Yesterday, the Centers for Medicare & Medicaid Services (CMS) took action to improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care. Currently, Medicare-participating healthcare providers and suppliers are surveyed either by State survey agencies or by Accrediting Organizations (AOs) to ensure that they meet CMS’ quality and safety standards. AOs receive deeming authority from CMS, which affirms that AOs’ health and safety standards meet or exceed those of Medicare. Only facilities and suppliers that have been deemed by state or AO surveyors to meet CMS’ standards may receive payments from Medicare. There are currently 10 CMS-approved AOs, each of which surveys one or more different types of facilities. CMS will enhance and strengthen its oversight and quality transparency of AOs in three ways: 1) the public posting of AO performance data; 2) a redesigned process for AO validation surveys and 3) the release of the Annual Report to Congress. Taken together, these efforts will provide important insights to the public and assist AOs, providers, and suppliers in ensuring patient health and safety. (CMS.gov)
A group of 100+ health organization wrote a letter to HHS Secretary Alex Azar yesterday regarding their concern for cutting funding to public health and medical research programs and reallocating it to immigrant children detained at the Mexican border. The letter reads: "The decision to use the Secretary’s authority to cut public health and medical research programs is understandable given the immediacy of this crisis. We fear, however, that funding transfers to date are just the beginning. To the community’s knowledge, the administration has not yet submitted a comprehensive funding request to Congress to avoid future transfers, which is particularly concerning given that lawmakers have finalized funding for fiscal year 2019."
Mercy O. Ainabe, a patient recruiter from Houston, TX, was sentenced to 108 months in prison today for her role in a $3.6 million Medicare fraud scheme involving fraudulent claims for home health services. According to evidence presented at trial, Ainabe, a long-time patient recruiter in the Houston area, controlled a substantial population of Medicare patients whose personal information she sold to home health care companies in exchange for kickbacks. The evidence at trial showed that Ainabe and her co-conspirators used a home health care company called Texas Tender Care to submit claims to Medicare for home health services that were not medically necessary and/or were not provided. Ainabe paid beneficiaries, doctors, physical therapy companies and others for the paperwork, Medicare beneficiary information and services needed to facilitate the fraud. To cover up the fraud, Ainabe tried to make it look as though she was being paid an hourly wage as a legitimate marketing representative, the evidence showed. (Justice.gov)
Affordable Care Act
Applicants for the Iowa Farm Bureau's new health coverage will be asked whether they've been diagnosed or treated for a range of ailments, including diabetes, heart problems, or mental issues, new documents show. The company could turn away or charge more to some applicants with pre-existing health problems, company officials acknowledged Wednesday. The policies, which will go on sale Nov. 1, are expected to have lower premiums than standard health insurance policies. The controversial new plans offer an alternative to health insurance policies, which must comply with the federal Affordable Care Act, also known as Obamacare. Iowa is allowing the new policies’ sale under a law passed last spring that declared the Farm Bureau coverage technically would not be insurance, so it would not have to follow state or federal insurance regulations. Known legally as "health benefit plans," the new policies don't have to follow the rules that apply to health insurance — even though the policies offer members similar coverage to health insurance. (DesMoinesRegister.com)
Yesterday Blue Cross Blue Shield of Massachusetts became the first health plan in the state to provide opioid toolkits for employer customers. The kits, designed to be kept in the workplace, contain two doses of Narcan nasal spray, a surgical mask and gloves, and instructions on administering Narcan. Along with the kits, Blue Cross will provide onsite employee education and Narcan training, and an online opioid resource center, with information on family support, medication safety, pain management and opioid use disorder treatment care options, including information on how to access medication-assisted treatment. This decision was made in response to an opinion poll conducted last month by Anderson-Robbins Research and released by Blue Cross which revealed that 70% of Massachusetts residents believe the opioid-reversal drug commonly known as Narcan should be widely available in workplaces, similar to automated external defibrillators (AEDs). (BlueCrossMA.com)