Insurance Industry Insider Instructs Providers

CMS

Insurance Industry Insider Instructs Providers

September 16, 2020

by Wendell Potter

(Adapted with permission from an article posted on the author’s Twitter feed. –Editor)

Wendell PotterMy former colleagues in the health insurance industry claim they are waiving all costs of testing and treatment for COVID-19. This is a lie.

I will explain the reality that this promise does not apply to everyone, in fact to a fraction of covered lives, and there is no enforcement mechanism to ensure that it will. Here is the truth: When insurers and the Trump administration say insurers are “doing their part” to end the pandemic, they are counting on Americans to be fooled by industry lingo, to believe that COVID-19 health expenses are covered. When I worked as VP of PR for Cigna, I would have gotten a bonus for achieving this deception.

In reality, this is world-class propaganda on display. To see how the industry is pulling the wool over our eyes, go to the website of its trade group, AHIP (America’s Health Insurance Plans). It is, intentionally, close to impossible to follow what each insurance company is actually doing.

A secret: The main purpose of insurers’ web sites and documents is to provide a space to crow about their “charitable” donations, which are a tiny percentage of their revenues. I know firsthand! One of my roles at Cigna was to head the company’s meagerly-endowed foundation.

An example: To see how they mislead regarding actual COVID-19 costs, let’s examine the hidden caveat in one company’s claim. Aetna says it

“will waive co-pays for all diagnostic testing related to COVID-19… That includes all member costs associated with diagnostic testing for Commercial, Medicare, and Medicaid lines of business. Self-insured plan sponsors will be able to opt-out at their discretion. Aetna is also offering zero co-pay telemedicine visits for any reason, and extending [additional benefits] to all fully insured members.” 1

Notice the catch? They mention “self-insured” plan sponsors. Nearly 80% of Aetna’s health plan members are in these types of plans. If you get your coverage through your employer, you likely are one of them. Aetna does not consider these people “fully insured.” Therefore, their promises may only apply to 20 percent of their members.

Of course, most folks probably have no idea whether they are in a “fully insured” or “self-insured” plan, but it makes a world of difference, especially during this pandemic. And believe me, these companies are thrilled by your confusion. It could save them millions.

Maybe we should expect private insurers to be dishonest by now, or rely on government watchdogs to take care of us. That is the other problem. There is no watchdog at any level of government monitoring this deceptive practice. In other words, there are no consequences to insurer deceit. And they know it. Again, I know it because I used to be one of them.

The answer? All insurers should be required to state exactly what percentage of their members actually benefit from their “promise” to fully cover COVID-19 testing and treatment. And Congress should look into this ASAP.  It would be a great chance for Representative Katie Porter (D-CA) to embarrass the insurers yet again.2

Wendell Potter is a former insurance industry PR executive and the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans” and “Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It,” both published by Bloomsbury Press. He is the founder of Tarbell™ a non-partisan news publication of To Be Fair, Inc., an IRS-approved 501(c)3 non-profit organization. He also serves as senior analyst at the Center for Public Integrity, one of the nation’s oldest non-partisan, nonprofit investigative news organizations, and is a contributor to The Huffington Post and healthinsurance.org. His work has also appeared in NewsweekThe Nation and The Guardian.

Bi-Partisan Congressional Committees Demand CMS Administrator Repay Misspent Funds

CMS

Bi-Partisan Congressional Committees Demand CMS Administrator Repay Misspent Funds

his month, two House committees and two Senate committees published a report of a joint investigation into Centers for Medicare and Medicaid Services Administrator Seema Verma’s spending of taxpayer funds. The complete 56-page report is available in our “Partner News” section in the footer of our web site. For convenience, we reprint highlights from the report’s Executive Summary here.

The House Committee on Energy and Commerce, House Committee on Oversight and Reform, Senate Committee on Finance Minority, and Senate Committee on Health, Education, Labor, and Pensions Minority (the Committees) conducted a year-long investigation into Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s use of taxpayer funds to retain communications consultants with strong Republican political ties.

The Committees’ investigation shows that Administrator Verma and her top aides abused the federal contracting process to stock CMS with handpicked Republican consultants who billed the government hourly rates of up to $380. In less than two years, Administrator Verma’s consultants charged CMS nearly $6 million for work that included boosting her public profile and personal brand, serving as her preferred communications advisors, arranging private meetings for her with media personalities and other high-profile individuals, and routinely traveling with her to events across the country. By retaining these consultants, Administrator Verma misused funds appropriated by Congress, wasting taxpayer dollars intended to support federal health care programs.

The evidence obtained by the Committees expands on the findings of a recent audit conducted by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) and demonstrates that Administrator Verma’s expenditures potentially exceeded the scope of CMS’s authority under the applicable appropriations. Congress appropriated taxpayer funds to CMS to ensure that Americans have access to and are aware of opportunities to enroll in federal health care programs, including Medicare, Medicaid, and the Affordable Care Act. Congress did not intend for Administrator Verma or other senior CMS officials to use taxpayer dollars to stockpile CMS with handpicked consultants or promote Administrator Verma’s public profile and personal brand. Given the reckless disregard she has shown for the public’s trust, Administrator Verma should reimburse the taxpayers for these inappropriate expenditures.

