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What We're Reading: CMS Was Overcharged a Record Billion Dollars
What We’re Reading, July 25, 2016: Keeping dementia at bay in the elderly; PhRMA spends more and insurers spend less on lobbying, so far in 2016; and a record-breaking fraud case in Florida.
Keeping the brains of older adults active via a digital training exercise can reduce the risk of dementia, according to a study that was presented at the Alzheimer’s Association International Conference in Toronto. STAT news reports that the ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) study, initiated in 1998, followed more than 2800 older adults (74 years and older when recruited) who received 1 of 3 forms of cognitive training or none. While 14% of participants in the untrained group developed dementia a decade later, only 8.2% of those who completed 10 sessions of computer-based training developed dementia.
The Pharmaceutical Research and Manufacturers of America (PhRMA) has already spent close to $12 million on lobbying efforts so far this year, according to The Commonwealth Fund. With providers and insurance companies spending less this year compared with the same period last year, and the increased focus on election campaigns, PhRMA is focused on defending its members from concerns over prescription drug costs. Lobbying arms representing the health insurance industry and healthcare provider groups, on the other hand, have spent less so far. The American Medical Association, for instance, has spent just about one-third the amount compared with this time last year.
Another fraud case filed by the justice department is a record breaker—the owner of a network of Florida nursing facilities has been charged with cheating Medicare and Medicaid for nearly a decade and a half to the tune of more than a billion dollars. The owner, Philip Esformes, along with his accomplices, rotated 14,000 elderly people through his nursing homes and assisted-living places regardless of their needs. “This was a whole network of people scratching each other’s backs, paying kickbacks and giving each other referrals. It shows what people can do when they’re determined to put their hand in the Medicare pot,” said Leslie R. Caldwell, who leads the Justice Department’s criminal division
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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Commonwealth Fund Report Details Pervasive Racial and Ethnic Disparities in US Health Care, Outcomes
April 18th 2024Using 25 health system performance indicators, the Commonwealth Fund 2024 State Health Disparities Report evaluated racial and ethnic disparities in health care and health outcomes both within and across US states and highlighted the urgent need for equitable health care policies and practices in the US.
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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.
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