Industry News: Volume 3, Issue 24

Health insurers face wave of questionable claims for overseas injuries

By Allison Bell

benefitspro.com – Employers and their benefits professionals may have to look even harder at requests for reimbursement for care that health plan members said they received while outside the United States.

Prosecutors in Boston last week accused five Massachusetts residents and a New York resident of conspiring to file fraudulent claims for reimbursement for care allegedly received overseas.

The defendants said they had suffered traumatic injuries, such as stabbings and gunshot wounds, while traveling and had paid for care out of their own pockets.

To view the article in its entirety, click here.

Online portals deliver scary health news before doctors can weigh in

By Fenit Nirappil

thewashingtonpost.com – More Americans are learning of devastating health diagnoses through their phones and computers instead of personally from their doctors because of a federal requirement that people receive immediate access to medical test and scan results, from routine bloodwork to MRIs.

This shift has sparked a debate in the medical community about whether instant information empowers patients or harms them.

To view the article in its entirety, click here.

CMS’ proposed 2.8% physician pay decrease for CY2025 earns quick condemnation from docs

By Dave Muoio, Emma Beavins, Noah Tong

fiercehealthcare.com – The Biden administration is proposing a 2.8% decrease to physician payments in its newly released pay proposal for physicians, drawing near-immediate protest from the industry.

Unveiled Wednesday afternoon, the calendar year 2025 Medicare Physician Fee Schedule proposed rule outlines new policies focused on primary care, preserved telehealth flexibilities and a strengthened Medicare Shared Savings Program (MSSP).

However, the release is headlined by a proposal to decrease average base payment rates by 2.93% from calendar year 2024.

To view the article in its entirety, click here.

Louisiana Reclassifies Drugs Used in Abortions as Controlled Dangerous Substances

By Rosemary Westwood, WWNO

kffhealthnews.org -Louisiana lawmakers have added two drugs commonly used in pregnancy and reproductive health care to the state’s list of controlled dangerous substances, a move that has alarmed doctors in the state.

Mifepristone and misoprostol have many clinical uses, and one use approved by the FDA is to take the pills to induce an abortion at up to 10 weeks of gestation.

The bill that moved through the Louisiana Legislature this spring lists both medications as Schedule IV drugs under the state’s Uniform Controlled Dangerous Substances Law, creating penalties of up to 10 years in prison for anyone caught with the drugs without a valid prescription.

To view the article in its entirety, click here.

 Facing Financial Ruin as Costs Soar for Elder Care

By Reed Abelson and Jordan Rau

nytimes.com – Margaret Newcomb, 69, a retired French teacher, is desperately trying to protect her retirement savings by caring for her 82-year-old husband, who has severe dementia, at home in Seattle. She used to fear his disease-induced paranoia, but now he’s so frail and confused that he wanders away with no idea of how to find his way home. He gets lost so often that she attaches a tag to his shoelace with her phone number.

To view the article in its entirety, click here.

Women with endometriosis face fourfold higher risk of ovarian cancer, study suggests

By Jacqueline Howard

cnn.com – The risk of developing ovarian cancer appears to jump about fourfold among women with endometriosis, compared with women who haven’t been diagnosed with the condition, a new study finds.

Scientists have known that endometriosis may be linked with an increased ovarian cancer risk, but the study details how that risk can vary by subtypes of endometriosis.

Endometriosis is a common and often painful condition that happens when tissue similar to the lining of the uterus grows outside the uterus itself.

To view the article in its entirety, click here.

Health systems snapping up hospitals in neighboring states

By Alan Condon

beckershospitalreview.com – Healthcare is shifting to a multi-region model and the number of health systems operating in multiple states is rapidly increasing.

The trend is becoming more prominent as health systems diversify portfolios, increase their bargaining power with payers and vendors and pursue further economies of scale amid challenging financial headwinds.

To view the article in its entirety, click here.

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