Health Estimates
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Health Estimates Newswire

Sep. 20, 2018: CMS Analysis Shows RACs Recovered $473.9 Million In Improper Medicare Payments

CMS Analysis Shows RACs Recovered $473.9 Million In Improper Medicare Payments.

Modern Healthcare  (9/19, Dickson, Subscription Publication) reports Recovery Audit Contractors (RACs) are hoping CMS will “reverse course on its decision to limit the number of claims they can review” after a CMS analysis  showed “RACs recovered $473.92 million in improper payments in fiscal year 2016.” Kristin Walter, a spokesperson for a RAC trade association, says, “The vital billing oversight provided by the RAC program continues to be severely hampered by a [documentation] limit that allows 99.5% of Medicare fee-for-service claims to be paid without review.” However, the American Hospital Association says claims should reviewed by quality improvement organizations (QIOs) instead of RACs, since in QIOs, physicians are typically “the first to review claims in these organizations.”

        Fierce Healthcare  (9/19, Sweeney) reports that Walter, spokesperson for the Council for Medicare Integrity, said, “Recently, CMS Administrator Seema Verma shared concerns that the Medicare program reviews less than three-tenths of 1% of the nearly 1.5 billion claims paid each year. ... This lack of oversight is taking place at a time when the program is losing approximately $40 billion per year due to preventable billing mistakes.”

Legislation and Policy

HHS Awards More Than $1 Billion In Grants To Help Combat Opioid Epidemic.

The Hill  (9/19, Hellmann) reports that on Wednesday, HHS announced “it has awarded more than $1 billion in grants to states, communities and organizations fighting the opioid crisis.” Most of that money – “$930 million – is intended to support states’ efforts to provide treatment and prevention services to combat opioid abuse.” The Hill says an additional “$352 million was awarded to 1,232 community health centers to increase access to services for substance use disorder and mental health needs.” HHS Secretary Alex Azar said, “Addressing the opioid crisis with all the resources possible and the best science we have is a top priority for President Trump and for everyone at HHS. ... The more than $1 billion in additional funding that we provided this week will build on progress we have seen in tackling this epidemic through empowering communities and families on the frontlines.”

        The AP (9/19) reports that while “opioid-related deaths are still high, Azar says there are signs of progress, such as a drop in prescriptions for opioid” pain medications.

Arkansas Official Proposes Folding Insurance Exchange Into State Agency.

The Arkansas Democrat Gazette  (9/19, Davis) reports that Arkansas Insurance Commissioner Allen Kerr told state lawmakers on Tuesday that the state Insurance Department “could lower a fee charged to insurance companies and reduce state spending by more than $3.2 million by taking over responsibility for the state’s health insurance exchange.” Officials with the Arkansas Health Insurance Marketplace, which now has responsibility for the exchange, “countered that the savings would be less than that because the marketplace has already been cutting its own spending.” A legislative panel is “exploring whether the marketplace’s responsibilities should be shifted to the Insurance Department.”

Public Health and Private Healthcare Systems

After Years Of Premium Hikes, Houston-Area Insurers Now Seeking Rate Reductions For ACA Plans.

The Houston Chronicle  (9/19, Deam) reports that after increasing ACA premiums for years, insurers in the Houston area are now requesting rate reductions. For instance, “Blue Cross and Blue Shield of Texas...filed a request for 2019 to cut rates by about 6 percent for two ACA individual plans after making national headlines by requesting increases for 2017 of nearly 60 percent.” The article says these “rate reductions come, ironically, as the health care law, known as Obamacare, continues to come under attack by the Trump administration and its Republican allies.”

Montana Forming Working Group To Determine If State Could Benefit From A Reinsurance Program.

The Montana Standard  (9/19, Michels) reports that Montana is mulling whether a state-run “reinsurance program would help lower the premiums people who buy their health insurance on the federal marketplace pay, in some cases by 10-20 percent.” The article says insurers purchase “reinsurance to offset risks from covering people with high-cost and sometimes pre-existing conditions, essentially protecting the companies from high claims for that group of people.” Gov. Steve Bullock (D) and Department of Administration Director John Lewis are forming “a 13-person working group to explore how a state-run reinsurance program might work in Montana.”

DOJ Says CVS Health And Aetna Need To Disclose Medicare Part D Assets Before It Will Approve Merger.

Healthcare Finance News  (9/19, Morse) reports that due to antitrust concerns, the Justice Department said “CVS Health and Aetna need to divest some of their Medicare Part D assets” before it “will grant approval for their proposed $69 billion mega-merger.” The piece says, “The merger...would add a pharmacy benefit manager to one of the nation’s largest health insurance companies.”

Walmart Inks Deal With Anthem Will Bring OTC Medications, Health Supplies To Stores.

CNN Money (9/19, Luhby) reports Walmart inked a deal last month with Anthem “to entice more Medicare enrollees to buy over-the-counter medications and health supplies at its stores.” Walmart’s moves “will help it gain a further foothold in this market and deepen its relationship with its 140 million weekly customers” as the company “is looking to fend off rivals, including Amazon.” The article says Walmart “is eyeing both the Medicare and Medicaid markets since many of its customers are senior citizens and lower-income Americans” and its prices are “generally lower than at pharmacy chains, such as CVS.”

Also in the News

Tax Break For Humana Expansion In Massachusetts Delayed Over Incomplete Application.

The Boston Globe  (9/19, Chesto) reports a tax break for Humana to open a digital health and analytics center in the Boston area, has been delayed as the state’s Economic Assistance Coordinating Council has unexpectedly “rejected that initial request after noticing that Humana failed to answer a question about past labor disputes in its application.” The council did “certify the company’s expansion project as eligible for a tax break” and may take the issue up again at its December meeting, the article says.

Jeff Sopko