Medicare Overpaid $251 Million in 18 Months for Drugs
By reimbursing certain drug providers based on outdated pricing, Medicare has squandered millions of dollars that could have been saved if the recommendations of a government watchdog had been followed.
As reported by The Washington Examiner, the Office of the Inspector General for the Health and Human Services Dept. found that Medicare has continued to pay providers of infusion drugs, which are delivered through IV pumps, at higher prices than necessary. HHS is paying providers based on 2003 prices when the drugs were more expensive--this despite warnings from the IG, most recently in February, 2013.
“Medicare payment amounts for infusion drugs…substantially exceeded the estimated acquisition costs,” according to findings reported on the IG’s website.
The IG said that had its recommendations been implemented, $251 million would have been saved over an 18-month period.
The Centers for Medicare & Medicaid Services (CMS) apparently ignored the IG when it proposed that the agency push legislation that would have brought the method of reimbursement for infusion drugs in line with the process for other pharmaceuticals. As an alternative, the IG recommended that the CMS employ competitive bidding to supply infusion drugs.
“CMS partially concurred with the first recommendation, but has not taken steps toward seeking legislation,” The IG’s report said. “CMS concurred with the second recommendation but said subsequently that…infusion drugs will not be included in competitive bidding until at least 2017.”
So presumably the overpaying won’t stop anytime soon.
Increasing Number of Americans Delay Medical Care Due to Cost: Gallup
From Gallup: “A record 25% of Americans say they or a family member put off treatment for a serious medical condition in the past year because of the cost, up from 19% a year ago and the highest in Gallup's trend. Another 8% said they or a family member put off treatment for a less serious condition, bringing the total percentage of households delaying care due to costs to 33%, tying the high from 2014.”
Number of the Day: $213 Million
That’s how much the private debt collection program at the IRS collected in the 2019 fiscal year. In the black for the second year in a row, the program cleared nearly $148 million after commissions and administrative costs.
The controversial program, which empowers private firms to go after delinquent taxpayers, began in 2004 and ran for five years before the IRS ended it following a review. It was restarted in 2015 and ran at a loss for the next two years.
Senate Finance Chairman Chuck Grassley (R-IA), who played a central role in establishing the program, said Monday that the net proceeds are currently being used to hire 200 special compliance personnel at the IRS.
US Deficit Up 12% to $342 Billion for First Two Months of Fiscal 2020: CBO
The federal budget deficit for October and November was $342 billion, up $36 billion or 12% from the same period last year, the Congressional Budget Office estimated on Monday. Revenues were up 3% while outlays rose by 6%, CBO said.
Hospitals Sue to Protect Secret Prices
As expected, groups representing hospitals sued the Trump administration Wednesday to stop a new regulation would require them to make public the prices for services they negotiate with insurers. Claiming the rule “is unlawful, several times over,” the industry groups, which include the American Hospital Association, say the rule violates their First Amendment rights, among other issues.
"The burden of compliance with the rule is enormous, and way out of line with any projected benefits associated with the rule," the suit says. In response, a spokesperson for the Department of Health and Human Services said that hospitals “should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it.”
See the lawsuit here, or read more at The New York Times.
A Decline in Medicaid and CHIP Enrollment
Between December 2017 and July 2019, enrollment in Medicaid and the Children's Health Insurance Program (CHIP) fell by 1.9 million, or 2.6%. The Kaiser Family Foundation provided an analysis of that drop Monday, saying that while some of it was likely caused by enrollees finding jobs that offer private insurance, a significant portion is related to enrollees losing health insurance of any kind. “Experiences in some states suggest that some eligible people may be losing coverage due to barriers maintaining coverage associated with renewal processes and periodic eligibility checks,” Kaiser said.
