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What We're Reading: MA Plans Overbill; Biden Cancer Initiative Suspends Activities; CMS to Cover Some Acupuncture
July 16, 2019 – AJMC Staff
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July 11, 2019 – Jaime Rosenberg
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This Week in Managed Care: June 21, 2019
June 21, 2019
5 Findings From the June 2019 Issue of AJMC®
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CMS Proposes Electronic Prior Authorization for Part D Drugs
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What We're Reading: MA Plans Overbill; Biden Cancer Initiative Suspends Activities; CMS to Cover Some Acupuncture

AJMC Staff
Medicare Advantage (MA) plans have overbilled the government by nearly $30 billion the past 3 years alone, and CMS said it is moving forward with plans to attempt to get back $1 billion; the Biden Cancer Initiative is suspending operations while its founder, former Vice President Joe Biden, runs for president; CMS said Medicare will cover acupuncture for some patients with chronic low back pain.

CMS Seeks to Recoup $1 Billion From $30 Billion in Overpayments to MA Plans 

Medicare Advantage plans have overbilled the government by nearly $30 billion the past 3 years alone, and CMS said it is moving forward with plans to attempt to get back $1 billion by 2020 from the private insurance plans, Kaiser Health News reported. The insurance industry is opposing the enhanced audits.

 

Biden Cancer Initiative Suspends Operations During Joe Biden's Presidential Campaign

The Biden Cancer Initiative is suspending operations while its founder, former Vice President Joe Biden, runs for president. The Hill reported that Greg Simon, president of the Biden Cancer Initiative, said the organization is “suspending activities given our unique circumstances.” The organization was launched in 2017 as an offshoot of the Obama administration's Cancer Moonshot program. 

 

Medicare to Pay for Some Acupuncture for Low Back Pain

CMS said Medicare will cover acupuncture for patients with chronic low back pain enrolled in research to see if the treatment is effective. The proposal is part of the government’s effort to develop alternatives to opioids for pain. Eligible studies must be sponsored by the National Institutes of Health or approved by CMS.

 
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