June 3, 2021

CMS Inspector General Find Millions in Overpayment to Anthem Health Care

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 system of risk adjustment determined by the health status of each enrollee. CMS relies on Medicare Advantage insurers to collect diagnosis codes from providers and submit them to CMS. Some of the diagnoses are at a higher risk of being miscoded.  For the audit, CMS sampled 203 unique enrollee-years from Anthem and focused on seven groups of high-risk diagnosis codes to determine whether the codes […]
June 3, 2021

U.S. Department of Health and Human Services Announces Several New Appointments

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 counselor to the secretary, Affordable Care Act/marketplaces/Office for Civil Rights/Center for Medicare & Medicaid Innovation. 3. Steven Lopez was named counselor to the secretary, Equity/Office of the Assistant Secretary for Health/Health Resources and Services Administration/Indian Health Service. 4. Ben Scott was chosen as advance representative in the Office of the Secretary. 5. Josie Villanueva Prescott was chosen as counselor to the secretary, Administration for Children […]
June 3, 2021

Two Reports on Health Care Trends Released

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 estimates of 2020 health spending from Altarum, a private research organization that focuses on health policy. Health spending was 17.7% of GDP in 2019 and increased by 4.6% from 2018 spending to $3.8 trillion ($11,582 per capita). Spending in hospital care (6.2%) and prescription drugs (5.7%) grew faster than physician services (4.2%) in 2019. In 2019, spending growth in Medicare (6.7%) and out-of-pocket payments (4.6%) […]
June 3, 2021

U.S. Senate Approves Biden Administration Nominee as CMS Administrator

U.S. Senate Approves Biden Administration Nominee as CMS Administrator On Tuesday, May 25, 2021, the U.S. Senate confirmed President Joe Biden’s pick to run U.S. health insurance programs, putting in place a key player who’ll carry out his strategy for expanding affordable coverage and reining in prescription drug costs. Chiquita Brooks-LaSure was approved by the Senate and will be the first Black person to head the CMS. The Senate vote was 55-44, with five Republicans joining Democrats in approving her nomination. Brooks-LaSure had been expected to win stronger bipartisan support, but a controversy over a CMS action affecting the Medicaid program in Republican-led Texas appears to have spoiled those chances. Brooks-LaSure, 46, has spent most of her career in government […]