Morning Briefing
Summaries of health policy coverage from major news organizations
New Medicare Rule Targets Medical Equipment
A federal rule issued Tuesday requires prior authorization before Medicare will pay for certain wheelchairs, prosthetics, orthotics and other medical equipment — sources of Medicare fraud and improper payments for years. The rule could save Medicare $10 million the first year, $200 million in five years and $580 million over a decade, says Aaron Albright, spokesman for the U.S. Centers for Medicare and Medicaid Services. (Ungar, 12/29)
Doctors frequently order patients to take urine drug tests to safeguard against prescription pain-pill abuse. But federal investigators and Medicare say these routine tests — designed to ensure patients properly use opioid drugs — have led to questionable billing practices by some for-profit labs, doctors, and addiction-treatment centers. ... The U.S. Department of Justice is cracking down on private labs that investigators say offer incentives to doctors to frequently refer patients for lucrative testing. And Medicare, citing the potential for billing abuses, is overhauling its billing codes and payment rates used for drug tests. (Alltucker, 12/26)
Meanwhile, the Centers for Medicare & Medicaid Services is fining insurers for errors in Medicare Advantage plan directories and for errors in plans sold on the federally run insurance exchanges -
New regulations allow the Centers for Medicare and Medicaid Services to fine insurers up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run insurance exchanges in 37 states. States are imposing their own rules and sanctions. (Beck, 12/28)
