Journalists Sue Obama Admin Over Medicare Advantage Transparency

Posted 05/29/2014 | In The News0
by Sarah Hurtubise –

A Pulitzer-prize winning investigative journalism organization filed a lawsuit against the Obama administration Tuesday for refusing to disclose Medicare Advantage documents.

The Center for Public Integrity (CPI), a left-leaning nonprofit research outlet, is suing the Department of Health and Human Services over public documents available through the Freedom of Information Act that the administration will not disclose.

CPI has struggled for a year to obtain documents that concern an HHS subagency, the Centers for Medicare and Medicare Services’, oversight of the Medicare Advantage program — a privately-run and often lower-cost alternative to Medicare. The federal government is required by law to respond to public records requests within 20 business days; but while CPI received an acknowledgment of their request in May 2013, they’ve yet to receive any documents.

Fred Schulte, a senior reporter at CPI, requested that CMS provide program audits, billing data and the names of health insurance plans that the administration suspected had overcharged the federal government for Medicare Advantage patients. Medicare Advantage costs taxpayers $150 billion annually.

“The information about Medicare Advantage that we are asking for should be readily available to the taxpaying public,” CPI Executive Director Bill Buzenberg said in a statement. “There’s no excuse for ignoring our request.”

CPI and The Wall Street Journal successfully sued the Medicare administrator in 2009 over a failure to disclose Medicare billing records.
The center promised to publish the results of the investigation next month.

It’s the latest of several recent lawsuits against the Obama administration for its lack of transparency. Judicial Watch, a right-leaning nonprofit government watchdog, filed two lawsuits against the Obama administration’s CMS last month for refusing to release documents relating to Obamacare.

Judicial Watch is seeking documents about HealthCare.gov files that communicate enrollment in Obamacare exchanges between the federal government and private insurers, as well as records relating to the administration’s oversight and requirements for Obamacare navigators.

http://amac.us/journalists-sue-obama-admin-medicare-advantage-transparency

Today's Datapoint

$3,138 ... is the annual drug cost threshold for 2015 that was recently set by CMS, up slightly from 2014’s threshold of $3,017.

Quote of the Day

“I think that [lacking scale] is a concern when you are looking at smaller [insurers] throughout the country. There is a lot of pressure on them as they meet a lot of regulatory requirements, IT requirements, either with the ACA changes or other things that are going on in the industry like with ICD-10, and all the requirements to really be competitive and maintain a low administrative expense base. Combining resources [like the recent alliance between CDPHP and Independent Health in New York] just makes a lot of sense.”

— Steve Zaharuk, senior vice president at Moody’s Investors Service, told AIS’s Health Plan Week.

Biologic's and Generic's Share of Pharmaceutical Market

Biologics share of total pharmaceutical sales worldwide:
2014 2015 2016 2017
11% 15% 18% 19-20%

Generics market share:
Developed Markets Emerging Markets Rest of World World
2012 16% 58% 27% 27%
2017 21 63 31 36
Publication Source: Managed Care, May 2014

Data Source: IMS Institute for Healthcare Informatics

According to a recent report,

...the percentage of workers who had employment-based health coverage from their own job in 2012 was: • 12.8% of workers who were employed less than 30 hours per week • 33.6% of workers who were employed between 30–39 hours per week • 60.5% of workers who were employed at least 40 hours per week Source: "Trends in Health Coverage for Part-time Workers," Employee Benefit Research Institute Press Release, May 22, 2014, http://www.ebri.org/pdf/PR1078.Prt-time.22May14.pdf

Doctors Found Sanctioned for Negligence by the New York State Department of Health Allowed to Continue to Practice

According to The New York Public Interest Research Group, over three-quarters of doctors found sanctioned for negligence by the New York State Department of Health are allowed to continue to practice. Nearly 60% of New York State actions against doctors were based on sanctions taken by other states, the federal government, or the courts, not directly as the result of an Office of Professional Medical Conduct (OPMC)-initiated investigation. One of the arguments as to why New York State does not revoke questionable doctors' licenses is that they are an important resource. However, over the past ten years, New York's population has grown by about 2%. Its doctor population has swelled by 36%. Source: The New York Public Interest Research Group

According to a recent survey of large employers with a median employee population of 23,000:

• 91% believe they have a ‘good to excellent’ understanding of the complexities involved in moving to a private exchange • 60% said they would want to remain self-insured if they moved to a private exchange • 37% have no plans to evaluate private exchanges • 13% have done an evaluation and decided not to proceed with replacing their current medical benefit plan with an exchange • 35% said that they have started to evaluate private exchanges as a potential benefits strategy for active employees • 11% are interested in evaluating exchanges • 3% are currently in an exchange Source: Large Employers ‘Fully Committed” to Company-Sponsored Benefits, Express Mixed Reaction to Private Health Insurance Exchanges." Pacific Resources Press Release, April 29, 2014, http://www.pacresbenefits.com/press-releases/large-employers-fully-committed-to-company-sponsored-benefits-express-mixed-reaction-to-private-health-insurance-exchanges-