Geisinger to Pay $18M for Alleged Medicare Billing Violations

November 05, 2021 - Hello darkness, my old friend. It's time to turn the clocks back and bid an early goodnight to the sun.

Geisinger Settles Allegations for Medicare Billing Violations

The US Attorney’s Office for the Middle District of Pennsylvania announced that Geisinger Community Health Service (GCHS) reached an agreement to pay more than $18.5 million for allegedly violating Medicare billing rules for hospice and home health services.

GCHS voluntarily disclosed the violations between January 2012 and December 2017 to the United States Attorney’s Office.

The settlement resolves allegations concerning GCHS submitting claims to Medicare for hospice and home health services that violated Medicare rules and regulations regarding physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients. 

According to the Department of Justice, once Geisinger uncovered the fraudulent claims, they reported it to the United States Attorney’s Office,” said spokesperson from the health system, regarding the claims. READ MORE

How Sharing Decision-Making Can Lead to Prevention

It’s not unusual for a patient to have preventive care gaps, but with the help of shared decision-making and individualized treatment plans, researchers from the Cleveland Clinic have found patient engagement in preventive care can improve.

The study, published in JAMA Network Open, showed that a decision-making tool outlining individualized options for preventive care made it easier for patients to understand what care they needed. The study also indicated the tool increased the odds the patient would access preventive care.

Particularly, the researchers said preventive care plans aren’t usually individualized, leaving patients to think a certain screening is not applicable to them. It may also hamper provider efforts to recommend the highest-yield service to a patient who has to prioritize which health services she accesses.

Patients who access the tool tended to be able to better identify which preventive service would have the biggest impact on their life expectancy and overall health, with 69 percent able to identify such compared to 30 percent of patients without access to the tool. Conversely, 43 percent of intervention patients could identify the preventive service least likely to make an impact on their health, compared to 0 percent of patients who did not use the tool. READ MORE

US Government Purchases More Doses of Eli Lilly COVID-19 Therapy

The US government recently purchased additional doses of Eli Lilly and Company’s combination COVID-19 antibody treatment.

Under the agreement, Eli Lilly and Company will supply 614,000 doses of bamlanivimab and etesevimab no later than January 31, 2022, for a total of $1.29 billion. The company will supply a minimum of 400,000 doses no later than December 31, 2021.

Eli Lilly and Company will generate nearly $840 in revenue and approximately 25 cents of additional earnings per share with the new government purchase.

In February, FDA authorized the company’s COVID-19 treatment for adult and pediatric patients 12 years of age and older, those at high risk for progressing to severe disease, and those 65 years of age with a chronic condition And in August, the agency broadened the authorization to allow for treatment without remdesivir. READ MORE

Language Gaps Limiting Access to Telehealth Services

Patients with limited English proficiency were less likely to use telehealth video visits when accessing virtual services during the pandemic compared to adults comfortable speaking English, a JAMA Network Open study found.

To understand how these disparities impact telehealth use among patients with limited English proficiency, researchers retrospectively analyzed primary care telehealth visits within Kaiser Permanente Northern California. The visits occurred between March 16 and October 31, 2020, and the patients scheduled the appointments themselves using a patient portal.

The researchers used EHR data to determine patient level of English proficiency. If a patient’s EHR documented the need for an interpreter, she was considered to have limited English proficiency. Out of the over 600,000 patients, 22,476 (2.4 percent) had limited English proficiency.

The analysis revealed that patients with limited English proficiency used video visits less frequently than patients who did not have limited English proficiency. Only 7,765 patients who had a documented need for an interpreter attended a telehealth visit via video, compared to 371,237 patients without limited English proficiency.  READ MORE

Pandemic Leaves Mark on Health Insurer, Enrollee Trends

The coronavirus pandemic has left its mark on health insurer and enrollee trends, an eHealth report confirmed.

The report based its findings on over 2,200 anonymous survey responses from the American public and nearly 4,280 responses from Medicare beneficiaries. The survey was fielded from October 12 to October 25, 2021. Additionally, the researchers interviewed 16 insurance industry representatives, whose companies collectively covered over 100 million consumers.

Overall, enrollees were most concerned about out-of-pocket healthcare spending, with 42 percent saying that this is their primary coverage concern. More than one out of every five respondents (22 percent) said that monthly premiums were their main concern. Others named keeping their providers in-network and covering medications as chief concerns.

Over half of the 16 insurer participants told the researchers that they had spent more on member medical care due to the coronavirus pandemic, with most citing an increase of 10 percent or less. However, 45 percent of the respondents saw no change in their medical care costs. READ MORE

Data Analytics Tapped to Improve Patient Blood Management Programs

A Mayo Clinic study using data analytics indicates that hospitals can reduce unnecessary blood transfusions and costs by implementing patient blood management programs. According to the findings, blood management programs can also reduce the length of hospital stay and improve patient outcomes.

The study followed admissions at Mayo Clinic Hospital, Methodist Campus, and Saint Marys Campus, with a total of 2,059 licensed beds. According to the data, a total of 30,052 units of blood were transfused in 2010, compared to 20,926 units in 2017. The reduction was made possible by eliminating some transfusions and reducing the number of units transfused.

For surgical patients, the data indicated that the annual rate of transfusions per 1,000 cases decreased from 762 to 480 during the study. According to the researchers, widespread education efforts, improving decision-making practices, and analytics providing direct feedback played an important role in reducing the rate of transfusions.

Additionally, hospital length of stay was 15-percent lower than projections during the study period and the hospitals saw an estimated $7 million saved annually. READ MORE