An investigation into 2012 Medicare claims for HIV-infected patients unearthed payment for prescriptions that were filled up to 32 days after the patient's passing.
Call it drugs for the departed: Medicare's prescription program kept paying for costly medications even after patients were dead.
The problem was traced back to a head-scratching bureaucratic rule that's now getting a second look.
A report coming out Friday from the Health and Human Services Department's inspector general says the Medicare rule allows payment for prescriptions filled up to 32 days after a patient's death — at odds with the program's basic principles, not to mention common sense.
"Drugs for deceased beneficiaries are clearly not medically indicated, which is a requirement for (Medicare) coverage," the IG report said. It urged immediate changes to eliminate or restrict the payment policy. Medicare said it's working on a fix.
Investigators examined claims from 2012 for a tiny sliver of Medicare drugs — medications to treat HIV, the virus that causes AIDS — and then cross-referenced them with death records. They found that the program paid for drugs for 158 beneficiaries after they were already dead. The cost to taxpayers: $292,381, an average of $1,850 for each beneficiary.
Medicare's "current practices allowed most of these payments to occur," the report said.
Complete report on abcNews: http://abcn.ws/1u0NPUN
CMS released a final rule to help patients obtain Children’s Health Insurance Program (CHIP) coverage and issued a proposed rule to update Medicare payment policies and rates for inpatient rehabilitation facilities; debate over if gift card incentives are acceptable in health care marketing.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
A global AIDS program that was in limbo for months got temporary relief after congressional negotiators agreed to a 1-year renewal in the next government funding package; the outcome of the November presidential election could determine the state of fetal tissue research in the US; federal officials and industry executives failed to make improvements that stop hacking attacks.
Read More