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United Health: apparently does not like protesters outside of HQ
Protesters say 11 arrested outside UnitedHealthcare HQ in Minnetonka
https://www.startribune.com/unitedhealth-protest-minnetonka-arrests/600380907/
Warren Blasts United Health CEO for Monopolistic Practices that Harm Patients
Critics have held a series of events highlighting what they describe as a pattern of improper coverage denials by the nation’s largest health insurer.
Protest organizers say 11 people were arrested Monday outside UnitedHealthcare’s headquarters in Minnetonka during an event spotlighting what critics say is a pattern of improper coverage denials by the nation’s largest health insurer.
Protestors blocking a road were arrested by the Minnetonka Police Department, according to a news release from People’s Action Institute, a consumer group that protested at UnitedHealth Group’s Optum headquarters in Eden Prairie in April.
Minnetonka police said the protestors were cited with misdemeanors and released from the scene. Three of those arrested were from Minnesota, according to police, while others came from Illinois, Maine, New York, Texas and West Virginia.
“UnitedHealthcare policyholders and medical professionals have petitioned, protested and spoken directly to the chief medical officer of UnitedHealth Group about our concerns, but their leadership has refused to acknowledge that prior authorizations and claim denials are a widespread problem,” Aija Nemer-Aanerud, a director with Chicago-based People’s Action Institute, said in a news release Monday.
In a statement, UnitedHealthcare said: “The safety and security of our employees is a top priority. We have resolved the member-specific concerns raised by this group and remain open to a constructive dialogue about ensuring access to high-quality, affordable care.”
UnitedHealthcare is the health insurance business at Minnetonka-based UnitedHealth Group, the largest company in Minnesota by revenue. Its Optum division runs clinics, manages pharmacy benefits and consults with health care providers on data and information technology needs.
Health policy experts say there’s been a lack of comprehensive data on the frequency of and causes for insurance coverage denials.
Critics in recent years have focused on prior authorization rules that patients and health care providers say have wrongly led to coverage denials, blocking needed care in the process. Insurers contend the rules help control costs and can improve quality.
UnitedHealthcare announced in March 2023 that it was dialing back some requirements for prior authorizations. The subject, however, has been a source of controversy for decades, including a pledge by UnitedHealthcare in 1999 to move away from “restrictive ‘mother-may-I-medicine,'” the Wall Street Journal reported at the time.
People’s Action Institute says it launched a campaign in 2022 to fight back against coverage denials by health insurers. After the protest at Optum headquarters in April, critics met with UnitedHealthcare executives, pushing to help individual patients and for broader reforms at the company.
“Health insurance coverage has expanded in America,” Nemer-Aanerud said, “but we are finding it is private health insurance corporations themselves that are often the largest barrier for people to receive the care they and their doctor agree they need.”
In Monday’s incident, Minnetonka police said, public nuisance citations were issued for interfering/obstructing/rendering dangerous for passage any public highway or right-of-way.
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Today: Make America SAFE ONCE AGAIN
In this interview on Fox Cable Fox & Friends today, they were actually talking about illicit street fentanyl analog that is killing our citizens. Not just stating that the person OD’d from Fentanyl.
There are some 100-200 known different Fentanyl analogs and only two are approved by the FDA to be used in humans. Fentanyl citrate is the one most – and longest being used in humans.
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FDA’s new reporting of drug shortages
https://cdernextgenportal.fda.gov/publicportal/s/dsm-submission
FDA’s new reporting of drug shortages
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Asked to share!
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More call for violence: MS congressman’s staffer says ‘don’t miss next time’ after Trump assassination attempt
Mississippi congressman’s staffer says ‘don’t miss next time’ after Trump assassination attempt
A now-deleted Facebook post by a staffer of Mississippi’s lone Democrat congressman appeared to support the attempted assassination of former President Donald Trump on Saturday.
The deleted post by Jacqueline Marsaw, a field director for U.S. Rep. Bennie Thompson, D-Mississippi, said “I don’t condone violence but please get you some shooting lessons so you don’t miss next time ooops [sic] that wasn’t me talking.”
