�鶹Ů��

Private Medicare insurers got about $4.2 billion in extra federal payments in 2023 for diagnoses from home visits the companies initiated, even though they led to no treatment, a new inspector general’s report says. The extra payments were triggered by diagnoses documented based on the visits, including potentially inaccurate ones, for which patients received no other medical services, the report says. Insurers offering private plans under Medicare, known as Medicare Advantage, are paid more when patients have costly conditions. (Weaver and Mathews, 10/24)

For the past six months, the CBS News Texas I-Team has spoken with more than a dozen Medicare recipients who reported fraudulent activity on their accounts. According to a federal government report, an estimated $60 billion is lost annually to Medicare fraud. Earlier this year, Medicare suspended the accounts of 11 medical suppliers suspected of fraudulently billing the government for nearly $3 billion worth of urinary catheters. One of these companies listed its headquarters at an office in Grand Prairie, but by the time their account was suspended, those in charge had long disappeared. (New, 10/23)

Medicare marketers expect shifts in the Medicare Advantage market to prove lucrative as beneficiaries react to changing benefits and less competition in certain regions, even though insurers such as Centene and Aetna have cut back on commissions. “We haven't seen this much disruption in years, where you have a lot of consumers who need to shop and likely need to make switches,” GoHealth CEO Vijay Kotte said. “We’re feeling pretty good.” The Medicare annual enrollment period began Oct. 15 and ends Dec. 7. (Tepper, 10/23)

In the midst of open enrollment, there’s a lot of consumer (and investor) focus on Medicare Advantage STAR ratings that were announced earlier this month. STAR Ratings seem simple enough on the surface. Plans are rated by the Centers of Medicare and Medicaid Services (CMS) on a scale of 1 (low) to 5 (high) based on a basket of measures that capture a Medicare Advantage health plan’s clinical performance and member experience. (Jain, 10/24)

Allina Health has notified thousands of patients with Humana Medicare Advantage plans that their doctors might be out-of-network next year and therefore only available with higher out-of-pocket costs unless the Kentucky-based insurer agrees to a contract that reduces claims denials and prior authorization rules. The Minneapolis-based health system, one of the largest operators of hospitals and clinics in Minnesota, alerted about 18,000 patients of the potential disruption last week, just as Medicare open enrollment was getting underway. (Snowbeck, 10/23)

It's official: The massive cyberattack against UnitedHealth Group unit Change Healthcare was the biggest healthcare data breach in history. The ransomware incident in February affected 100 million people, or nearly 30% of the U.S. population, according to the Breach Portal maintained by the Office for Civil Rights at the Health and Human Services Department. That's consistent with what CEO Andrew Witty told a House subcommittee in May, when he testified that the breach ensnared about one-third of the country. (Berryman, 10/23)

Dozens of former federal officials from the last five presidential administrations have a plan for how the next administration should address cybersecurity issues — regardless of who takes office in January. The suggested plan of action, obtained first by POLITICO, is composed of around 40 recommendations put together by officials on both sides of the aisle and is aimed at creating a pathway forward to expand the Biden administration’s cyber policy work. Cyber threats span every sector and are a rare subject where bipartisanship often prevails both on Pennsylvania Avenue and on Capitol Hill. (Miller, 10/22)

The push for more transparency in the health system is increasingly taking aim at "ghost networks" — the inaccurate health provider directories that critics say are keeping Americans from getting mental health care. A lawsuit filed against Anthem Blue Cross and Blue Shield this week comes as Congress and the White House are stepping up efforts to require insurers to accurately account for which providers are in network. (Reed, 10/24)

Federal price transparency rules are showing signs of stoking more hospital competition and making prices more reflective of the cost of care, a new review found. There's still limited understanding of how the rules are affecting market dynamics, and experts acknowledge they haven't yet translated to lower across-the-board patient costs. (Goldman, 10/24)

