Welcome to Capsule—your weekly dose of health-care news, where we give you a recap of this week’s highs and lows for key players in the health-care industry. You can expect us every Friday morning as a bookend for your week.
Gobble gobble, everyone. I hope you had a lovely Thanksgiving. Running around Walmart in search of Black Friday deals is one way to burn off Turkey Day bloat, but please be careful. I don’t want next week’s Capsule to include a story about someone’s enormous hospital bill from being trampled by a discount-frenzied mob. If you’re looking for something to read while you stand in line, let’s take a look at this week’s health news.
Here’s who ended the week on a high note:
- The federal Medicare agency gets a lot of flak for bad money management, but a financial report shows the Centers for Medicare & Medicaid Services slashed its improper payments to health providers by $4.6 billion in FY 2018 compared with the year before, James Swann reports.
- That brings the agency’s improper payment rate to 8.1 percent, which is the lowest it has been since 2010. Don’t get too excited, though. That new error rate still means the CMS wasted $31.6 billion this year. The waste results from a range of problems, from paperwork errors to deliberate fraud.
- The chairman of the Senate committee in charge of government oversight wants to know whether the CMS plans to get any of this wasted money back, Shira Stein writes, particularly Medicaid money wasted in California.
- Sen. Ron Johnson (R-Wis.) probed Seema Verma, administrator of the CMS, on how the agency plans to conduct more oversight of the California’s Medicaid program and whether there are plans to recoup roughly $3.3 billion in improper Medicaid payments made there.
- Scott Lloyd is settling in as senior adviser in the Department of Health and Human Services’ Center for Faith and Opportunity Initiatives, Shira Stein reports. Lloyd used to work in the office in charge of sheltering children who were separated from their parents after being brought into the U.S. Now he’ll likely use his new status to champion religious rights and anti-abortion sentiments.
- You may remember when he worked to prevent several undocumented teens from getting abortions, which led to the ACLU fighting in court to stop the policy.
- Lloyd said he will help “develop bold ideas on how communities and faith-based entities can play a central role in successfully achieving the Secretary’s priorities.” Religious freedom has been a major priority for this administration—as has restricting federal funding for abortions, which critics say will lead to access issues.
- The number of Americans looking to buy their way into Medicaid is growing after more Democratic governors and state legislators were elected recently, Sara Hansard writes.
- A buy-in program would be another option for those who earn too much to get help paying for health insurance under Obamacare. Under the Affordable Care Act, people with incomes below 400 percent of the federal poverty line qualify for subsidies to help them pay premiums.
- States that are contemplating Medicaid buy-in programs have already expanded their Medicaid programs to cover people at 138 percent of the federal poverty level, as allowed under the ACA. Health insurers fear they’ll lose business if people are allowed to buy into Medicaid at cheaper rates than individual health insurance plans, Hansard reports.
- Governors-elect in New Mexico, Illinois, and Connecticut have called for allowing residents to buy into Medicaid. New Mexico is furthest along in planning for a possible Medicaid buy-in option.
It was a bleak week for others. Here’s whose Thursday closed on a downswing:
- California residents affected by the wildfires are struggling as the death count rises and hundreds of people remain missing. At least 77 people are dead and more than 900 are unaccounted for after the Camp Fire swept through the Sierra foothills town of Paradise, destroying more than 11,000 homes and scorching an area hundreds of square miles wide, Bloomberg News’ Kristen V. Brown reports.
- Many victims were burned beyond recognition, making identifying remains a difficult task using traditional DNA-analysis techniques. Consequently, California officials have turned to DNA-testing technology designed for war zones—a testament to the devastating power of the state’s deadliest fire in a century.
- Authorities called in ANDE, a firm that specializes in rapidly analyzing DNA from the field. Family members of those missing are being asked to give cheek swabs to help identify the dead.
Federal Employees’ Opioids
- Opioid blowback reached federal employees this week when the Labor Department began scrutinizing how much government workers use prescription opioids, much to the chagrin of federal employee unions, Jaclyn Diaz reports.
- The department has set aside more than $3.5 million for the job. That includes hiring 31 full-time employees to analyze prescriptions, encouraging doctors and patients to consider alternatives to opioids, and even denying benefits coverage for opioids in some cases.
- The plan has raised a red flag for federal employee unions, Diaz writes. Those groups question whether the added scrutiny is necessary, and they say there’s no clear evidence of a high rate of opioid abuse among federal workers.
- The effort is part of President Donald Trump’s larger focus on combating the opioid epidemic, which culminated in him signing a massive bill into law in October. That bill didn’t cover prescriptions for federal workers, but the DOL’s changes follow a much wider effort across the country to drastically reduce the length of opiate prescriptions.
Sketchy Drug Facilities
- Unscrupulous substance abuse treatment providers are facing increased government scrutiny, Matt Phifer writes. The Justice Department is taking a new hard line on kickbacks, unnecessary treatments, and excessive urine tests at “sober homes” and other substance abuse facilities.
- Southern Florida has been hit especially hard. So far this year at least 34 people there were charged, 19 people convicted, and more than $20 million in restitution ordered for a variety of crimes related to substance abuse treatment fraud and the illegal distribution of opioids.
- Fraud doesn’t only mean improper toxicology exams. Sometimes patients’ insurances are billed for unnecessary medications, psychological exams, and evaluations. Patients are also potentially being kept in facilities longer than necessary, a former Justice Department attorney tells Phifer.
Thanks for joining us this week and have a great weekend. I’m all ears when it comes to your two cents, tips, critiques, or coordinating exclusive interviews. Send them my way at firstname.lastname@example.org.
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