With all the talk about how our tax dollars are being managed, it makes you wonder if there are places we could cut costs. For example, should the courts really be focusing on whether wings can be called “boneless” if they have bones? What do you think? Hit reply, and let us know!
-The Editors

🏥Medicare Insights:

The One-Hour Nurse Visits That Let Insurers Collect $15 Billion From Medicare

Millions of Medicare recipients receive annual home visits from nurses, not for treatment, but to see if they can diagnose new health conditions. These new diagnoses allow private Medicare Advantage insurers to claim extra funds from the federal government.

A Wall Street Journal investigation revealed that from 2019 to 2021, these visits, lasting about an hour each, resulted in insurers earning an average of $1,818 more per visit. This practice led to about $15 billion in additional payments during that period.

Shelley Manke, a former nurse practitioner with UnitedHealth Group’s HouseCalls, explained that her routine included tests to measure blood flow to check for peripheral artery disease, which could earn the insurer about $2,500 annually for each new case. However, Manke and other nurses distrusted the accuracy of some devices and questioned the validity of many diagnoses they were encouraged to make.

From 2019 to 2021, insurers gained nearly $50 billion from self-reported diagnoses, many of which were not treated by doctors or hospitals. Around 30% of this amount stemmed from diagnoses made during home visits. For instance, more than 700,000 cases of peripheral artery disease diagnosed during these visits added $1.8 billion in payments.

Medicare Advantage plans pay insurers a fixed sum to provide benefits, with payments increasing for patients with certain conditions, creating an incentive to identify these diagnoses. Interviews with nurses, patients, managers, and executives, along with internal documents, revealed a system where software and audits were used to generate diagnoses during home visits. Nurses felt pressured to diagnose conditions prompted by the software, even without thorough testing.

UnitedHealth’s software, for example, would suggest diagnoses like secondary hyperaldosteronism based on certain criteria without requiring lab tests. UnitedHealth identified this condition 246,000 times after home visits, leading to $450 million in payments, compared to $42 million by all other Medicare insurers combined.

UnitedHealth and CVS Health, which owns Signify Health and Aetna, claimed these home visits help by catching diseases early and ensuring medication adherence, sharing findings with primary-care doctors. However, concerns remain about the appropriateness and accuracy of these diagnoses.

The Medicare Payment Advisory Commission has recommended that diagnoses from home visits should not qualify for extra payments, and the Centers for Medicare and Medicaid Services has increased audits and is eliminating some diagnoses from qualifying for additional payments.

Read more here.

🤡 Wacky News Pieces

Yes, there's never a dull moment in this crazy carousel of current events. Today, stories can be as unpredictable as they are entertaining! Enjoy these real life news stories happening around us.

• “Bones in Boneless Chicken Wings are Okay, Rules Ohio Supreme Court"
  The Ohio Supreme Court decided that the presence of bones in "boneless chicken wings" is not a breach of duty by the restaurant. This ruling came after a customer claimed to have choked on a bone in a so-called boneless wing. Critics argue this decision undermines the jury system​ (Star Tribune).

• "Man Breaks into Bank to Heat Up Hot Pockets"
  A man in San Diego broke into a Wells Fargo bank, not to steal money, but to use the microwave in the break room to heat up his Hot Pockets. When asked if the Hot Pockets were worth it, he confidently replied, “Hell yeah, it was worth it”​​ (ABC).

• “Nebraska Man Pulled Over with 2,200-Pound Bull Riding Shotgun" In Norfolk, Nebraska, a man was pulled over while driving with his enormous 2,200-pound bull named Howdy Doody sitting in the passenger seat of his modified car. The car’s roof was removed to accommodate the bull, who is a regular attraction at local parades​ (KTTN)​
  

📚Interesting Study:

Eggs May Not Be Bad For Your Heart After All

Eggs, often avoided due to fears about cholesterol, might not be as detrimental as once thought. A study presented at the American College of Cardiology's Annual Scientific Session found no significant difference in cholesterol levels between people who ate fortified eggs regularly and those who didn't.

In the PROSPERITY trial, 140 patients with or at high risk for cardiovascular disease were assigned to eat either 12 fortified eggs a week or fewer than two eggs a week. Over four months, researchers monitored HDL ("good" cholesterol) and LDL ("bad" cholesterol) levels, among other cardiovascular markers.

Dr. Nina Nouhravesh, lead author and research fellow at Duke Clinical Research Institute, noted, "Our study provides reassurance that eating fortified eggs doesn’t negatively impact cholesterol levels over four months, even in a high-risk population." Fortified eggs, which are lower in saturated fat and enriched with vitamins and minerals, were the focus of the study.

Results showed minor reductions in HDL and LDL cholesterol in the fortified egg group, but these changes weren't statistically significant. Secondary measures also suggested potential benefits, such as reductions in total cholesterol and insulin resistance.

Continue reading here.

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