After a year-long takeover battle for the owner of France’s best-selling painkiller, Sanofi’s decision to sell its over-the-counter business to a US buyout firm descended into mudslinging, public rebukes and political discord. The French drugmaker’s sale of a controlling stake in its Opella unit to US financial juggernaut Clayton Dubilier & Rice for €16 billion ($17.3 billion) was sealed over the weekend. The decision brought an end to an unusually fierce campaign — fought in private and public — by Paris-based rival PAI Partners, which refused to accept it had lost and tried to upend the transaction, triggering a rigorous response from the other side. (Kirchfeld, Barbaglia, Nair, Nussbaum, and Gopinath, 10/24)

Sanford Health and Marshfield Clinic Health System have signed a definitive merger agreement. The proposed transaction to form a combined 56-hospital system with more than $10 billion in revenue is expected to close by the end of the year, pending customary regulatory approvals, according to a Wednesday announcement from the nonprofit health systems. (Kacik, 10/23)

Walmart will be liable for millions of dollars in civil penalties and costs for allegedly dumping hazardous waste and sensitive customer records in California landfills, according to a stipulated judgment filed this week in Alameda County Superior Court. The judgment would settle a lawsuit brought against Walmart by California Atty. Gen. Rob Bonta and the district attorneys of 12 counties in December 2021. Under its terms, the nation’s largest retailer will be required to pay penalties for allegedly dumping in state landfills nearly 80 tons of hazardous waste and confidential customer information from its stores throughout the state. (Mendez, 10/23)

�鶹Ů�� Health News: A California Official Helped Save A Mental Health Company’s Contract. It Flew Him To London

The director of California’s mental health commission traveled to London this summer courtesy of a state vendor while he was helping to prevent a $360 million budget cut that would have defunded the company’s contract. Emails and calendars reviewed by �鶹Ů�� Health News show Toby Ewing, executive director of the Mental Health Services Oversight and Accountability Commission, made efforts to protect funding for Kooth, a London-based digital mental health company the state hired to develop a virtual tool to help tackle its youth mental health crisis. (Castle Work, 10/24)

Dr. Kirstin Lyerly saw a patient this month who wanted her IUD replaced but was nervous about the potential pain. It was toward the end of the day and there wasn’t enough time for the patient to pick up a prescription to relieve her anxiety and return, so Lyerly suggested they reschedule the procedure for a later date. “She looked me square in the eye and said: I have to do it now, I have to get it now, I have to get it done before the election, because I don’t know what’s going to happen after the election,” Lyerly recalled. (Becker, 10/23)

Donald Trump has repeatedly refused to say if he would veto a national ban if it crossed his desk as President—a scenario that’s highly unlikely unless Republicans earn significant majorities in both chambers of Congress. The Trump campaign did not answer this question in its statement. (Lee, 10/23)

Democratic nominee Vice President Kamala Harris has positioned herself as the reproductive rights candidate, vowing to restore reproductive freedoms and garnering endorsements from organizations like the Planned Parenthood Action Fund (PPAF), the Committee to Protect Health Care, and Reproductive Freedom for All. She has promised to support a bill restoring Roe’s protections or veto any national abortion ban. (Lee, 10/23)

It’s 108 degrees outside as Mayra Rodriguez guides her Winnebago into the parking lot of a Hispanic grocery store in North Phoenix, a few weeks before election day. Rodriguez is the state director for Moms for Arizona, an anti-abortion group campaigning against Proposition 139, a ballot measure that would expand access to abortion in the state. Her Winnebago is a roving billboard, emblazoned with warnings about what she believes are the dangers of abortion — English on one side, Spanish on the other. (Caldwell, Chang and Troop, 10/24)

A company got access to a mobile phone-tracking tool used by law enforcement and U.S. government agencies across the country. They found significant privacy vulnerabilities. (Tau, 10/23)

While Vice President Harris and former President Trump are dominating the headlines in the last two weeks before the election, there is a lengthy list of health care proposals and down-ballot races that could heavily shape health policy. More than a dozen states are voting on health care issues ranging from abortion access to psychedelics use, paying for long-term care, and medically assisted suicide. (Owermohle, 10/24)

