CMS, Medicare

A Covid Test Medicare Scam May Be a Trial Run for Further Fraud

By Susan Jaffe, KHN  | May 18, 2023 | This story also ran on  

Medicare coverage for at-home covid-19 tests ended last week, but the scams spawned by the temporary pandemic benefit could have lingering consequences for seniors.

Medicare advocates around the country who track fraud noticed an eleventh-hour rise in complaints from beneficiaries who received tests — sometimes by the dozen — that they never requested. It’s a signal that someone may have been using, and could continue to use, seniors’ Medicare information to improperly bill the federal government. …One beneficiary in Indiana suspected something was amiss after receiving 32 unrequested tests over a 10-day period. [Continued on Kaiser Health News, NPR, Yahoo News, and St. Louis Post-Dispatch]

The Lancet

US Surgeon General: loneliness is a public health crisis

Volume 401, Issue 10388   ||   13 May 2023  

 

WORLD REPORT  A new report by the USA’s leading public health advocate calls for widespread efforts to address social isolation. Susan Jaffe reports from Washington, DC.

The USA has an “epidemic of loneliness”, according to a new advisory from the Surgeon General, Vivek Murthy. “Loneliness is far more than just a bad feeling—it harms both individual and societal health”, Murthy warns. “It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death.” [Continued here.] 

FDA, The Lancet

Drug developers caution against US mifepristone ban

Volume 401, Issue 10385
22 April 2023 

 

WORLD REPORT     A lawsuit against the FDA embroils pharmaceutical companies in debates over access to
abortion. Susan Jaffe reports from Washington, DC.

Less than 1 year after the US Supreme Court ended its 1973 constitutional guarantee to an abortion and told state lawmakers that they could decide whether a person ends their pregnancy, abortion is now back before the court. But this fresh legal challenge has dragged the nation’s entire drug approval system along with it, rousing a powerful lobbying group and economic force that has mostly managed to avoid the fray—the pharmaceutical industry. [Continued here.]

EPA, The Lancet

Hazardous train spills prompt calls for tougher safety rules

Volume 401, Issue 10383
8 April 2023 

 

WORLD REPORT  New bipartisan legislation has been proposed to protect health and safety following a train derailment in East Palestine, Ohio, USA. Susan Jaffe reports from Washington, DC.

A flammable brew of toxic chemicals from a freight train that went off the tracks in the Ohio village of East Palestine is no longer burning but the impact of the wreck is far from over. A massive clean-up continues along with water, soil, and air monitoring. Several government agencies are involved in recovery efforts and are investigating what went wrong. And in a rare show of bipartisanship, Democrats and Republicans in Congress have proposed legislation aimed at closing the gaps in rail safety rules that the accident exposed. The accident’s aftermath has also reached the courts. [Continued here.]

CDC, CMS, EPA, HHS

US plan to shield science from “inappropriate influence”

Volume 401, Issue 10375
11 February 2023 

 

WORLD REPORT  The Biden administration is launching a new initiative on scientific integrity in federal agencies following multiple lapses. Susan Jaffe reports from Washington, DC.

Just a week after Joe Biden was sworn in as president in January, 2021, he created a multi-agency Task Force on Scientific Integrity to restore “trust in government through scientific integrity and evidence-based policy making”…Last month, the White House Office of Science and Technology Policy released A Framework for Federal Scientific Integrity and Practice, a follow-up to the task force’s 2022 recommendations that provides a blueprint for implementation. [Continued here.] 

Affordable Care Act, EPA, Global Health, Medicaid, The Lancet

Modest health goals for new US Congress

Volume 400, Issue 10369
17 December 2022 

 

WORLD REPORT  With Congress almost evenly split between Republicans and Democrats, consensus on any major health legislation is unlikely.  Susan Jaffe reports. 

When a new US Congress convenes in January, 2023, the slim Republican majority in the House of Representatives and the Democrats’ even smaller margin in the Senate will not enable either party to make major changes in the health-care system. With President Joe Biden promising to use his veto power to defend his health-care agenda, no significant fixes are expected. But there appears to be bipartisan support for some less ambitious legislation on issues that will overcome congressional gridlock.[Continued here.]

CDC, The Lancet

US CDC begins agency-wide changes after pandemic failures

Volume 400, Issue 10365
19 November 2022 

 

WORLD REPORT  An independent review made several recommendations for improving the public health agency. Susan Jaffe reports from Washington, DC.

The US Centers for Disease Control and Prevention (CDC) is on a mission to reorganise and modernise itself, so that its mistakes during the pandemic will not happen again. The aim is to make the nation’s leading disease detective more nimble and accountable, and fortify its role as public health protector. But although some changes have been made, progress will be limited without support from Congress. [Continued here.] 
CMS, Drugs

Medicare Plan Finder Likely Won’t Note New $35 Cap on Out-of-Pocket Insulin Costs

By Susan Jaffe, KHN  | November 15, 2022 | This story also ran on

A big cut in prescription drug prices for some Medicare beneficiaries kicks in next year, but finding those savings isn’t easy.

Congress approved in August a $35 cap on what seniors will pay for insulin as part of the Inflation Reduction Act, along with free vaccines and other Medicare improvements. But the change came too late to add to the Medicare plan finder, the online tool that helps beneficiaries sort through dozens of drug and medical plans for the best bargain.

To fix anticipated enrollment mistakes, Medicare officials will give beneficiaries who use insulin a chance to switch plans next year. Typically, people are locked in for an entire year. [Continued on Kaiser Health News and US News & World Report]

CMS, HHS, Medicare, Medicare costs

Medicare considers expanding dental benefits for certain medical conditions

By Susan Jaffe, KHN  | October 17, 2022 | This story also ran on

Proposed changes in Medicare rules could soon pave the way for a significant expansion in Medicare-covered dental services, while falling short of the comprehensive benefits that many Democratic lawmakers have advocated.

