‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions
The New York Times | By Reed Abelson and Margot Sanger-Katz
By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.
The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.
Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.
Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.
Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost. If trends hold, by next year, more than half of Medicare recipients will be in a private plan.
But a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.
The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.
As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.
Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.
The fifth company, CVS Health, which owns Aetna, told investors its practices were being investigated by the Department of Justice.
In statements, most of the insurers disputed the allegations in the lawsuits and said the federal audits were flawed. They said their aim in documenting more conditions was to improve care by accurately describing their patients’ health.
Read Full Article |
New NCCIH Music and Health Fact Sheet
A growing body of research shows that music can be good for you. Listening to or making music affects the brain in ways that may help promote health and manage disease symptoms.
For example, there’s evidence that music-based interventions may help ease pain and anxiety; relieve distress in people with cancer; improve sleep quality in people with insomnia; and improve emotional well-being and quality of life in people with Alzheimer’s disease or other forms of dementia.
Learn More |
|
Meet the Newly Elected Board Members
The 2022 Board elections began on September 1, 2022 and ended at 9:00 AM MT on Saturday, October 1, 2022. The election was sent out to 1,855 PT and PTA members of the Colorado Chapter. Of those, only 85 submitted a ballot.
All votes were verified by the appointed teller committee.
- Erin Hayden, PT, DPT, OCS
- Rebekah Griffith, PT, DPT, NCS
- Elizabeth Black, PT, DPT
Below are the candidates that won the election:
Treasurer
Director at Large - Finance Director
Delegates at Large
Bylaw Amendment for Article VII – Passed Support Statement for the Colorado Chapter to allow the Chair of the DEI Committee to become a voting member of the Board:
The Colorado Chapter is fully engaged in working on being an inclusive organization. To keep in alignment with the APTA vision and mission the Colorado Chapter formed a DEI committee in 2021. The Committee is engaged in helping the Chapter increase outreach, participation and knowledge of the populations that are underserved by the chapter and our profession. To ensure that the DEI committee is getting representation the Colorado Chapter Board would like to allow this committee to be a voting member of the Board. Similar actions were taken 3 years ago to allow the Professional Development Committee (PDC) voting rights on the Board. The PDC is vital to the well-being of the Colorado Chapter with it primary focus of the state convention generating significant revenue for the Chapter. Likewise, the value that the DEI committee brings to the Chapter is an asset and should be given a voice on the direction of the Colorado Chapter. |
Congratulations to the 2022 Chapter Award Recipients
At the APTA Colorado annual conference last weekend in Breckenridge, the 2022 award recipients were recognized. Congratulations to all of the award recipients!
2022 Colorado Physical Therapist of the Year
- Chris Edmundson, PT, DPT, OCS, FAAOMPT
2022 Colorado Physical Therapist Assistant of the Year
Bob Doctor Profession Service Award
- Lara Canham, PT, DPT
- Nancy Mulligan, PT, DPT
- Emily Stone, PT, DPT, OCS, FAAOMPT
- Ted Weber, PT, DPT
PT Clinical Educator of the Year
Polly Cerasoli“ACE” Award for DPT Student of the Year
- 2022/2023: Melissa Tran, SPT (UCDenver)
- 2021/2022: Jason Nadeau, PT, DPT, MS (CU Anschutz)
Polly Cerasoli“ACE” Award for PTA Student of the Year
- Carmen Martinez Baez, Pueblo Community College
|
|