If Vice President Harris wins the presidency, in many ways, she’ll work to achieve health care ideas that Democrats couldn’t quite push across the finish line during President Biden’s tenure. (Zhang, 10/24)

Vice President Harris wants to put ObamaCare front and center in the campaign’s final weeks. Abortion has been the primary health issue for much of the campaign, but Harris is reopening Democrats’ successful 2018 playbook by elevating the Affordable Care Act.  ... Early in the campaign, Trump revived his previous calls for repealing the law and replacing it with something better. Senate Republicans were quick to shut down any talk of bringing up repeal again, even if they were to control the government. Lately, Trump has slightly shifted his tone. (Weixel, 10/24)

�鶹Ů�� Health News: Voters Fret High Medical Bills Are Being Ignored By Presidential Rivals

Tom Zawierucha, 58, a building services worker in New Jersey, wishes candidates would talk more about protecting older Americans from big medical bills. Teresa Morton, 43, a freight dispatcher in Memphis, Tennessee, with two teenagers, wants to hear more about how elected officials would help working Americans saddled with unaffordable deductibles. (Levey, 10/24)

A costly proposed national certification exam for psychologists has been scrapped for now after Texas’s licensing authority led the fight against it by considering crafting a cheaper alternative to alleviate the mental health provider shortage. (Simpson, 10/23)

VA health systems in the Tampa Bay region are working to get veterans' care back on track after hurricanes Milton and Helene caused disruptions. The storms led to thousands of outpatient appointment cancellations and forced one hospital to temporarily evacuate. But patients with critical needs continued to receive care throughout the disasters, and national VA officials are recognizing personnel for their hard work. (Colombini, 10/23)

Pittsburgh's needle exchange program is running again after the city suspended it last year after collection problems. Many of the homeless encampments have become dens of open-air drug sales and drug use. But while it's shutting down a camp on Grant Street for that reason, the city continues to provide syringes to those who live in others but rejects criticism it's aiding and abetting the drug problems there. (Sheehan, 10/22)

For years, it has been a reliable way to cut back on the consumption of cigarettes and sugary drinks: raise taxes on them. So it might seem an obvious tactic to apply to alcohol, which contributes to untold injuries, diseases and deaths in the United States each year. (Cueto, 10/24)

For the family of the Army reservist who carried out a mass shooting across Maine's second-largest city one year ago, dissecting what provoked the deadly rampage has been daunting. ... But the unspeakable violence inflicted on this community has spurred a very public purpose for the family: bringing awareness to traumatic brain injuries among military members and a call to action for continued research. "We want to make sure this doesn't ever, ever happen again to another family," said Nicole Herling, the sister of gunman Robert Card. (Breslauer and Ortiz, 10/23)

In anticipation of three Taylor Swift concerts, which could draw around 150,000 visitors to New Orleans’ Superdome this weekend, state authorities on Wednesday began clearing a nearby homeless encampment. Roughly 75 people who were living in tents beneath an overpass would be relocated roughly two blocks away, Louisiana State Police said. Advocates said the sweep would disrupt progress in finding long-term, permanent housing for those affected. Other people without shelter living in the historic, tourist-dependent French Quarter neighborhood would also be moved to the same location, officials said. (McGill, 10/23)

Jahmeik Modlin was found emaciated in a Harlem apartment stocked with food. His family’s child-welfare case had been closed two years before. (Newman, 10/23)

On Wednesday, members of the Advisory Committee on Immunization Practices voted to lower the recommended age for the pneumococcal vaccine from 65 to 50 and older. ... ACIP members also voted to recommend adults 65 and older get a second dose of the updated COVID-19 vaccine this fall. Eligible patients should ask their provider the best time to take an additional dose. Health experts say older adults are more likely to experience the worst consequences of the virus: They're more likely to develop more severe cases, be hospitalized and die. (Rodriguez, 10/23)

