ACHP Media Monitoring Report: May 16, 2017

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ACHP in the News: The health care industry is cautiously optimistic it will have more weight in the Senate health care debate than it did in the House. Some industry groups, including ACHP, are encouraged that the Senate is taking steps to speak with patients, providers and plans.

Whistleblower tells of Medicare Advantage scheme
A former official at UnitedHealth Group is alleging that large insurers are gaming the system to reap billions of dollars from Medicare Advantage. According to the whistleblower, some big insurers are combing through health records and changing diagnosis codes to make patients look sicker than they really are in an effort to increase payments by Medicare Advantage. The higher payments are determined by a complicated risk scoring system, which is all about diagnoses. So a scheme to complicate a diagnosis to raise risk scores means higher payments, higher revenue and bonuses for employees. A UnitedHealth spokesman said the company plans to contest the allegations. Some have warned for years that MA has been vulnerable to cheating since risk scoring was phased in, from 2004 to 2008. The inspector general at HHS audited a small sample of MA plans early on and found overpayments of up to $650 million in 2007. It predicted even more in 2008, but then came budget cuts and those audits stopped. The Government Accountability Office reported last year that CMS had identified $14.1 billion of overpayments to insurers in 2013 and did not have a clear plan for recovering the money.

Report shows coverage gains stalled
For the first time since 2010, coverage gains have stalled. For five consecutive years, the number of uninsured Americans has decreased, yet the number remained relatively unchanged from 2015 to 2016. According to a Centers for Disease Control and Prevention report, the uninsured rate was 9 percent in 2016, barely different from 9.1 percent in 2015. The numbers suggest that the main components of the ACA have reached their limits, and health economists hope the progress made in coverage gains will remain under new legislation.

Small-business health exchange closes will no longer offer small-business plans. The change signals the Administration’s intention to scale back the ACA through executive authority. According to analysts, the move is more of a gesture than one that will have a large impact on consumers. Less than 8,000 employers enrolled in the small-business plans in 2017.

Senators hold bipartisan health care meeting
A bipartisan gathering of moderate Senators convened Monday evening to discuss health care legislation. The meeting demonstrated that moderates are searching for middle ground on the issue. Sen. Susan Collins (R-ME) told reporters the meeting was an effort to move away from the partisanship that has made finding solutions a challenge.

Report shows progress of MLTSS programs
More states are turning to Medicaid managed long-term services and supports (MLTSS) programs to rebalance spending and improve consumer experience. A new report by the Center for Health Care Strategies in partnership with the National Association of States United for Aging and Disabilities finds most states are making progress in reaching these goals, yet many states need expanded data to gain support from stakeholders.