Bill Introduced in Congress to Limit Medicare Advantage Prior Authorization On May 21, 2021, House Bill 3173 (117th Congress), which seeks to cut red tape on prior authorizations in Medicare was introduced. The bill would require Medicare Advantage plans to report approval and denial rates. The bill was introduced by Representative Larry Buchon, MD, and...

CMS Inspector General Find Millions in Overpayment to Anthem Health Care On May 24, 2021, CMS’ Inspector General announced a finding that health insurer Anthem failed to comply with some federal coding requirements, resulting in overpayments to Anthem of $3.47 million.  Under the Medicare Advantage program, CMS makes monthly payments to organizations according to a...

U.S. Department of Health and Human Services Announces Several New Appointments On May 25, 2021, the U.S. Department of Health and Human Services announced 15 new appointments: 1. Steve Cha, MD, was named counselor to the secretary, Agency for Healthcare Research and Quality/Food and Drug Administration/National Institutes of Health. 2. Melanie Fontes Rainer was named...

Two Reports on Health Care Trends Released The American Medical Associaion released two separate reports on health care trends in May. The first report was on 2019 health care spending. This report provides a detailed look at the official U.S. health care spending estimates through 2019 using data from the CMS. It also presents preliminary...