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What We're Reading: HHS OIG Cites MA Plans; Shifts in Place of Death; FDA Warns Drugmaker
The HHS’ Office of the Inspector General (OIG) released a report that says Medicare Advantage (MA) plans received an estimated $6.7 billion in 2017 after adding diagnoses to patients' files that were not supported by their medical records; more Americans are dying at home rather than in hospitals or nursing homes; the FDA warned Alkermes, maker of Vivitrol, a long-acting antiaddiction medication, that its printed advertisement does not include the risk of an increased chance of a “potentially fatal” opioid overdose as the effects wear off.
Inspector General Says MA Plans Received Billions From Adding Unsupported Diagnoses
The HHS’ Office of the Inspector General released a report that says Medicare Advantage (MA) plans received an estimated $6.7 billion in 2017 after adding diagnoses to patients’ files that were not supported by their medical records. Reuters reported that MA plans added diagnoses for diabetes, heart disease, and other conditions in 99.3% of chart reviews of patient information and deleted incorrect diagnoses less than 1% of the time. The deleted information cut government payments by nearly $200 million, netting $6.7 billion.
More Americians Dying at Home, Not Hospitals, Nursing Homes
More Americans are dying at home rather than in hospitals or nursing homes, according to a report published in The New England Journal of Medicine. The report used government health statistics on deaths from natural causes from 2003 through 2017. Hospital deaths fell from 40% to 30% over that period and deaths in nursing homes from 24% to 21%. The shift to home deaths—not seen in about a hundred years or more—reflects more hospice care and progress toward the kind of end-of-life care that most people say they want.
FDA Warns Alkermes That Vivitrol Ad Lacks Information About Potential Risk of Overdose
The FDA warned Alkermes, maker of Vivitrol, a long-acting antiaddiction medication, that its printed advertisement does not include the risk of an increased chance of a “potentially fatal” opioid overdose as the effects wear off. Vivitrol, a long-acting version of naltrexone, is administered by injection every 28 days. If patients miss a dose or stop using it altogether, they risk overdosing if they take a legal or illegal opioid in the same amount they were previously consuming, The Washington Post reported.
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
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Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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