The Mississippi Republican Party’s X account said Thompson should “FIRE his field director for condoning the attempted assassination of President @realDonaldTrump !!!” The post also said state Democrats “must repudiate these despicable statements.”
Trump was wounded in the ear and rushed off the stage Saturday at a rally in Butler, Pa. by U.S. Secret Service agents and other law enforcement officers.
In a post to X after the shooting, Thompson said “There is no room in American democracy for political violence. I am grateful for law enforcement’s fast response to this incident. I am glad the former President is safe, and my thoughts and prayers go out to everyone involved.”
Thompson is the author of the Denying Infinite Security and Government Resources Allocated toward Convicted and Extremely Dishonorable Former Protectees Act. House Resolution 8081 would strip Secret Service protection for anyone convicted of a state or federal crime and sentenced to a year or more in prison.
With Trump having already been convicted in May of 34 counts in New York of falsifying business records related to hush money paid to porn actress Stormy Daniels, the bill by the ranking Democrat on the House Committee on Homeland Security is clearly aimed at the former president.
The bill introduced on April 19 has yet to receive a committee hearing or a floor vote.
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Is this a call for violence: Biden Threat ‘To Put Trump in a Bullseye’
Biden Threat ‘To Put Trump in a Bullseye’ Met With Shrugs, in Contrast With Firestorm Over Palin ‘Crosshairs’
“It’s time to put Trump in a bullseye,” President Biden is heard telling supporters in a recent conversation. Will he be accused of advocating violence the way, say, Governor Palin of Alaska was accused of inspiring an attempt on a congresswoman’s life?
On Monday, in a donors-only call given to Politico, Mr. Biden said he wanted to “move forward” and was “done talking about the debate.” It was then that he made the remark about “bullseye.”
This incident invites comparison to Ms. Palin — known to readers of the Sun as the Alert Alaskan — the Republican vice-presidential nominee in 2008. In 2010, a graphic designer for her PAC used what the New York Times deemed “stylized crosshairs” to mark congressional districts the PAC was contesting.
One of Ms. Palin’s aides said the illustrations were “surveyors symbols,” and the creative flourish was politically inert until the following January. An Arizona Democrat representing one of the enumerated districts, Congresswoman Gabrielle Giffords, was targeted by an assassin.
Jared Loughner wounded 12 and killed six, leaving Ms. Giffords with brain injuries that forced her retirement. Loughner had a murky political ethos, although he listed “The Communist Manifesto” among his favorite books. The opportunity to blame his act on Ms. Palin and others on the right — including my late boss, Rush Limbaugh — proved irresistible to their opponents.
In 2017, the Times resurrected the map myth after a left-wing gunman, James Hodgkinson, targeted congressional Republicans at baseball practice. He shot six and almost killed the House Majority Whip, Congressman Steve Scalise.
Unlike Loughner, Hodgkinson had a political motive. He railed against Republicans and worked for the campaign of the presidential Democratic-Socialist, Senator Sanders. “Conservatives and right-wing media were quick,” the Times wrote, “to demand forceful condemnation of hate speech and crimes by anti-Trump liberals.”
The Times agreed that the left “should of course be held to the same standard of decency that they ask of the right.” It then cited Ms. Palin’s map as a moral equivalence, writing that “the link to political incitement was clear” between it and Loughner. After an outcry, they added a correction that “no connection … was ever established.”
The Washington Post wrote that the editorial “showed how pervasive this debunked talking point still is on the political left.” Ms. Palin sued the Times for libel. The case was dismissed in 2022, but her appeal is pending before the Second Circuit.
As the Times did with Ms. Palin’s map, Mr. Biden has made hay of divining evil motives to Trump’s rhetoric. In March, Mr. Biden stripped a speech his opponent gave to Ohio automobile employees of all context to pluck out a single word.
The autoworkers, Trump said, are “not going to be able to sell” cars if he loses. “It’s going to be a bloodbath.” One definition of the word in Merriam-Webster’s is “a major economic disaster.” Mr. Biden chose the more violent definition and cast it as threatening murder in the streets.
Unlike bloodbath, “bullseye,” has no banal application. Mr. Biden can say he was using hyperbole and colorful language; he’s welcome to do so. If he’s going to infer the most extreme intent from Trump’s words as the Times did with Ms. Palin’s map, though, then turnabout is fair play.
