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House committee questions Cigna over ProPublica report
Plus: Potential new billing law in TX and a blast from the past with Leslie Nielson
Good morning and happy Friday,
You’re reading the Friday Pulse Check from Fulcrum Strategies and FLATLINING.net.
In the news:
Congressional committee questions Cigna over ProPublica report
In March, our own President and CEO Ron Howrigon was interviewed for a ProPublica investigation that investigated Cigna’s use of software to routinely deny claims. Using the system, Cigna (CI 0.00%↑) was able to deny 60,000 claims in a month; that is a little high and raises eyebrows. The House Energy and Commerce Committee took notice of the report and has demanded information from Cigna. They want to know how the system works, what plans (including Medicare Advantage plans) are run through the system, the number of claims denied, the number of denials that were overturned upon appeal, and more. Read more from the Energy and Commerce Chair.
New Texas billing transparency law heads to governor’s desk
Texas SB 490 has passed the Texas legislature and is on its way to Governor Greg Abbott’s desk. The new bill would require hospitals to provide an itemized bill to patients after they receive medical services. In current Texas law, patients can request an itemized bill but it is not automatically sent. The bill also requires hospitals to include a plain language description of the charge and billing codes. The bill was amended before it was passed; the amended bill only applies to hospitals and healthcare facilities, not physicians or federally qualified healthcare facilities. Read the text of the bill on Texas Legislature Online.
Some Medicaid patients in South Dakota and North Carolina may face a coverage gap in the coming months. During the COVID-19 pandemic, states were barred from disenrolling people from the medical safety net program even if they no longer qualified. Now that the health emergency is over and pandemic-era orders have lifted, states will go about cleaning up their Medicaid rolls. In South Dakota and North Carolina where voters and the legislature respectively have elected to expand Medicaid enrollment, some patients will be removed from the rolls for a few months because they no longer qualify, but they will qualify in a few months. In North Carolina, one official estimates one-third of those disenrolled will re-qualify. Read more from CBS News.
COVID-19 test Medicare scam could be bell weather test for future fraud
The Department of Health and Human Services has received complaints from around the country that allege at-home COVID-19 tests, which are no longer covered by Medicare, are being illegally billed to Medicare. HHS says that scammers are using Medicare information obtained illegally, likely on the dark web, to scam money from the federal government. If Medicare members are receiving tests they did not order, it could mean that their information has been stolen and there could be more fraud in the future. Read more from KFF Health News.
Other articles of interest:
The FLATLINING Podcast
In other payor news this week, reactions poured in from gastroenterologists who are frustrated that UnitedHealthcare will be requiring prior authorizations for diagnostic and surveillance colonoscopies. Clearly, it is a way for UnitedHealthcare to save a buck.
UnitedHealthcare (UNH 0.00%↑) says the change is only to clamp down on overutilization and will only affect those who abuse the system already. Hmmm. At the same time, UnitedHealthcare also claims their cutting prior authorizations by twenty percent across the board. Hmmm.
Additionally, in other payor and Congressional news, the Senate Health, Education, Labor, and Pensions Committee passed pharmacy benefit reform this week. The new bill ends the PBM practice of price spreading. It will probably be introduced on the Senate floor later this year with a package of other healthcare bills.
We talked about all of this on the FLATLINING Podcast. You can listen here on FLATLINING.net or by searing for the FLATLINING Podcast wherever you listen to podcasts.
In Ukraine’s Zaporizhzhia region, physicians working at medical clinics are working hard to provide first aid to soldiers and civilians before they are sent to hospital’s further away from the fighting. According to one of the doctors, artillery accounts for ninety percent of the injuries they treat. Read more from Reuters via Microsoft Start.
When writing the section on Medicare fraud above, I looked for a public service announcement I saw on television not too long ago, reminding seniors not to share their Medicare number. I couldn’t find it, but I did find this gem from 2001 featuring the late actor Leslie Nielsen encouraging seniors to call 1-800-Medicare for questions about their plan and claims. That phone number is still an active way to get in touch with Medicare.
Have a good weekend.