Audit finds $12 mil in overcharges by MA plans
Plus: AI passes medical exam and Sec. Beccera turns 65
Good morning; it is Friday, 27 January 2023. This is the Friday Pulse Check from www.FLATLINING.net and Fulcrum Strategies. Keep reading on to the Final Thought to hear what Health and Human Services Secretary Xavier Beccera has to say about picking a Medicare plan now that he is sixty-five.
In the news:
Medicare Advantage plans overcharged the government by about $12 million
Kaiser Health News released previously unavailable audits conducted by the federal government between 2011 to 2013 into various Medicare Advantage plans across the US. KHN was able to access the records after a Freedom of Information Act lawsuit against the Centers for Medicare and Medicaid Services which was settled in September. The biggest overchargers were Humana ($2,965,323) (HUM 0.00), Cigna ($1,737,505) (CI 0.00), and Aetna ($1,274,399) (CVS 0.00). Also in the top ten list were WellCare, UnitedHealthcare (UNH 0.00), Molina (MOH 0.00), Blue Cross and Blue Shield of North Carolina, and UPMC Health System. CMS is expected to make a decision about how much money is owed back to the US Treasury by 1 February. Read more from Kaiser Health News.
Note to our readers on Substack: The green or red numbers next to the companies are live stock prices. The bold dollar amounts are the total overcharges.
Thousands of fake nursing diplomas issued from schools in south Florida
On Wednesday, federal agents from Health and Human Services and the Office of the Inspector General executed search warrants on twenty-five individuals in several states for being part of a scheme to issue fake nursing diplomas. The “students” at these schools would pay upwards of $10,000 for a diploma which enabled them to take the national nursing board exam. Roughly thirty percent of the “students” passed the exam and went on to work at Veterans Affairs hospitals, assisted living facilities, and with Medicaid patients across several states. The twenty-five individuals who sold the diplomas are facing charges but many of those who bought the diplomas could only lose certification. Read more from NewsNation.
ChatGPT passes US medical licensing exam
A language model called ChatGPT has been used to pass MBA and medical licence exams. The model was trained on a large dataset of exam questions and was able to generate answers that were indistinguishable from those written by a human. The model was able to pass the exams with a high degree of accuracy, raising concerns about the implications of using AI in education and professional certification.
That previous paragraph was written by the said AI bot. The artificial intelligence program is being studied at the University of Pennsylvania and researchers discovered that it passed the Ivy League Wharton School of Business MBA operations management exam with a B or a B-. Separately, Ansible Health researchers found that it “performed at or near the passing threshold for all three exams” to become a licensed physician in the US. On the flip side, the Pennsylvania researchers found that it has trouble computing basic sixth-grade math problems and in December, ChatGPT failed the Evidence and Torts section of the Multistate Bar Exam with a grade of only 50.3%. Read more from Global News.
Other items of interest:
NHS hospital fined £800,000 after infant death – Sky News
FDA shifts COVID-19 booster guidelines to match flu shots – National Public Radio
“Immediate jeopardy” status for OHSU after fire in OR – KGW Portland, Oregon
Ascension Texas and BCBS TX reach deal ahead of 1 Feb termination – Austin American-Statesman
Most people disenrolled from Medicaid have insurance 12 months later – Kaiser Family Foundation
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The FLATLINING Podcast
On the podcast this week, Ron and I discussed what happens if the US defaults on its debt, focusing specifically on Medicare. Right now, even though Treasury Secretary Janet Yellen has said the US is taking “extraordinary measures,” Medicare claims are still being processed and paid.
If a default happens, however, they might be delayed. Ron and I discussed what Congress is doing (or not doing) right now to keep that from happening and whether or not Republican hostage-taking will work. Also, I still can’t get over that some think a $1,000,000,000,000 coin would solve the problem.
We also covered some other healthcare headlines from the week.
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Russian President Vladimir Putin said on Tuesday that his country is facing a shortage of some medications. At the start of the war, Russia quickly began to manufacture more of its own pharmaceuticals and, according to Putin, they produce sixty percent of their own drugs. Western sanctions do not apply to drugs or medical equipment. Read more from FOX News.
Despite our differences in opinion in how existing laws should be enforced (ahem, the No Surprises Act), we’d like to wish a happy birthday to HHS Secretary Xavier Beccera. Secretary Beccera turned sixty-five yesterday making him eligible for Medicare.
He celebrated at the Vida Senior Centers in Washington with songs, speeches about COVID-19 vaccines, and was even gifted a giant, replica Medicare card (all things every sixty-five-year-old wants on his or her birthday).
And, of course, he was asked if he was going to opt for traditional Medicare or Medicare Advantage. He said, “I am, right now, still covered through the federal health benefits program. So I’m applying for Medicare Part A, but that’s only [because] I’m still getting covered through my employee benefits.”
Very diplomatic for someone whose department uncovered $12 million in overcharges by big insurance.
Have a good weekend,