Let’s talk Medicare Advantage – NC Health News

By Thomas Goldsmith

Privately run Medicare Advantage insurers attract more enrollees each year with prominent advertising and enticing perks. But the program, with about 1 million North Carolina enrollees, faces challenges on specifics from federal regulators, the courts and Congress about the profits it makes, its consumer advertising and some of its internal practices. 

As federal regulators are taking aim at aspects of Medicare Advantage, such as allegedly fraudulent billing practices, a report from the U.S. Senate Finance Committee is one of the sources that lists complaints calling its marketing misleading. Those problems have been seen in North Carolina, as well as across the country.

“The North Carolina Department of Insurance shared that its Seniors’ Health Insurance Information Program (SHIIP) had received a number of complaints involving dually eligible beneficiaries who had their enrollment changed to a different [Medicare Advantage] plan even though neither the beneficiary, family member, or power of attorney had been engaged in an enrollment discussion with the plan or an agent,” the August 2022 report reads.

(Dually eligible beneficiaries are eligible for Medicaid, the health insurance that covers low-income people, and for Medicare, which is mostly for people older than 65.) 

Now, federal regulators are proposing new rules to curb such deceptive practices. Regulators say the rules are necessary to make sure potential Medicare Advantage customers can receive accurate information about the plans and their differences from traditional Medicare.

In addition to restricting the advertising that draws millions of enrollees to Medicare Advantage, the federal Centers of Medicare and Medicaid Services is working with the federal Department of Justice to crack down on billing practices that they contend can unnecessarily increase company profits by billions annually.

Recently announced moves by CMS to improve the accuracy of billing by Medicare Advantage companies won praise late last week in a joint letter from a group of more than three dozen leading figures from public health, public policy, health care and clinical care.

“CMS has taken a strong and appropriate approach to improving the accuracy of payment in the MA Program,” said Dr. Don Berwick, a former administrator of the Centers for Medicare and Medicaid Services who signed the letter. 

Additional signers included faculty from Yale, Harvard, Stanford, Southern California, Pennsylvania and New York universities, as well as former officials of CMS, the Center for Medicare and Medicaid Innovation and the Medicare Payment Advisory Commission, known as MedPac,

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Court docket lets Tennessee 6-7 days abortion ban take impact | Overall health and Fitness

NASHVILLE, Tenn. (AP) — A federal courtroom on Tuesday permitted Tennessee’s ban on abortion as early as six weeks into being pregnant to take impact, citing the Supreme Court’s selection final week overturning the landmark Roe v. Wade abortion rights case.

The motion by the 6th U.S. Circuit Court docket of Appeals comes ahead of Tennessee’s other abortion ban, the so-known as cause ban, is predicted to limit abortion pretty much solely by mid-August, according to a recently thorough lawful interpretation by the condition lawyer general. Both actions would make accomplishing an abortion a felony and subject doctors to up to 15 yrs in jail if convicted.

Republican Legal professional Normal Herbert Slatery submitted an emergency movement Friday to let condition to start utilizing the 6-week ban. GOP supermajorities in the Legislature passed the law in 2020 with Republican Gov. Invoice Lee’s backing, and it was immediately blocked in federal court docket.

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Especially, the ban halts abortion after cardiac exercise is detected, which is all-around 6 months in pregnancy— when most girls don’t know they are pregnant.

“There are a good deal of issues that I am quite passionate about and choose really individually in this work that I have, but … this was the most critical detail that I could do as governor,” Lee explained whilst speaking pretty much with anti-abortion religious leaders Friday, immediately after the Supreme Court docket ruling.

Lee reported Tuesday that the federal appeals court’s final decision marked “another significant defense for unborn little ones in our state.”

It only can make an exception when an abortion is important to stop the woman’s death or “serious hazard of sizeable and irreversible impairment of a main bodily perform.” Nonetheless, it specifies that a woman’s mental health and fitness does not qualify for an exemption.

“Abortion bans rob folks of their potential to make the selections that are greatest for themselves, their lives, and their futures,” said Ashley Coffield, president and CEO of Planned Parenthood of Tennessee and North Mississippi, in a assertion. “It is unconscionable that Tennesseans will drop accessibility to abortion in their communities for the reason that of this selection.”

Prepared Parenthood was not executing abortions at its services in Nashville and Memphis on Monday in anticipation of courtroom action to unblock the 6-week ban, reported spokesperson Matt Anderson.

Separately,

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