Re-published with permission of Columbia Journalism Review
Reporters don't often cover the
rule-making process that goes on at government agencies. If they do, they
typically borrow from a press release announcing the agency has proposed this
or that new regulation, and then the story dies a quiet death. Rarely is there
any follow-up when regulated industries howl, or when successful lobbying
results in the agency cancelling its proposed regulations.
There should be more of that coverage--and the Centers for Medicare and Medicaid
Services (CMS) is a juicy target for it. "When federal officials adjust
payments to Medicare Advantage plans, they spend billions of tax dollars. Yet
CMS officials seldom explain these decisions to the pubic," says Fred Schulte,
the lead writer on the Center for Public Integrity's expose of Medicare Advantage plans, which we've just praised here. Schulte helped me develop this list of recent
examples of Medicare cave-ins to industry pressure. It's a good place to start.
Medicare Advantage plan rate cut
turns into an increase, April 2014.
Sound familiar? Same crew, same cast of "grassroots" characters lobbied hard to
turn a proposed 2 percent payment reduction into a small increase. The precise rate adjustment has been
disputed by insurers, Schulte says, but "the rate setting system is so complex,
it's difficult to tell who is right."
CMS cancels Part D changes, March 2014. America's high health spending
is driven in part by the high cost of prescription drugs here, and CMS thought it had identified ways to improve Part D, the
Medicare drug benefit, that would save a billion dollars or so over five years.
Administrators wanted to eliminate some drugs from insurers' formularies while
still assuring sufficient choice, and hoped to limit the number of stand-alone
drug plans (there are way too many in some areas) and ensure that patients
really do get the lowest prices for their medications when they use so-called
"preferred networks." But the proposed rules were abruptly cancelled after insurers, drug companies, and the
"consumer advocacy" groups they fund used their muscle in Congress to get the
agency to back off.
CMS scraps rule to restrict home care visits, April 2014. In 2013
administrators were troubled by signs that sellers of some Medicare Advantage
plans were arranging home care visits to patients, and that in some cases those
visits did little but drive up costs. They proposed restricting those visits. The industry didn't like
that and fought back, arguing such limits would cut their payments by as much
as $3 billion a year. By early April those visits didn't seem to trouble CMS.
It announced it was not "finalizing the policy," but "may
reconsider" in the future.
CMS curbs the number of Medicare Advantage audits, 2012. In 2009,
shortly after taking office, President Obama seemed eager to make good on his
campaign
promise to cut payments to Medicare Advantage plans. CMS said it would conduct
90 confidential audits of health plans each year. By 2012, the number of actual
audits each year had shrunk to 30. CMS won't release any of the audits, the
names of health plans that may have overbilled the government, and the amounts
of the overcharge.
CMS decides not to pursue overpayments, 2012. In February 2012 CMS
decided to forgive overpayments to Medicare Advantage plans made from 2008
through 2010 even though the agency's own estimate showed they had made more
than $32 billion in "improper" payments over those three years. The agency
didn't say why it made this decision, Schulte reported.
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