That’s because, under current law, Medicare can pay for limited dental care only if it is medically necessary to safely treat another covered medical condition. In July, officials proposed adding conditions that qualify and sought public comment. Any changes could be announced in November and take effect as soon as January. The review by the Centers for Medicare & Medicaid Services follows an unsuccessful effort by congressional Democrats to pass comprehensive Medicare dental coverage for all beneficiaries, a move that would require changes in federal law. As defeat appeared imminent, consumer and seniors’ advocacy groups along with dozens of lawmakers urged CMS to take independent action. [Continued on Kaiser Health News and CNN]

Appeals, CMS, Medicare Advantage

Nursing Home Surprise: Advantage Plans May Shorten Stays to Less Time Than Medicare Covers

“The health plan can determine how long someone is in a nursing home typically without laying eyes on the person.”

By Susan Jaffe  | Kaiser Health News | October 4, 2022 | This KHN story also ran on Fortune logo

Amy Loomis (left) and Paula Christopherson (photo by Charles Christopherson)

After 11 days in a St. Paul, Minnesota, skilled nursing facility recuperating from a fall, Paula Christopherson, 97, was told by her insurer that she should return home.

“This seems unethical,” said daughter Amy Loomis, who feared what would happen if the Medicare Advantage plan, run by UnitedHealthcare, ended coverage for her mother’s nursing home care.  The facility gave Christopherson a choice: pay several thousand dollars to stay, appeal the company’s decision, or go home.

But instead of being relieved, Christopherson and her daughter were worried because her medical team said she wasn’t well enough to leave.

Health care providers, nursing home representatives, and advocates for residents say Medicare Advantage plans are increasingly ending members’ coverage for nursing home and rehabilitation services before patients are healthy enough to go home.  [Full story in and Fortune, Kaiser Health News, The Philadelphia Inquirer, and Yahoo News]

 

Drugs, FDA, The Lancet

FDA panel says preterm birth drug should be withdrawn

Volume 400, Issue 10362
29 October 2022 

 

WORLD REPORT  Makena has been given to hundreds of thousands of patients over the past 11 years. Susan Jaffe reports from Washington, DC.  

The only treatment in the USA to prevent premature births is ineffective and should be withdrawn from the market, according to the Food and Drug Administration’s (FDA) Obstetrics, Reproductive and Urologic Drug Advisory Committee. The recommendation has renewed scrutiny of a special drug approval process that raises patients’ hopes by allowing them to take medications that have not been fully tested for efficacy and safety [Continued here.] 

EPA, Medicare costs, The Lancet

Health organisations welcome US climate crisis law

Volume 400, Issue 10354
3 September 2022 

 

WORLD REPORT  The recently passed Inflation Reduction Act will provide billions of dollars of incentives to reduce greenhouse gas emissions. Susan Jaffe reports.

There are no emission limits or pollution penalties in the landmark Inflation Reduction Act that Congress approved in August. Instead of forcing cuts, the climate change and healthcare law provides US$370 billion worth of incentives to ratchet down the planet-warming greenhouse gases from fossil fuels that have caused record-breaking heat waves, wild fires, droughts, and floods.  …The law provides $60 billion for communities that have been disproportionately affected by toxic hazards and the consequences of climate change.  [Continued here.] 

Affordable Care Act, CMS, Drugs, Medicare costs, The Lancet

US Congress lets Medicare negotiate lower drug prices

Volume 400, Issue 10352
20 August 2022 

 

WORLD REPORT  A new law also targets climate change in a major victory for Democrats and President Joe Biden. Susan Jaffe reports from Washington, DC.

Shattering decades of opposition from the pharmaceutical industry and its allies, slim Democratic majorities in the US House of Representatives and Senate have passed landmark legislation to begin to control runaway drug prices for almost 50 million older Americans with Medicare’s pharmaceutical benefit. The bill also provides the largest federal investment in US history—US$370 billion—to slash greenhouse gases by 40% below 2005 emissions and respond to the devastating effects of climate change…. The legislation also ensures that no Medicare beneficiary pays more than $2000 a year for drugs. “That means you will have more money in your pocket”, said Tatiana Fassieux, education and training specialist at California Health Advocates. [Continued here.]
FDA, HHS, The Lancet

“Chaos” for patients and providers after US abortion ruling

Volume 400, Issue 10346
9 July 2022 

 

WORLD REPORT  A patchwork of state laws replace abortion rights once guaranteed by Roe v Wade. Susan Jaffe reports from Washington, DC.

The US Supreme Court’s bombshell decision overturning Roe v Wade on June 24, 2022, assures Americans that each state can choose whether and under what conditions its residents have a right to a safe and legal abortion. So far, the result is an incoherent and volatile jumble:16 states have severely restricted or banned the procedure and bans in ten more states are likely to take effect in a matter of weeks. [Continued here.]  

 

FDA, HHS, The Lancet

Federal abortion rights end, but not legal challenges

Volume 400, Issue 10345
2 July 2022  

WORLD  REPORT  The US Supreme Court’s decision to overturn Roe v Wade is due to spark further court cases. Susan Jaffe reports from Washington, DC. 

The Supreme Court’s momentous decision to abolish the half-century-old federal right to abortion not only rapidly reconfigures the political and legal landscape in the USA, threatening a host of other long-held personal freedoms. The seismic shift also ignites new legal battles within states that ban or severely restrict abortions, only 4 months before the mid-term elections that will establish which party controls Congress for the next 2 years.  Put simply, the ruling is “the legal equivalent of a nuclear bomb”, according to legal affairs correspondent for National Public Radio and veteran Supreme Court observer, Nina Totenberg. [Continued here.]