Keeping you updated on the latest Medicare and Part D news

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California’s Patient Safety Ballot Measure Sparks Controversy

In the upcoming November election, California voters will decide on Proposition 46, a controversial patient safety initiative that could reduce “doctor shopping” and adverse events. If passed, doctors would need to consult the state database of serious narcotic prescriptions before prescribing painkillers to first-time patients. Currently, eight other states have this requirement, including Tennessee and New York, which both saw significant drops in the number of narcotics prescriptions as a result.

However, Proposition 46’s other provisions have made it unpopular with doctors. Namely, the law would raise the noneconomic malpractice award (a.k.a. pain and suffering damages) cap from $250,000 to $1.1 million. It also mandates drug and alcohol testing for doctors, both randomly and within 12 hours of an unexpected patient death or injury. Together, doctors and insurance companies have raised $57 million to defeat Proposition 46, making it the most expensive campaign of the fall election.



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CMS Audits of Medicare Health Plans Find Serious Violations, Result in Civil Fines and Sanctions

A recent New York Times article recaps findings from federal audit reports of Medicare health plans, notably the serious areas of noncompliance and resulting penalties.


• In more than half of all audits, “beneficiaries and providers did not receive an adequate or accurate rationale for the denial” of coverage when insurers refused to provide or pay for care.

• When making decisions, insurers often failed to consider clinical information provided by doctors and failed to inform patients of their appeal rights.

• In 61 percent of audits, insurers “inappropriately rejected claims” for prescription drugs. Insurers enforced “unapproved quantity limits” and required patients to get permission before filling prescriptions when such “prior authorization” was not allowed.

Medicare plans frequently missed deadlines for making decisions about coverage of medical care, drugs and devices requested by doctors and patients.