Bundled payments could reduce costs, fraud, experts say

Published on May 21, 2014 at 1:23 AM · No Comments

Policy experts say switching to this type of payment system could save millions of dollars over the fee-for-service approach, reports USA Today. Meanwhile, The Center For Public Integrity says that federal investigators are probing alleged overbilling by Humana's Medicare Advantage program.

USA Today: Bundled Payments Could Cut Medicare Fraud, Experts Say
Health and policy experts are pushing for a system that pays doctors a lump sum for medical care or allows them to share in savings, saying it will save millions of dollars over current fee-for-service payments that can lead to fraud and over-use of medications. In the new system, doctors would not be entitled to extra pay should they prescribe costlier medication (Kennedy, 5/19).

The Center For Public Integrity: Feds Investigating Allegations That Humana Inc. Overcharged Medicare Advantage Program
Giant health insurer Humana Inc. faces multiple federal investigations into allegations that it overbilled the government for treating elderly patients enrolled in its Medicare Advantage plans, court records reveal. The status of the investigations is not clear, but they apparently involve several branches of the Justice Department. The U.S. Attorney's Office in Miami wrote in a court document filed in March that officials expect that at least one of the probes will be completed and the findings made public "in the next few months" (Schulte, 5/16).

In other news -

Modern Healthcare:  HHS Trying To Shield Federal Docs From Malpractice Scrutiny, Former Officials Allege
Two former high-ranking federal officials are alleging that HHS is trying to gain authority that would allow it to hide information on malpractice cases against some of its doctors-;information that would be publicly reported if the incidents happened at community hospitals and clinics. All payments for malpractice settlements are, in theory, reported to the public in the National Practitioner Data Bank. But the proposed policy would protect federally employed doctors, nurses and dentists with malpractice settlements when government officials independently decide that the clinicians met the appropriate standard of care. The HHS' Office of Inspector General concluded several years ago that hundreds of federal malpractice claims appeared to have been omitted from the databank already (Carlson, 5/19).


http://www.kaiserhealthnews.orgThis article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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