There’s little doubt that if Mr. Biden’s “forceful message,” as Politico described it, had come out of Trump’s mouth, the left would be outraged and the incumbent would be exploiting it to the hilt.
As tiresome as this “What if…?” game is in politics, Mr. Biden’s “bullseye” crack cries out for application of that even-handed “standard of decency” the Times mentioned in its correction, yet nobody has printed a word of objection.
After the FBI was given an authorization to use lethal force in its raid on Mar-a-Lago, Trump accused Mr. Biden of trying to “assassinate” him.
If he repeats the allegation in light of the “bullseye” remark, expect to find that those who imagine links between the right’s rhetoric and violence to shrug until the next time seizing on someone’s words aligns with their political bent.
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CVS Health Co: CMS cites Aetna in 1st No Surprises Act audit
CMS cites Aetna in 1st No Surprises Act audit
https://www.beckerspayer.com/payer/cms-cites-aetna-in-1st-no-surprises-act-audit.html
Aetna failed to accurately calculate qualified payment amounts for air ambulance services, CMS’ first audit of an insurer’s No Surprises Act compliance found.
The audit, issued May 29, examined the rates Aetna Health in Texas charged for an out-of-network air ambulance provider between January and June 2022.
The No Surprises Act requires insurers to calculate a qualified payment rate for out-of-network emergency services. This rate is generally the median contracted rate the insurer has with other providers for similar services in the area.
CMS’ audit found Aetna used the wrong methodology to calculate the qualified payment rates, calculating the amount based on claims paid rather than contracted rates.
In its audit, CMS instructed Aetna to conduct a self-audit of all of the qualified payment amounts it calculated for air ambulance services in Texas during the audit period, and refund members if their cost-sharing should have been lower based on the correct payment amount.
The agency also found that Aetna failed to give providers required notice that they may initiate the independent dispute resolution process within four days after the end of the open-negotiation process. Aetna also failed to share the qualified payment amount it calculated to providers in notice or denial of payment.
“This routine audit took place during the first six months of 2022, following the initial implementation of the requirements,” an Aetna spokesperson said in a statement shared with Becker’s. “We addressed all the report’s findings to CMS’ satisfaction.”
Aetna could be subject to more audits of its payment rates in the future, CMS said.
The audit is the first examination CMS has published on an insurer’s compliance with the No Surprises Act. The bill passed at the end of 2020 in an effort to end surprise medical bills for emergency care.
In February, the American Hospital Association called on CMS to up its oversight of payers compliance with the act, adding it is “deeply concerning that the departments have not completed a single audit of payers when the law has been in effect for nearly two full years.”
Provider groups have expressed concerns that the act’s current enforcement and dispute resolution process favors payers.
The law has faced several legal challenges, and a backlog of disputed claims. Data published in February found the number of disputes initiated during the first six months of 2023, were 13 times greater than federal agencies initially anticipated.
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House committee hears from FTC commissioners on PBM report
House committee hears from FTC commissioners on PBM report
https://ncpa.org/newsroom/qam/2024/07/11/house-committee-hears-ftc-commissioners-pbm-report
On Tuesday—the same day the agency released its interim report on PBMs—the five FTC commissioners testified before the U.S. House Committee on Energy and Commerce on their FY25 budget request. Numerous committee members wanted to hear from the commissioners about the new report, however.
Rep. Mariannette Miller-Meeks (R-Iowa) highlighted the year-over-year increase in PBM control over prescriptions nationwide, speaking with Commissioner Alvaro Bedoya about the risks of vertical integration and consolidation in the health care industry, as well as PBM noncompliance with the FTC’s information requests in compiling the report. Bedoya in particular pointed to the harms caused by PBMs steering patients towards preferred pharmacies.
Rep. Buddy Carter (R-Ga.) spoke extensively about the challenges pharmacists face as a result of PBMs, noting the loss rate of one pharmacy closure per day. Carter also sought reassurance from Commissioner Melissa Holyoak that her dissent in releasing the interim report was only due to her desire to see a more comprehensive report from the FTC, rather than any support for PBM practices. Holyoak pointed to her work as Utah Solicitor General in holding PBMs accountable.
