BY SUSANNAH LUTHI: Federal audits of Medicare Advantage plans’ provider directories have revealed sweeping inaccuracies for the third straight year, raising the specter of fines or other penalties for the insurers.
Nearly 50% of provider directory locations showed at least one mistake in the latest audit results, the CMS said late Friday. Those errors included the wrong location, phone number or the directory claimed the listed provider was accepting new patients when they weren’t.
The agency looks at about one-third of Medicare Advantage plans every year since the audits started under the Obama administration. (read more)
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BY PAIGE WINFIELD CUNNINGHAM: The Trump administration is holding off on punishing Medicare Advantage plans for error-ridden doctor directories — further evidence the conservative-led Centers for Medicare and Medicaid Services is showing special favor to the alternative program over traditional Medicare offerings.
In an audit quietly released late Friday, CMS found that nearly half the Medicare Advantage plans it reviewed had at least one error in the directories used by patients to find a health provider. In some cases, directories listed the wrong location or phone number. Sometimes they indicated a doctor is accepting new patients even though he or she isn’t. (read more)
BY MARTY STEMPNIAK: A new study out of Brown University takes a closer look at how private Medicare plans are attempting to influence which skilled nursing facilities patients use, and for how long.
Researcher Emily Gadbois, Ph.D., and coauthors noted that Medicare Advantage plans are typically giving patients specific lists of facilities that they can use where their care would be covered. And aiming to lower lengths of stay, plans are authorizing stays for only a certain number of days, and requiring that SNFs stick to those time limits, shows the analysis, published Monday in the American Journal of Managed Care. (read more)
OPINION: Trump Medicare plan promises lower prescription prices for seniors, but also risks losing coverage of some critical cancer, HIV, depression drugs
BY PETER J. PITTS and MERRILL MATTHEWS: Is the direct federal negotiation of drug prices a good idea? Consider the “non-interference clause” that currently prohibits such actions in Medicare Part D — the federal program that subsidizes prescription drugs for seniors. Surprise. The non-interference clause was written by Sens. Ted Kennedy and Tom Daschle — and it’s a good idea.
Nobody doubts that President Trump and his team are shrewd negotiators. But the sorts of “negotiations” that the president refers to in Medicare have nothing in common with haggling over a real estate deal. Specifically, his desire to repeal the non-interference clause would result in a sharp increase in Medicare drug prices and a substantial decline in patient choice. (read more)
BY SALVADOR RIZZO: The Defense Department is awash with money. So much money that neither the staff nor 1,200 auditors could make sense of where it all went. (The Pentagon recently failed its first big audit in history.)
Enter Ocasio-Cortez. She supports expanding Medicare to people under 65, what’s known as single-payer or Medicare-for-all. But the big question is how to pay for all that health care. According to an estimate from the Urban Institute, the price tag on Sen. Bernie Sanders’s Medicare-for-all proposal would be $32 trillion over 10 years. (read more)
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