GAO Report Details 2017 Improper Payments in Medicare, Medicaid

A new report from the Government Accountability Office (GAO) indicates that the Medicare program spent $23.2 billion on improper payments in 2017 due to insufficient documentation. The GAO found that Medicaid made $4.3 billion in erroneous payments that same year. These amounts total 6 percent of Medicare claims and 1.3 percent of Medicaid claims. The agency makes four recommendations for CMS to strengthen its oversight of provider claims and to ensure that Medicaid medical reviews effectively address the causes of improper payments and result in corrective actions. CMS did not concur with all of the GAO’s recommendations, raising concerns about increasing the burden on state Medicaid agencies. The issue of Medicare and Medicaid improper payments is the subject of a probe from Senate Finance Committee Chairman Chuck Grassley (R-Iowa). Grassley has stated that he is still waiting to hear from CMS Administrator Seema Verma in response to a letter regarding additional data on improper Medicaid payments.

Court Strikes Down WH Expansion of Association Health Plans

U.S. District Court Judge John Bates ruled last week that the administration’s efforts to expand the availability of association health plans is a deliberate and illegal “end run” around the ACA. Association health plans allow businesses and individuals to band together to create less expensive group plans that are not subject to the coverage requirements of the 2010 health care law. The White House and Republican lawmakers argue that such plans offer a more affordable options for people, who have been priced out of the individual market. The Labor Department’s rule to expand the availability of association health plans was issued to comply with the President’s October 2017 executive order. It was challenged in court by 11 Democratic-led states and the District of Columbia, who argued that the regulation violated federal law. It is not clear if the administration plans to appeal the court’s decision.

There’s still time to register for West Health’s April 2 Healthcare Cost Crisis Summit

Don’t miss West Health’s free healthcare costs summit tomorrow at the Ronald Reagan Building and International Trade Center. The day-long event, which will be livestreamed, brings together healthcare and business leaders, patient advocates and policy experts to explore the impact of high healthcare costs on individuals, businesses, the economy and the state of public health. Participants will discuss current and proposed policies to curb costs and map out immediate and long-term actions that can meaningfully and sustainably improve healthcare quality and lower costs. “High Costs, Broken Promises: West Health’s 2019 Healthcare Costs Innovation Summit,” will feature the unveiling of results from a new national survey from Gallup and West Health on how skyrocketing healthcare costs are impacting the daily lives of Americans. West Health is a nonpartisan, nonprofit organization dedicated to lowering healthcare costs to enable successful aging. Learn more and register at hcidc.org.

Upcoming Congressional Hearings and Meetings

Senate Special Committee on Aging hearing to examine Alzheimer’s, focusing on new directions in biomedical research and caregiving; 9:30 a.m., 106 Dirksen Bldg.; April 2

House Energy and Commerce Oversight Subcommittee hearing “Priced Out of a Lifesaving Drug: The Human Impact of Rising Insulin Costs;” 10:30 a.m., 2322 Rayburn Bldg.; April 2

House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions hearing “Examining Surprise Billing: Protecting Patients from Financial Pain;” 10:15 a.m., 2175 Rayburn Bldg.; April 2

House Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee hearing on the National Institutes of Health Budget Request for FY 2020; 10:30 a.m., 2358-C Rayburn Bldg.; April 2

House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies hearing “Food and Drug Administration Budget Request for FY 2020;” 9:00 a.m., 2362-A Rayburn Bldg.; April 3

House Appropriations Subcommittee on Defense hearing “Defense Health Programs;” 3:00 p.m., 2359 Rayburn Bldg.; April 3

Senate Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee hearing to review the Fiscal Year 2020 funding request and budget justification for the U.S. Department of Health and Human Services; 10:00 a.m., 124 Dirksen Bldg.; April 4

Senate Finance Committee hearing on drug pricing with pharmacy benefit managers invited to testify; time and place TBD; April 9

House Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee Public Witness Hearing; 2:00 p.m., 2358-C Rayburn Bldg.; April 9

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