Labor day is the traditional start of fall in the United States even though it doesn’t occur in the mainland US until later in the month. In any case, it’s tough to tell that fall is getting close from the outside temperature, at least not on the east coast.
Weather-wise it’s been a very difficult year all over the country, but Medicare and Medicare policy don’t take the summer off, so here’s a compendium of Medicare news from the last couple of months. Please note that some of these articles are behind a paywall, but I’ve provided free links where possible.
Some big news for Medicare beneficiaries concerns the new Federal drug- pricing guidelines that are part of President Biden’s Inflation Reduction Act (IRA). But equally important is that we can’t count our savings just yet; Big Pharma isn’t happy about anything that could put a dent in their huge profits and many companies are suing the Department of Health and Human Services (HHS) as Medpage Today details.
But those of us who’ve been buying our prescriptions through Medicare-Part-D insurance policies are already too familiar with Big Pharma’s profit-making agenda. This is especially true of some of the most popular drugs on the market, as AARP describes. In addition, if you’re not already aware of it, the same drugs that are included in the IRA are already sold to people in other countries at prices far lower than in the United States, according to the Lever.
Price gouging by a range of Medicare providers isn’t exactly news to beneficiaries, but the last several months have seen an increase in reporting about these issues. The Lever documents the ways in which Medicare Advantage (the private insurance alternative to Medicare) pads its profits by denying care. And the Washington Monthly shows us that it’s not Medicare, but medical monopolies that are responsible for higher medical bills.
While we’re on the subject of price gouging, Medicare fraud continues to be a very profitable business model. Here are just a few recent examples:
The New York Times reports that some nursing homes illegally misused Medicare and Medicaid funds for personal enrichment and neglected patients, according to the New York attorney general, Letitia James.
According to Axios the Centers for Medicare and Medicaid Services CMS) cited the growing popularity of schemes in which providers, sometimes listed at false addresses, fraudulently claim they are providing hospice care for patients who are not terminally ill.
STAT News reports that the Federal government is fining Medicare Advantage plans for overcharging their members.
The Department of Justice (DOJ) stays on top of Medicare fraud; unfortunately there’s plenty of work for them.
Watermark Retirement Communities to Pay $4.25 Million for Allegedly Receiving Kickback in Violation of the False Claims Act
Lab Owner Sentenced for $463M Genetic Testing Scheme
Doctor Convicted for COVID-19 Health Care Fraud Scheme
Chief Compliance Officer Convicted of $50M Medicare Fraud Scheme