public pressure.  But there is at least evidence that public policy on inflation caps and rebates do help. We should do more of this.

#drugpricing #ira #branddrugmakers

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States Tackling Ground Ambulance Billing Problem

Good article on how states are now tacking the problem of high ground ambulance bills because the No Surprises Act carved out ground ambulances when it was passed.  Good news for consumers.  The model is similar to the approach in the NSA in terms of what consumers pay.

#surprisebilling #nsa #nosurprisesact

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— Marc S. Ryan

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