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Posted on October 27, 2023 by Dr. David Edward Marcinko MBA
By Staff Reporters
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A spike in rude behavior emerged as one of the pandemic’s many societal consequences and has not receded alongside the public health crisis. The uptick in poor behavior is likely driven by increased stress and isolation from society, TheAtlantic’sOlga Khazanreported in 2022. In many cases, these stressors mean people are easily set off when encountering innocuous requests, Keith Humphreys, PhD, a psychiatry professor at Stanford University, told The Atlantic.
The trend has hit healthcare hard. Hospitals and health systems nationwide have reported an uptick in disrespectful, discriminatory, or violent behaviors from patients since the pandemic. Nearly 24 percent of physicians reported experiencing workplace mistreatment in 2020, including verbal mistreatment or abuse, according to a study published in JAMA Network Open.
Posted on October 3, 2023 by Dr. David Edward Marcinko MBA
Hospitals are Dropping Medicare Advantage [Part C] Plans – Left and Right
By Dr. David Edward Marcinko MBA
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Hospitals SayBye-Bye?
Medicare Advantage provides health coverage to more than half of the nation’s seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping the private plans altogether. Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.
“It’s become a game of delay, deny and not pay,” Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker’s. “Providers are going to have to get out of full-risk capitation because it just doesn’t work — we’re the bottom of the food chain, and the food chain is not being fed.” Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end December 31st for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net and a few more smaller carriers.
Source: Becker’s Hospital Review [9/27/23]
COMMENTS APPRECIATED
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Cigna to Pay $172M Over Alleged Medicare Advantage Fraud
The Cigna Group will pay $172.3 million to resolve allegations that it violated the False Claims Act by submitting incorrect Medicare Advantage patient data to CMS to receive higher payments from the agency. The U.S. Attorney’s Office for the Eastern District of Pennsylvania alleged Sept. 30 that Cigna also falsely certified that the submitted data was accurate, failed to withdraw the “untruthful” data, and did not repay CMS.
Cigna will use $135.3 million from the settlement to resolve the allegations from the Justice Department. The remaining $37 million will resolve allegations related to unsupported diagnoses for Medicare Advantage enrollees that received in-home services from Cigna. As part of the settlement, Cigna has entered into a five-year accountability and auditing agreement with HHS’ Office of Inspector General, which will require company executives and board members to certify Cigna’s compliance moving forward. The payer must also conduct annual risk assessments and submit to independent risk adjustment audits.
Source: Jakob Emerson, Becker’s Payer Issues [10/2/23]
Posted on September 4, 2023 by Dr. David Edward Marcinko MBA
By Staff Reporters
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A spike in rude behavior emerged as one of the pandemic’s many societal consequences and has not receded alongside the public health crisis. The uptick in poor behavior is likely driven by increased stress and isolation from society, TheAtlantic’sOlga Khazanreported in 2022. In many cases, these stressors mean people are easily set off when encountering innocuous requests, Keith Humphreys, PhD, a psychiatry professor at Stanford University, told The Atlantic.
The trend has hit healthcare hard. Hospitals and health systems nationwide have reported an uptick in disrespectful, discriminatory, or violent behaviors from patients since the pandemic. Nearly 24 percent of physicians reported experiencing workplace mistreatment in 2020, including verbal mistreatment or abuse, according to a study published in JAMA Network Open.