improperpayments

House CR Unveiled With No Doc Fix House Speaker Mike Johnson, R-LA, unveiled the FFY 2025 continuing resolution (CR) through the end of the fiscal year in September. If the bill passes the House, it goes to the Senate. At least one House GOP member has announced opposition, but the lack of a Medicare physician rate fix could mean others drop off. Passage in the Senate is unknown because 60 votes are needed and Democrats appear to be lining up against it. But moderate Democrats could have a change of heart. The bill also extends some critical healthcare programs that would expire on March 31. The House may vote on the bill Tuesday. In other news, a bipartisan proposal to further extend telehealth, reform pharmacy benefits managers (PBMs), reverse Medicare physician pay cuts, and address the opioid crisis has failed to be called up in the Senate. Additional articles: https://insidehealthpolicy.com/daily-news/providers-furious-house-continuing-resolution-omits-doc-pay-fix

Trump May Support Changes To Medicare Drug Negotiations Big Pharma says that President Donald Trump and Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. are sympathetic to the drug lobby’s concerns regarding the Inflation Reduction Act’s (IRA) “pill penalty” provision within the Medicare drug price negotiations. Drug makers say the law discourages research into small molecule drugs. Small-molecule drugs are exempt from Medicare drug price setting for nine years after FDA approval, while biologics are exempt for 13 years. Big Pharma has been lobbying to extend the small-molecule drug exclusivity period to 13 years. Some congressional bills would extend the period before price negotiation can begin for small molecule drugs to match biologics. (Article may require a subscription.) #ira #drugpricing #branddrugmakers https://insidehealthpolicy.com/daily-news/pfizer-ceo-trump-kennedy-sympathetic-pill-penalty-concerns Makary Backs Swifter Approval of Generics President Donald Trump’s nominee to lead the Food and Drug Administration (FDA), Dr. Marty Makary, pledged to accelerate the approval of

Paragon Says Improper Medicaid Payments Could Be Over $1 Trillion The Paragon Health Institute is an extremely powerful think tank with the ear of the Trump administration and some in Congress. Its newest report, in conjunction with the Economic Policy Innovation Center, says that improper payments under Medicaid could be as much as $1.1 trillion over ten years. The Centers for Medicare and Medicaid Services (CMS) estimated improper payments at $543 billion over ten years, but Paragon says that does not include eligibility check errors. The report urges Congress to cut funding to states found with greater than 3% erroneous payments based on eligibility errors. Many of the errors are tied to the suspension of eligibility checks during the COVID pandemic. The ineligible population includes people over income limits and illegal immigrants. The report gives hope that the GOP Congress can reduce Medicaid spending and perhaps certain Medicare spending without