Two studies published today in Science Translational Medicine differ on whether COVID-19 vaccine boosters can trigger an immune response in mucous cells in the nose and mouth—a longtime goal of vaccine researchers. Despite the disparate findings, editorial writers say mucosal immunization could go further than current intramuscular COVID-19 vaccines by preventing infection altogether, disrupting viral transmission and the ability of the virus to evolve. (Van Beusekom, 10/23)

As winter approaches, health officials in the Bay Area are strongly encouraging residents to get vaccinated soon against both coronavirus and influenza. This is the ideal time for people to roll up their sleeves and get the shots in light of an expected winter respiratory virus surge, particularly due to the emergence of the XEC variant. “October is the perfect time to vaccinate against respiratory viruses like COVID-19, flu and RSV,” Marin County’s health department wrote in an update. (Vaziri, 10/23)

Colorado funeral home owners accused of misspending nearly $900,000 in COVID-19 pandemic relief funds and living lavishly, all while allegedly stashing 190 decaying bodies in a building and sending grieving families fake ashes, are expected to plead guilty to federal charges Thursday. Jon and Carie Hallford, owners of Return to Nature Funeral Home about an hour’s drive south of Denver, have been charged with 15 federal offenses related to defrauding the U.S. government and the funeral home’s customers. Additionally, over 200 criminal counts are already pending against them in Colorado state court, including for corpse abuse and forgery. (Bedayn, 10/24)

Orange County First District Supervisor Andrew Do agreed to plead guilty to conspiracy to commit bribery in federal court relating to a scheme involving Viet America Society and the embezzlement of millions in COVID-relief funds intended to help the county’s most vulnerable residents during the pandemic. As part of his agreement, he resigned Tuesday from the Board of Supervisors. (Torres, Saavedra and Slaten, 10/23)

The California Department of Public Health (CDPH) today reported two more H5 avian influenza infections, both confirmed by the Centers for Disease Control and Prevention (CDC), raising the state's total to 15. ... The newly confirmed California cases raise the US number of human H5 infections this year to 27, which doesn't yet include four presumptive positive cases reported in poultry workers in Washington state. (Schnirring, 10/23)

The U.S. Department of Agriculture weakened an emergency order last spring designed to prevent the spread of bird flu among the nation's dairy cattle after pushback from state and industry officials, according to state and federal records seen by Reuters. (Douglas and Polansek, 10/23)

McDonald’s Corp. supplier Taylor Farms is recalling some yellow onion batches produced in a Colorado facility in response to a deadly E. coli outbreak at the burger chain. Taylor Farms, which supplied onions to the McDonald’s restaurants impacted by a multistate health investigation, said it hasn’t found traces of E. coli yet, but decided to pull the products “out of an abundance of caution.” Another of Taylor Farms’ big customers, US Foods Holding Corp., also told at least one restaurant it supplies to destroy the onions. (Shanker and Sirtori, 10/24)

The person who died in Colorado and whose death is tied to a multi-state McDonald's E. coli outbreak lived in Mesa County. That's according to Mesa County Public Health, which has not released the identity of the deceased person. According to the Colorado Department of Public Health and Environment, it was a man who was in his older years. (Sarles, 10/23)

TreeHouse Foods has expanded an earlier recall of frozen waffles to include all its griddle products, including Belgian waffles and pancakes, over possible listeria contamination. Though no illnesses have been reported, TreeHouse Foods has previously said that the breakfast products were widely distributed throughout the United States and Canada, primarily as private-label offerings by Walmart, Target, Tops, Harris Teeter, Publix and other large merchants. (Gregg, 10/22)

Janel Wright had just days left in her insulin supply in early January when a pharmacist told her there was none of the drug left to fill her prescription. Her neighborhood Fred Meyer pharmacy in Anchorage, Alaska hadn't called in weeks to offer an automatic refill, and Wright's supply of NovoLog insulin had dwindled to nearly nothing. The 62-year-old administrative law judge has Type 1 diabetes and needs the medication to live. (Alltucker, 10/24)

