Medicare Probes Whether Health Care Providers Steered Patients To Private Plans
The investigation will look at whether the providers, such as dialysis centers, encouraged people eligible for Medicare and Medicaid to buy private plans instead so that the providers could get higher reimbursements. Meanwhile, Medicare prescription drug spending jumps 17 percent In 2014.
The Wall Street Journal:
U.S. Opens Probe Into Concerns Over Health-Provider Payments
The Obama administration has launched a probe into whether health-care providers such as dialysis centers are steering patients eligible for Medicare and Medicaid benefits into insurance plans offered on the health law’s exchanges. The Centers for Medicare and Medicaid Services on Thursday said it sent warning letters to all dialysis centers that participate in the federal Medicare program. The agency also said it is weighing financial penalties on providers who are found to have directed people eligible for Medicare into Affordable Care Act plans instead. “We are concerned about reports that some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients’ needs,” said CMS Acting Administrator Andy Slavitt in a news release. (Armour and Wilde Mathews, 8/18)
Reuters:
U.S. Health Agency Weighs Rules On Outside Payments For Obamacare
A U.S. government health agency on Thursday said that it was considering new rules to prevent healthcare providers or related groups from steering patients into Obamacare individual insurance plans instead of Medicare or Medicaid in order to receive higher payments for medical services. The Centers for Medicare & Medicaid Services on Thursday said it is seeking public comment and considering rules including prohibiting or limiting premium payments or cost-sharing for the individual marketplace plans, monetary penalties and limits on such payments. (Humer, 8/18)
Modern Healthcare:
Medicare Part D Spending Rose 17% In 2014 Because Of High-Cost Drugs
Medicare spending on prescriptions increased more than 17% in 2014, despite a claims increase of only about 3%, according to data released Thursday. The second annual set of data shows prescription drugs paid for under the Medicare Part D Prescription Drug Program, which has 38 million beneficiaries. (Muchmore, 8/18)
In other national health care news —
The Wall Street Journal:
T. Rowe Price Sues Valeant, Alleging ‘Fraudulent Scheme’
Mutual-fund giant T. Rowe Price Group Inc. has filed suit against Valeant Pharmaceuticals International Inc., alleging the Canadian drug company engaged in “a fraudulent scheme” that cost T. Rowe Price and other Valeant investors billions of dollars. Valeant used mail-order pharmacy Philidor Rx Services LLC, deceptive pricing and reimbursement practices and “fictitious accounting” to artificially inflate its results and shield its drugs from competition, T. Rowe Price and Alleghany Cos., another Valeant shareholder, alleged in the lawsuit filed earlier this week in federal court in New Jersey that became publicly available Thursday. (Rapoport, 8/18)
The New York Times:
New Cluster Of Zika Cases Is Reported In Miami Beach
A cluster of Zika cases most likely transmitted by local mosquitoes has been identified in Miami Beach, and federal and state officials are considering whether to advise pregnant women to avoid traveling to the city and possibly even all of Miami-Dade County, a health official said Thursday. Such a decision would signal that the potential threat of local Zika transmission had catapulted to a new level. It would no longer be confined to one zone of active local transmission in Miami — the only one identified in the continental United States up to now. (Alvarez and Belluck, 8/18)
The Washington Post:
Zika Can Infect Adult Brain Cells, Not Just Fetal Cells, Study Suggests
The more researchers learn about the Zika virus, the worse it seems. A growing body of research has established that the virus can cause severe birth defects — most notably microcephaly, a condition characterized by an abnormally small head and often incomplete brain development. The virus also has been linked to cases of Guillain-Barre syndrome in adults, a rare autoimmune disorder that can result in paralysis and even death. Now, in a study in mice, researchers have found evidence that suggests adult brain cells critical to learning and memory also might be susceptible to the Zika virus. (Dennis, 8/18)