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What We're Reading: CMS Investigating If Patients Are Steered to ACA Plans


What we're reading, August 19, 2016: CMS is investigating if patients are being steered away from Medicaid and Medicare to private plans; Medicare Part D paid 17% more for drugs in 2014 than in 2013; and 5 things to know about HIPAA today.

CMS is investigating whether providers are steering patients into Affordable Care Act plans instead of Medicare or Medicaid. CMS is concerned that providers or their organizations are paying insurance premiums for patients who quality for Medicare and Medicaid because the provider receive better reimbursements from insurance companies than from the federal health programs, reported The Wall Street Journal. UnitedHealth Group has already sued a kidney-care chain for such alleged actions.

CMS paid 17% more for drugs in 2014 compared with 2013. According to Healthcare Finance, Lantus Solostar and Lantus, both insulin products, had the highest increases year over year, but hepatitis C drug Sovaldi still had the highest total drug costs at $3.1 billion. Under the Medicare Part D program, the government spent $121 billion in 2014. By comparison, while the cost to CMS increased more than 17%, the total cost of claims only increased 3.3%.

This year the Health Insurance Portability and Accountability Act, or HIPAA, turns 20 years old, and things have changed a lot since Congress passed it. With electronic medical records and genomic research, balancing privacy with third-party access to data is difficult. STAT took a look at 5 things to know about HIPAA including that your data is out there, third parties actually have better access to patients’ medical information than the patient does, and medical identity theft is rising.

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