Medicare Advantage Plans Overcharged By Millions With Diminished Chance Of Getting Caught
The Center for Public Integrity reports that CMS officials perform only 30 in-depth financial audits to recover overpayments each year, when they have the capacity for 80. Meanwhile, news outlets report on other Medicare developments such as the impact of the budget deal on the program, the continued high out-of-pocket costs for oral cancer medications and 21st Century Oncology Holdings' $19.75 million settlement of a billing probe.
The Center for Public Integrity:
Lax Auditing Encouraged Overcharging By Medicare Advantage Plans
Despite facing mounting evidence federal officials were overpaying some Medicare health plans by tens of millions of dollars a year, the government dialed back efforts to recover as much of the money as possible, newly released records show. (Schulte, 12/18)
CQ Healthbeat:
Odds For Targeted Medicare Tweaks Appear Tougher After Omnibus
The odds grew tougher this week for groups seeking to make quick and targeted changes in federal health payment rules, including modifications to a new policy regarding hospital outpatient services. The fiscal 2016 omnibus emerged after weeks of negotiations relatively free of both controversial riders and the kind of add-on provisions that Congress can use to tweak the complex Centers for Medicare and Medicaid Services regulations through larger bills. (Young, 12/17)
Reuters:
Even With Smaller 'Donut Hole,' Medicare Cancer Pill Costs Stay High
Seniors insured by Medicare may still face high out-of-pocket costs for oral cancer medicines even after the government health program scales back a coverage gap known as the donut hole, a U.S. study suggests. To assess how changes in the Medicare drug plan known as Part D might impact patients, researchers compared benefits available in 2010 to the coverage set to take effect in 2020 and estimated how out-of-pocket costs for cancer pills could change under different prescription pricing scenarios. (Rapaport, 12/16)
The Wall Street Journal:
Cancer-Care Giant Agrees To Pay $19.75 Million To Settle Medicare Billing Probe
Cancer-care giant 21st Century Oncology Holdings Inc. agreed to pay $19.75 million to settle civil allegations by the Justice Department that its doctors performed a bladder-cancer test on Medicare patients more often than medically necessary, according to people close to the investigation. (Carreyrou, 12/17)