Trending News Today: UnitedHealth Group Alleged to Have Overcharged Government $1 Billion Through Medicare Advantage
Top news of the day from across the health care landscape.
The jury is still out on whether blockbuster proton pump inhibitors (PPIs) that treat gastroesophageal acid reflux cause kidney damage. According to Kaiser Health News, a growing body of evidence suggests a link between PPIs and serious adverse events, such as chronic kidney disease. Recently, lawsuits have been filed alleging that manufacturers should have known the potential harms of their medications; however, PPI manufacturers strongly stand behind their products, according to the report. A spokeswoman of AstraZeneca told KHN in an emailed statement that the company is “confident in the safety and efficacy of Nexium and Prilosec when used in accordance with the FDA approved label.” However, these PPIs are also frequently prescribed for minor indigestion, which often leads to chronic use, despite only being deemed safe by the FDA for short-term use. In 2016, 2 large studies that included data from hundreds of thousands of patients taking prescription PPIs raised concerns about a link between the pills and kidney failure, KHN reported. The results of both studies found that patients who took prescription PPIs were more likely to develop kidney disease than patients taking H2 blockers. Patients who took PPIs twice-daily were more likely to develop the disease, and the kidney risk associated with the pills increased over time for the first 2 years. A limitation of both studies was that they were observational and, therefore, could not prove cause and effect. There is some skepticism about the association, however, that PPIs have also been linked to several other risks, including a rare type of infectious diarrheas, pneumonia, and bone fracture. “Is it that the PPI is really causing all these different things or is it the fact that sicker people get PPIs and sicker people have bad outcomes?” Dr John Danziger, nephrologist at Beth Israel Deaconess Medical Center and professor at Harvard Medical School, told KHN. “I think it’s probably the latter.”
Under the American Health Care Act (AHCA), more than 6 million patients with preexisting conditions could face higher insurance premiums because of gaps in coverage, according to The Hill. States would be allowed to waive the community rating provision of the Affordable Care Act (ACA), which prevents insurers from charging more for patients with preexisting conditions. Conservatives argue that the provision will not affect a significant amount of people because it only targets enrollees who have had a gap in insurance of at least 63 consecutive days. However, a newly released analysis reveals that 6.3 million individuals with preexisting conditions also have had gaps in coverage that would result in a substantial premium increase. The legislation has kept the ACA’s ban on insurers denying coverage based on preexisting conditions, meaning those patients would instead be charged significantly more money, The Hill reports. In 2015, more than 27 million individuals had a gap in coverage of at least several months, the analysis reports.
The Justice Department accused UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans, Kaiser Health News reported. The 79-page lawsuit alleges that the insurance giant portrayed patients as sicker than they actually were to collect higher Medicare payments. The government conservatively estimated that UnitedHealth knowingly and improperly avoided repaying Medicare for more than a billion dollars over the course of the decade-long scheme, according to KHN. Tuesday’s filing is the second time the Justice Department has intervened to support a whistleblower suit against UnitedHealth under the federal False Claims Act. Earlier this month, the Justice Department joined a 2009 case brought by medical data consultant James Swoben, which also alleged that the insurer overbilled Medicare.