KHN Morning Briefing

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New Medicare Rule Targets Medical Equipment

The federal rule, which was issued last week and designed to tamp down on sources of Medicare fraud and improper billing, requires prior authorization before the Medicare program will pay for certain types of medical equipment, including some wheelchairs. Federal investigators also are scrutinizing routine tests — designed to ensure patients properly use opioid drugs — that they say have led to questionable billing practices by some for-profit labs, doctors and addiction-treatment centers.

USA Today: New Federal Rule Targets Medical Equipment Often Subject To Fraud
A federal rule issued Tuesday requires prior authorization before Medicare will pay for certain wheelchairs, prosthetics, orthotics and other medical equipment — sources of Medicare fraud and improper payments for years. The rule could save Medicare $10 million the first year, $200 million in five years and $580 million over a decade, says Aaron Albright, spokesman for the U.S. Centers for Medicare and Medicaid Services. (Ungar, 12/29)

Arizona Republic: Labs, Doctors Scrutinized Over Lucrative Drug Tests For Pain-Pill Abuse
Doctors frequently order patients to take urine drug tests to safeguard against prescription pain-pill abuse. But federal investigators and Medicare say these routine tests — designed to ensure patients properly use opioid drugs — have led to questionable billing practices by some for-profit labs, doctors, and addiction-treatment centers. ... The U.S. Department of Justice is cracking down on private labs that investigators say offer incentives to doctors to frequently refer patients for lucrative testing. And Medicare, citing the potential for billing abuses, is overhauling its billing codes and payment rates used for drug tests. (Alltucker, 12/26)

Meanwhile, the Centers for Medicare & Medicaid Services is fining insurers for errors in Medicare Advantage plan directories and for errors in plans sold on the federally run insurance exchanges -

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