�鶹Ů�� Health News: PBM Math: Big Chains Are Paid $23.55 To Fill A Blood Pressure Rx. Small Drugstores? $1.51

While customers at Adams Family Pharmacy picked up their prescriptions on a hot summer day, some stopped in for coffee, ice cream, homemade cake, or cookies. It wasn’t a bake sale, but the sweets bring extra revenue as pharmacist and co-owner Nikki Bryant works to achieve profitability at her business on the town square. Bryant said she is doing all she can to bolster it against a powerful force that threatens her and other independent pharmacists: the middlemen who manage virtually all prescriptions written in the U.S., called pharmacy benefit managers, or PBMs. (Miller, 10/24)

The Food and Drug Administration (FDA) issued a Class II recall of more than 7,100 bottles of the antidepressant duloxetine due to the possible presence of a carcinogen.  Duloxetine belongs to a group of drugs called selective serotonin and norepinephrine reuptake inhibitors that are used to treat depression and anxiety, according to the Mayo Clinic.  (O'Connell-Domenech, 10/23)

Science Corporation published preliminary data Tuesday from a late stage, multi-center clinical trial of a retina implant that showed promising results. Using this prosthetic, scientists partially restored vision to people whose central visual field has holes or blurry spots. Trial participants could read text and recognize playing cards when using the implant, even though they were legally blind. (Broderick, 10/23)

Researchers are making strides in therapy for Parkinson's and essential tremor, an even more common movement disorder that affects as many as 10 million people in the U.S. CBS News Chicago spoke to a patient at Northwestern Medicine who became the first in the Chicago area to try one of their new procedures. "Miracle" is a word Chuck Wicks has used a lot recently, less than two months after a procedure that stopped the tremors in his right hand. (Machi, 10/23)

When you need new eyeglasses, getting an appointment for a vision test is usually the hard part. But a Boston company called Eyebot is launching a do-it-yourself electronic kiosk that’s designed to make eye tests almost as simple as buying soda from a vending machine. “You should just get glasses like you buy shoes,” said Matthias Hofmann, Eyebot’s cofounder and chief executive. (Bray, 10/23)

The U.S. Supreme Court is set to decide whether states can ban gender-affirming care for minors. Two dozen states, including Alabama and Tennessee, have banned hormone therapy for transgender youth. On Dec. 4, the high court will begin hearing a challenge to Tennessee’s ban on hormone treatments, including puberty blockers, for patients younger than 18. “Tennessee’s ban is very similar to Alabama’s…and that’s very important because if the Supreme Court finds that these laws single out transgender people, then these bans in states across the country will likely be struck down,” said Shannon Minter, an attorney who represented transgender children and their families in Alabama and the legal director at the National Center for Lesbian Rights. (Tryens-Fernandes, 10/23)

Donald Trump and other GOP candidates are increasingly targeting transgender people in the election campaign’s closing days, invoking them at rallies and pouring millions into advertising tying Democrats to transgender rights. At a recent Trump rally in Reno, Nev., the Trump campaign played a video that included Rachel Levine, the highest-ranking transgender official in the Biden administration, wishing people a happy Pride Month. The crowd booed. When the screen cut to a TikTok video of a drag queen, the crowd booed even louder. (Caldwell, Goodwin and McDaniel, 10/22)

The biennial 2024 LGBTQ Community Center Survey Report, which was released Oct. 16, shows that 73 percent of 199 U.S.-based LGBTQ community centers that participated in the survey reported they had experienced anti-LGBTQ threats or harassment during the past two years. The survey, which included LGBTQ centers in 42 states, Washington, D.C., and Puerto Rico, is prepared by the Fort Lauderdale-based CenterLink, which provides services and support for LGBTQ community centers; and the Boulder, Colo.-based Movement Advancement Project (MAP), a research organization that focuses on social justice issues impacting the LGBTQ community. (Chibbaro Jr., 10/23)

