Medicare Prescription Drug premiums to drop in 2024
The Centers for Medicare & Medicaid Services (CMS) said Monday that it expects the average total monthly premium for Medicare Part D coverage in 2024 will be $55.50, a 1.8 percent decrease from 2023. The premiums are calculated based on plan bids submitted to CMS and the agency releases the information to help Part D plan sponsors finalize their offerings ahead of Medicare Open Enrollment, which takes place Oct. 15 to Dec. 7, 2023.
CMS attributed the stable premiums for 2024 based on improvements to the Part D program in the Inflation Reduction Act (IRA) that allow Medicare enrollees to benefit from reduced costs. The final total Part D premiums that beneficiaries will pay for Part D coverage may change and will be announced in September, prior to open enrollment.
CMS also announced that the Part D national average monthly bid amount for 2024 is $64.28, the 2024 Part D base beneficiary premium is $34.70, and the de minimis amount is $2.
Martin’s Point Health Care to pay $22M to resolve Medicare fraud claims
Martin’s Point Health Care Inc. (Martin’s Point), headquartered in Portland, Maine, has agreed to pay more than $22 million to resolve allegations that it violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees in order to increase reimbursements from Medicare.
The Department of Justice said that from 2016 to 2019, Martin’s Point conducted chart reviews of their Medicare Advantage beneficiaries to identify additional diagnosis codes that had not been submitted to Medicare. Many of the additional codes submitted, however, were not properly supported by the patients’ medical records. The government alleged that Martin’s Point nevertheless submitted those diagnosis codes, which resulted in higher payments from CMS.
“The government expects those who participate in Medicare Advantage to provide accurate information to ensure that proper payments are made for the care received by enrolled beneficiaries,” said Deputy Assistant Attorney General Michael D. Granston of the Justice Department's Civil Division, Commercial Litigation Branch, in the announcement. “Today’s result sends a clear message to the Medicare Advantage community that the United States will take appropriate action against those who knowingly submit inflated claims for reimbursement.”
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Alicia Wilbur, a former manager in Martin’s Point’s Risk Adjustment Operations group. As part of the settlement, Wilbur will receive approximately $3.8 million.
HHS establishes office to address Long COVID research, clinical trials
The U.S. Department of Health and Human Services (HHS) has formed the Office of Long COVID Research and Practice to lead the Long COVID response and coordination across the federal government. The National Institutes of Health (NIH) will launch the Long COVID clinical trials. Current estimates indicate that 7.7 to 23 million Americans have developed the condition.
“As our nation continues to make strides in combating COVID-19, it is crucial that we address the impact of Long COVID and provide resources to those in need,” said HHS Secretary Xavier Becerra in the announcement. “Last year President Biden called on HHS to coordinate the response to Long COVID. The Official establishment of the Long COVID Coordinating office and the launch of the RECOVER clinical trials solidifies this issue as an ongoing priority.”
The office will be located within HHS’ Office of the Assistant Secretary for Health under the leadership of the HHS Assistant Secretary for Health Admiral Rachel Levine. It will oversee the ongoing coordination of the whole-of-government response to the longer-term effects of COVID-19, including Long COVID and associated conditions and the implementation of the National Research Action Plan on Long COVID and Services and Supports for Longer-Term Impacts of COVID-19.