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    How Insurers Get Extra Medicare Payments for Diseases No Doctor Treated

    en-usJuly 08, 2024

    Podcast Summary

    • Biden's re-election intentionsAmid declining support and concerns over his fitness, President Biden has vowed to run for re-election, urging conversations about changing nominees to cease.

      Despite calls for him to step aside, President Biden has made it clear that he intends to run for re-election. Amid growing concerns over his fitness to serve another term, Biden has urged conversations about changing nominees to stop. The President's determination to remain in the race comes as he faces declining support from both Democrats and Republicans, with a significant portion of each party believing him to be too old to run. Meanwhile, US juries have been imposing large verdicts on corporations, giving individuals a sense of power in a world where they have few other options. In other news, a new investigation by The Wall Street Journal revealed that insurers are receiving billions of dollars in extra payments from Medicare for diseases that no doctor treated. President Biden's letter to congressional Democrats and his appearance on MSNBC's Morning Joe were efforts to quell these concerns and reaffirm his commitment to serving another term.

    • Nuclear Verdicts in US CourtsThe number and size of large damage awards, or 'nuclear verdicts,' in US courts against American companies are on the rise, reaching over $10 million and causing concern for businesses and insurers.

      The Republican Party's platform for the 2024 election is shorter and less detailed than in previous years, reflecting a desire to avoid internal disputes and align with Donald Trump's views. The platform emphasizes issues like stopping illegal immigration, boosting energy production, cutting taxes, and an America First stance on trade. Meanwhile, there's a growing trend of large damage awards, or "nuclear verdicts," in US courts against American companies, with the number of such verdicts increasing by over 27% in 2023. These awards, which can reach over $10 million, are a concern for businesses and insurers. While nuclear verdicts are not a new phenomenon, the rising number and size of these awards is causing increased attention and concern.

    • Large jury awards against corporationsThe increasing number of large jury awards against corporations in the US is a significant financial risk for businesses and insurers, potentially leading to increased insurance premiums for smaller and medium-sized businesses, while claimants prioritize holding corporations accountable for wrongdoing

      The increasing number of large jury awards against corporations in the US is a growing concern for businesses and insurers. Theories suggest that Americans, feeling powerless in their daily lives, are taking matters into their own hands through the jury system. For businesses and insurers, this trend poses a significant financial risk, as rising claims could lead to increased insurance premiums. Smaller and medium-sized businesses may be particularly affected, as they struggle to access affordable insurance coverage. From the perspective of those bringing the claims, holding corporations accountable for wrongdoing is a priority, and they believe that jurors are capable of determining fair compensation. As the Federal Reserve Chair, Jerome Powell, prepares to testify before Congress, the financial markets will be closely watching for any indication of when interest rate cuts might begin, which could help alleviate some of the financial pressure on businesses.

    • Questionable diagnoses in Medicare AdvantagePrivate insurers in Medicare Advantage are adding billions in extra costs to the program by adding questionable diagnoses to patients' records, contradicting doctors' views or involving diagnoses for conditions where no treatment was received, using methods like AI and home visits.

      Private insurers in the Medicare Advantage program are receiving billions of dollars in extra payments from the government by adding questionable diagnoses to patients' records. This practice, which contradicts doctors' views or involves diagnoses for conditions where no treatment was received, has added tens of billions of dollars in costs to the program, which was intended to save taxpayer money. Insurers use methods such as reviewing patient charts with artificial intelligence or sending healthcare professionals to patients' homes to make these diagnoses. While the intention behind allowing insurers to add diagnoses is to account for potential oversights by doctors, the practice has led to significant financial implications for the Medicare program.

    • Medicare Advantage diagnosesFrom 2018 to 2020, Medicare Advantage plans added $50 billion in questionable diagnoses for their patients, leading to potential anatomical impossibilities and lack of expected treatments. The issue persists due to the lack of a physician's record requirement for diagnosis addition.

      From 2018 to 2020, Medicare Advantage plans added questionable and potentially impossible diagnoses for their patients, leading to an extra $50 billion in payments. These diagnoses included conditions where patients weren't receiving expected treatments or were anatomically impossible. Despite some changes by Medicare to reduce payments for abused diagnoses, the issue remains due to the mechanism that allows for the addition of diagnoses without a physician's record. Insurers criticized the reporting methodology, but the journal used approaches such as identifying curable diseases like diabetic cataracts, where patients who had undergone surgery couldn't have the disease anymore, and looking at people's medical records to validate diagnoses. The findings highlight the need for further transparency and accountability in the Medicare Advantage system.

    • HIV diagnosisProper diagnosis of HIV by doctors leads to 100% prescription of antiretroviral drugs, while diagnosis by insurers results in only 17% prescription rate, raising concerns about potential consequences of undiagnosed or untreated cases.

      Access to healthcare and proper diagnosis can significantly impact the treatment and outcomes of certain diseases, such as HIV. According to a Wall Street Journal report, while nearly all HIV patients diagnosed by doctors are prescribed antiretroviral drugs, the rate drops to 17% for those diagnosed solely by insurers. This raises concerns among healthcare professionals and policy experts about the potential consequences of undiagnosed or untreated HIV cases. Moving on, the Paris Olympics are not just a major sporting event but also a significant economic one. If you have any questions about who benefits financially from the Olympics, feel free to share them with us. In other news, Hurricane Barbara made landfall in Texas, leaving over 1.3 million customers without power and causing over 1,200 flight cancellations. The storm, now a Category 1 hurricane, has already caused at least nine fatalities as it moved through the Caribbean. Lastly, every small town has its unique quirks. In DePere, Missouri, a mysterious jar of pickles left on an exit ramp years ago and replaced whenever it disappears has brought internet fame to the St. Louis suburb, which has a population of just 9,100. In summary, the importance of proper healthcare diagnosis, the economic impact of the Olympics, and the quirky mysteries of small towns are just a few of the topics covered in today's news.

    • Pickle Jar SensationAn ordinary pickle jar in a small town became a global sensation, attracting over 100,000 views on TikTok, a Wikipedia page, a Google Maps listing, and a Facebook page with over 29,000 members, despite its origins remaining a mystery.

      The mysterious pickle jar on the side of the road in DePair, Missouri, has become a unexpected local and global sensation. With over 100,000 views on TikTok, a Wikipedia page, a listing on Google Maps as a historical landmark, and a Facebook page with over 29,000 members, this seemingly ordinary pickle jar has captured the attention of people from all around the world. The jar's origins remain a mystery, but its allure has sparked intrigue and fascination among residents and visitors alike. Despite concerns about safety, the city's public safety director reports no complaints about the pickle jar. This small town's unusual reverence for pickles has put it on the map and created a unique sense of community and connection.

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