The City Council on Tuesday banned transgender people from using restrooms outside of the sex assigned to them at birth, following an emotionally charged exchange between residents and city leaders. In a 5-2 vote, members of the council expanded a 1989 ordinance that prohibits individuals from entering restrooms of the opposite sex, suggesting they were doing so to protect Odessans and their own families. (Ramos, 10/23)

An influential doctor and advocate of adolescent gender treatments said she had not published a long-awaited study of puberty-blocking drugs because of the charged American political environment. The doctor, Johanna Olson-Kennedy, began the study in 2015 as part of a broader, multimillion-dollar federal project on transgender youth. ... The researchers followed the children for two years to see if the treatments improved their mental health. An older Dutch study had found that puberty blockers improved well-being, results that inspired clinics around the world to regularly prescribe the medications as part of what is now called gender-affirming care. But the American trial did not find a similar trend, Dr. Olson-Kennedy said in a wide-ranging interview. (Ghorayshi, 10/23)

Long-acting injectable PrEP is now to be covered without cost-sharing under Affordable Care Act rules, the Biden administration announced October 21. The news comes just weeks after it was announced that all forms of PrEP will be covered without cost-sharing for Medicare patients under Medicare Part B. "With low uptake of PrEP among the communities most impacted by HIV, this insurance coverage requirement with zero cost-sharing will help jumpstart the use of more effective forms of PrEP and lead to fewer HIV transmissions," Carl Schmid, a gay man who is executive director of the Washington, D.C.-based HIV+Hepatitis Policy Institute, stated about the Biden administration's announcement. (Ferrannini, 10/22)

The study was based on outcomes seen among women who gave birth at the Shanxi Province Integrated Traditional and Western Medicine Hospital in China in 2023. The study included 119 pregnant women with COVID-19 and 412 pregnant women with no recorded COVID infections. (Soucheray, 10/23)

Lyme borreliosis is the most common tick-borne infectious disease in Europe. Up to 70,000 new cases are estimated each year in Austria alone. The bacterial infection can cause lasting health problems for patients. A research team has made significant progress in understanding the mechanism of infection and identified a potential way forward for the development of targeted therapies that do not rely on antibiotics. (Medical University of Vienna, 10/23)

A new study has demonstrated a new way to treat narcolepsy-related nightmares. The scientists combined cognitive behavioral therapy (CBT) and lucid dreaming to help patients in a small clinical trial. (Northwestern University, 10/23)

In 2020, I followed a lot of Covid-skeptical momfluencers on social media. I wanted to see how they voiced their concerns about mask-wearing and disease spread. I hoped that over time I could somehow reverse-engineer the information pathway that led some women from Covid skepticism to anti-vaccine activism and then, in some cases, to other fringe and conspiratorial beliefs. (Jessica Grose, 10/23)

Lead is a neurotoxin, and the dangers aren’t new. Benjamin Franklin warned in 1786 about the perils of drinking rainwater that had trickled off a lead roof. (Nicholas Kristof, 10/23)

Once, when I was the obstetrician-gynecologist assigned to cover Christmas at my hospital, I was called to the emergency department for a patient undergoing a first-trimester pregnancy loss. Early pregnancy losses are common and generally uncomplicated. But this patient showed signs of possible infection. (Chavi Eve Karkowsky, 10/24)

Imagine, for a moment, that you wake up one morning with a debilitating illness that won’t let go. Weeks and months pass, but the crushing fatigue, constant headaches, and aching muscles remain. You can’t think straight. Simply showering or doing the dishes leaves you floored for days at a time, and the unpredictable symptoms — shortness of breath, dizziness, a racing heart — ebb and flow without warning. You find your life as you knew it slipping away. (Julia Moore Vogel and Charlie McCone, 10/24)

Among the reasons the 2024 presidential campaign has become one of the most extraordinary in American history is how Vice President Kamala Harris and former President Donald Trump are trading direct and unrelenting vitriolic attacks on each other’s mental health. The personal venom is obscuring and trivializing the suffering of millions of Americans with mental health issues. (Lawrence K. Altman, 10/24)