News in brief - Dec. 1, 2003

CMS sets disease management demo - Medicare claims-error rate drops - Group urges scrutiny of drug program - Uninsured to have their day

CMS sets disease management demo

Three organizations will conduct a disease management project for patients with heart problems and complex diabetes, the Centers for Medicare & Medicaid Services said.

CorSolutions of Rosemont, Ill.; Diabetex/XLHealth of Baltimore; and HeartPartners, a Santa Ana, Calif.-based collaboration, will recruit up to 30,000 Medicare beneficiaries in Arizona, California, Louisiana and Texas. The project will test whether disease management and prescription drugs can improve outcomes.

Medicare claims-error rate drops

Medicare contractors made improper payments of about $11.6 billion in 2002, an error rate of about 5.8%, the Centers for Medicare & Medicaid Services said. From 1996 until last year, the Health and Human Services Dept. Office of Inspector General surveyed payment accuracy, looking at 6,000 claims. This year, a private contractor looked at 128,000 claims. The error rate has dropped from a high of 13.8% in 1996.

Group urges scrutiny of drug program

A study released by Taxpayers Against Fraud Education Fund in November recommends that the government draw lessons from its seven False Claims Act settlements with pharmaceutical manufacturers and apply that knowledge to any future Medicare coverage for outpatient prescription drugs. The settlements have netted $1.6 billion since 2001.

The report, "Reducing Medicare and Medicaid Fraud by Drug Manufacturers: The Role of the False Claims Act," concludes that companies mainly defrauded federal insurers by inflating the "average wholesale price" and then greatly reducing prices to physicians and by giving big discounts to large customers, such as managed care plans.

The fund is a nonprofit, nonpartisan organization dedicated to combating fraud against the federal government through qui tam provisions of the False Claims Act.

Uninsured to have their day

Speaking to health care leaders at Iowa's Des Moines University, an official from the Centers for Medicare & Medicaid Services said the agency would focus on reducing the number of uninsured Americans next year. The Bush administration has proposed the expansion of existing tax credits to everyone eligible for COBRA through their former employers -- approximately 10 million Americans. States would also be given more Medicaid flexibility so that they could broaden coverage to more low-income individuals and families.