During the course of the investigation, the Committees obtained tens of thousands of pages of documents from HHS and private parties, conducted interviews and briefings with employees and executives from two of the consulting firms used by CMS, and collected additional information from databases, court records, and press reports, among other sources. The Committees’ investigation shows:

 

    • Administrator Verma and her top aides misused federal contracts CMS held with consulting firms to bring handpicked Republican communications consultants into CMS operations.
    • Administrator Verma and her top aides built a shadow operation that sidelined CMS’s Office of Communications in favor of the handpicked consultants.
    • Consultants — particularly Pam Stevens — worked to promote Administrator Verma’s public profile and personal brand beyond her role as CMS Administrator, while also expanding the Administrator’s network.
    • Administrator Verma’s consultants charged CMS nearly $6 million in less than two years.
    • After CMS issued a stop-work order in April 2019, consulting firm Porter Novelli continued working for CMS under other task orders to pitch profile pieces on Administrator Verma to media outlets, including lifestyle magazines targeted in Pam Stevens’s Executive Visibility Proposal.
  • OIG issued an audit on July 16, 2020 (OIG Audit) containing findings consistent with the Committees’ investigation and concluding that CMS violated federal contracting requirements. The OIG Audit, which was requested by the Committees, found:
      • Administrator Verma and senior CMS officials allowed consultant Marcus Barlow to perform inherently governmental functions, such as making managerial decisions and directing CMS employees, thereby violating the Federal Acquisition Regulation (FAR).
      • CMS improperly administered certain contracts it held with consulting firms as personal services contracts. In doing so, CMS officials exerted a level of control over the consultants’ work that created an improper employer-employee relationship, exceeding what was permissible under the contracts.
    • CMS did not comply with the FAR and other federal requirements in managing contract deliverables, approving the use of a subcontractor, maintaining complete working files, and paying questionable

©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. This article originally appeared in Home Care Technology: The Rowan Report. Click here to subscribe. It may be freely reproduced provided this copyright statement remains intact. editor@homecaretechreport.com

New Training, New HH Compare

CMS

New Training, New HH Compare

Home Health Quality Reporting Training

September 01, 2020

Introduction to the Home Health Quality Reporting Program Web-Based Training

The Centers for Medicare & Medicaid Services is offering a web-based training course for those who are new to the Home Health Quality Reporting Program. This course is designed to provide a general overview of the program as well as a variety of links and resources for additional information. Specific topics include:

Lesson 1: What is the Home Health Quality Reporting Program (HH QRP)?

Lesson 2: The Outcome and Assessment Information Set (OASIS)

Lesson 3: OASIS Data Submission

Lesson 4: HH QRP Resources

CLICK HERE to access the training

Submit technical questions or feedback to: PAC Training mailbox.
Submit content-related questions to: HH Quality Reporting Program Help Desk

 


 

Home Health Compare merged with all other “Compare” databases

On September 3, CMS launched Care Compare, a streamlined redesign of eight existing CMS healthcare compare tools available on Medicare.gov. Care Compare provides a single user-friendly interface that patients and caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data. With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools.

For more than 20 years, Medicare’s online compare tools have served as the cornerstone for publicizing quality care information for patients, caregivers, consumers, and the healthcare community. Today’s announcement builds on the eMedicare initiative that first launched by the Trump Administration in 2018 to deliver simple tools and information to current and future Medicare beneficiaries.

Drawing on lessons learned through research and stakeholder feedback, Care Compare includes features and functionalities that appeal to consumers. By offering a user-friendly interface and a simple design that is optimized for mobile and tablet use, it is easier than ever to find information that is important to patients when shopping for healthcare. Enhancements for mobile use will give practical benefits like accessing the tool using a smartphone can initiate phone calls to providers simply by clicking on the provider’s phone number.

Currently, someone who is planning to have bypass surgery would need to visit Hospital Compare, Nursing Home Compare, and Home Health Compare individually to research providers for the different phases of their surgery and rehabilitation. Now, those patients can start their search at Care Compare to find and compare providers that meet their healthcare needs that includes information about quality measures presented similarly and clearly across all provider types and care settings.

Patients will also find helpful hints and guides throughout Care Compare. For example, when searching for a nursing home, patients have the ability to utilize a checklist with common questions and considerations when selecting a nursing home. While the measures and data used for Care Compare have not changed, the way information is displayed is now different. During a transition period, consumers and other stakeholders will be able to use the original eight compare tools while CMS continues to gather feedback and considers additional improvements to the tool. As new information about quality and cost are added to the compare tools, Care Compare will be updated to reflect that information.

©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. This article originally appeared in Home Care Technology: The Rowan Report. Click here to subscribe. It may be freely reproduced provided this copyright statement remains intact. editor@homecaretechreport.com