Other members who used their time to speak to the PBM problem included Rep. Larry Bucshon (R-Ind.) who noted serious concerns about PBMs’ new group purchasing organization (GPO) arrangements, and Rep. Diana Harshbarger (R-Tenn.) who askedFTC Chair Lina Khan about the issue of pharmacy deserts, especially in rural and underserved areas. In her conversation with Bedoya, he specifically highlighted the portion of the report detailing the faxed, opt-out-only nature of PBM contracts and the frequent changes PBMs make to them. NCPA looks forward to the FTC’s continued investigation into this issue, and to finding ways to hold PBMs accountable.
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Insurance Companies finding new ways to deny care?
If you have traditional Medicare, the vendor is required to notify the pt up front that Medicare is not expected to pay for the product/procedures, and the pt understands that they are responsible for costs associated with the product/procedure provided. That is called an Advance Beneficiary Notice of Non-coverage, https://www.medicare.gov/basics/your-medicare-rights/your-protections if the pt was not notified upfront and did not sign such a form. The pt is not required to pay for the products/services not covered and paid for.
However, since Medicare Part-C (Advantage) prgms are provided by for-profit private insurance companies, this policy & form may or may not apply. I guess that insurance companies are moving from using the prior authorization process to being able to deny care. To give the vendor a prior authorization approval upfront and then come back after the product/procedure was provided to “question” if the product/service was medically necessary and try to claw back the monies paid to the vendor or deny to pay the vendor.
ASCs see post-procedure payer clawbacks intensify
As scrutiny increases on payer prior authorizations, health plans are using a new tactic to disrupt provider cash flows: post-procedure clawbacks.
ASCs in some markets have noticed insurance companies scrutinizing even previously approved claims post-procedure and denying care or re-evaluating circumstances of the case to recover funds.
“All the insurance carriers are now hiring companies to look at a post-procedure type of prior authorization, or post-authorization,” said Adam Bruggeman, MD, a spine surgeon at San Antonio-based Texas Spine Care Center and chief medical officer of MPOWERHealth, during a June 21 panel at the 21st Annual Spine, Orthopedic & Pain Management-Driven ASC + The Future of Spine Conference in Chicago. “Essentially you’d perform the procedure and then after the procedure, using all the same data they asked for going into surgery, they’re now asking hospitals, surgery centers and doctors again to confirm that they really should have approved the surgery the first time and then they’re clawing back the money, or not paying the money as a result.”
To combat the clawbacks, Dr. Bruggeman’s team has identified the information payers ask for post-procedure and gathering it from physician offices before surgery.
Columbia (Mo.) Orthopaedic Group has seen similarly aggressive tactics by local payers and built a whole department focused on preauthorizations and post-surgery payer requests. The group spends hundreds of thousands of dollars per year to maintain the department, which is a heavy lift for an independent organization. But so far, the investment has paid off.
“Our physicians feel the pain in the clinic, but they haven’t felt it in their wallets yet because our departments are really, really good at making sure we get the money that’s theirs,” said Andrew Lovewell, CEO of Columbia Orthopaedic Group. “We have a lot of robust processes ahead of time where the doctors know the day before surgery exactly what codes are approved. They have to email if they do anything differently in the case. They have to tell us immediately or they face a penalty inside of our own group. We take both sides of it, not only to educate our providers but then go directly after the payers.”
Mr. Lovewell’s center does around 2,000 total joint replacements per year and a big payer has taken aim at the procedures.
“They’re going back and retro trying to deny implants we put in from six months ago. They’re doing a huge sweep,” said Mr. Lovewell. “They’ve hired a third party and then we’re spending money and time sending all these records back to them and they approve every single one of them. It’s just a nuisance headache.”
The payer requested almost 6,000 patient records on implants over a two-year period after approving everything upfront. Mr. Lovewell asked for an increase in rates because the business office will spend significant time pulling those records. He also threatened to go out of network and send those procedures back to the hospital.
“What I think we’re going to see, as more light gets focused on prior authorization, they’re going to shift to post-procedure techniques to try and extract the same amount of money and reduce the same payments,” said Dr. Bruggeman.
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