A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.
The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013.
As KHN reported late last month, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.
The Biden administration’s vaccination requirement is putting a squeeze on nursing homes as they try to balance protecting residents and retaining low-wage staff that have been reluctant to get the shot.
Later this month, the administration will outline a policy that requires all staff working at nursing homes to be vaccinated or risk the facilities losing federal funding.
The specifics of the policy are sparse so far, but it would effectively be a mandate for an industry that relies heavily on Medicare and Medicaid funding.https://aef67baff698e02f95a8ec2b0d53753d.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
Only about 62 percent of nursing home and long term care facility staff are fully or partially vaccinated nationally, according to federal data compiled by the Centers for Medicare and Medicaid Services (CMS).
“The biggest group of unvaccinated staff are certified nurse aides. They’re making close to minimum wage. They can make that, maybe even more, plus maybe even better benefits out in retail jobs, restaurant jobs. The vast majority of those employers are not imposing mandates,” Grabowski said.
When it comes down to it, I’ll suggest to readers that they don’t really believe that it matters. And with the Biden administration’s 2022 budget proposal comes a fairly strong indication that this is their point of view as well, that they expect, when the Trust Fund well comes dry, to simply tap general federal revenues for the necessary funds, in exactly the same manner as is done for Parts B (doctors) and D (drugs).
This single sentence makes it clear that’s not the case: the only premiums paid by Medicare recipients are partial-cost payments for Parts B and D. For Part B, this is 25% of the cost for most retirees; for those with income above $85,000/$170,000 single/married, premiums are higher, reaching as much as 85% of the total cost for the highest earners. For Part D, the premium is set to cover 25.5% of the standard drug benefit, plus any extra costs charged by particular private providers for enhanced benefit levels, and an extra flat charge for higher earners. The remaining cost, 75% of Part B and 74.5% of Part D, is funded by the federal government through its general revenues.
Much of the information submitted to C.M.S. is wrong. Almost always, that incorrect information makes the homes seem cleaner and safer than they are.
Some nursing homes inflate their staffing levels by, for example, including employees who are on vacation. The number of patients on dangerous antipsychotic medications is frequently understated. Residents’ accidents and health problems often go unreported.
In one sign of the problems with the self-reported data, nursing homes that earn five stars for their quality of care are nearly as likely to flunk in-person inspections as to ace them. But the government rarely audits the nursing homes’ data.
Data suggest that at least some nursing homes know in advance about what are supposed to be surprise inspections. Health inspectors still routinely found problems with abuse and neglect at five-star facilities, yet they rarely deemed the infractions serious enough to merit lower ratings.
At homes whose five stars masked serious problems, residents developed bed sores so severe that their bones were exposed. Others lost the ability to move.
For the first year since at least 1960 – when the Centers for Medicare and Medicaid Services (CMS) began tracking national health expenditures – total health spending in 2020 was less than in the previous year. While spending has recovered somewhat from its pandemic-related decline in the spring, our preliminary estimate is that national health spending in 2020 was 2.0% lower than in 2019, a decline of about $75.8 billion dollars. The exhibit shows annual growth rates for six major personal health care components of health spending in 2020 and, for comparison, 2019. The latter numbers match the CMS National Health Expenditure Accounts (NHEA) for 2019, while the 2020 values are based primarily on the latest BEA data, adjusted to match more nearly those that would be produced by CMS.
Author(s): George Miller, Corwin (Corey) Rhyan, Ani Turner