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What We’re Reading: Medicare Advantage Denies Care; US in Pandemic Transition Phase; Measles Cases Rise
Investigators have found that Medicare Advantage plans were denying care that should be covered for tens of thousands of people; Anthony Fauci, MD, claimed that the United States is in the transition phase of the pandemic; measles cases rose by 79% in 2022.
Investigators Find Inappropriate Claim Denials by Medicare Advantage
A report from the HHS Office of Inspector General found that some Medicare Advantage Organizations (MAOs) delayed or denied access to services for Medicare Advantage beneficiaries despite the claims meeting Medicare coverage rules. Additionally, payments to providers for certain services that met the rules for Medicare coverage and MAO billing were denied. “We are able to reverse this some of the time,” said Kashyap Patel, MD, CEO, Carolina Blood and Cancer Care Associations, and current president of the Community Oncology Alliance, in The New York Times. Still, these avoidable delays may lead to friction and could create additional burden for beneficiaries, providers, and MAOs, the HHS report noted.
Fauci Says US is in Transition Phase of Pandemic
According to CNN, Anthony Fauci, MD, chief medical adviser to President Joe Biden and director of the National Institute of Allergy and Infectious Diseases, clarified that the United States is in a transition phase of the pandemic after claiming that the country was out of the pandemic. Fauci said that his original comments had been mischaracterized by some to mean that the pandemic is over when he meant that the United States is in a new phase, heading toward controlling the crisis without total disruption of social, economic, educational, and societal systems. The news comes after The Associated Press reported data from the CDC show that an estimated 3 in 4 children have been infected by SARS-CoV-2.
Measles Cases Jump Dramatically in 2022
Global measles cases rose by 79% during the first 2 months of 2022 compared with 2021 following rising COVID-19 cases and lockdowns that prevented many children from receiving their routine vaccinations, according a report from Reuters. The data from UNICEF and the World Health Organization showed that 17,338 cases of measles were reported during January and February 2022, which was 9665 cases higher vs cases reported during the same period in 2021. Measles is known to be a highly contagious disease, spreading faster than Ebola, influenza, and COVID-19. The countries with the largest measles outbreaks were Somalia, Liberia, Yemen, Afghanistan, and the Ivory Coast.
Generic Drug Savings Possibilities: $3.6 Billion to Medicare Using DTC Pricing
June 22nd 2022How much would have Medicare saved if it had the same ability to purchase generic drugs at the same price as individuals using direct-to-consumer (DTC) pharmacies like the Mark Cuban Cost Plus Drug Company? Billions, as it turns out.
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Health Equity & Access Weekly Roundup: January 11, 2025
January 11th 2025ACA enrollment rate hits a milestone, though IRA subsidies may not extend beyond 2025; network adequacy standards fail to translate into efficient access to mental health care for Medicaid enrollees; research examines racial disparities in postpartum hypertension and vaccine uptake.
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Investigating How Care Fragmentation May Affect Primary Care Redesign in Medicare
March 20th 2022On this episode of Managed Care Cast, Lori Timmins, PhD, and Eugene Rich, MD, discuss the findings of their interim analysis of data from the first 3 years of the Comprehensive Primary Care Plus Initiative, a large-scale effort of primary care redesign meant to improve care fragmentation among Medicare fee-for-service beneficiaries.
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Year-End Spending Bill to Feature Reforms for Pharmacy Benefit Managers and Telehealth Access
December 18th 2024The health care provisions include key reforms targeting pharmacy benefit managers, extensions of Medicare telehealth flexibilities, and measures aimed at combating the opioid crisis and preparing for future pandemics.
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