RISE summarizes recent regulatory-related and news headlines.
Federal judge orders administration to restore government health websites
Judge John Bates with the U.S. District Court for the District of Columbia on Tuesday ordered federal health agencies to upload information they removed from government websites in response to President Trump’s orders that target diversity initiatives and gender ideology. The lawsuit was brought by Public Citizen on behalf of Doctors for America against the Personnel Management (OPM), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Health & Human Services (HHS). The temporary restraining order requires the agencies to restore the webpages and datasets of vital health-related data and other information by the end of the week.
“The judge’s order today is an important victory for doctors, patients, and the public health of the whole country. This order puts a stop, at least temporarily, to the irrational removal of vital health information from public access,” said Zach Shelley, a Public Citizen Litigation Group attorney and lead counsel on the case, in an announcement.
Former Inspector General Christi Grimm joins lawsuit to get her job back
Christi A. Grimm, the sixth inspector general of the U.S. Department of Health and Human Services who was fired in late January by President Donald Trump along with other inspector generals, is suing to get her job back. The lawsuit was filed Wednesday in the United States District Court for the District of Columbia by eight inspector generals, including those that oversaw the Departments of Veterans Affairs, Defense, and the Small Business Administration. They argue that Trump fired them four days into his current term in a two-sentence email without first notifying Congress at least 30 days in advance and providing a specific rationale for the terminations. The reason given in the email was “changing priorities.” The terminations were effective immediately and the government cut off access to their emails, computer networks, and their agency buildings.
Medicare enrollment forms will no longer contain sexual orientation, gender identity questions
The Centers for Medicare & Medicaid Services sent an email Wednesday to health care organizations, alerting them that the agency will remove the voluntary sexual orientation and gender identification questions from the Model C/D and LINET enrollment forms. The action was taken in response to President Trump’s executive order, Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government. Medicare Advantage and Part D plans were told to use the 2024 model enrollment form and previous LI-Net forms until the agency updates the new forms. The questions were added to the forms under the Biden administration.
UnitedHealth to pay $20M to settle federal government lawsuit over improper medical claim denials
UnitedHealth Group will pay approximately $20 million to settle a U.S. Department of Labor (DOL) lawsuit that claimed a division of the company wrongly denied claims for medical services, the Minnesota Star Tribune reports. The settlement calls on UnitedHealth’s subsidiary, UMR, to reimburse out-of-pocket costs patients had to pay when the claims for emergency room visits and urinary drug screenings were denied. The Labor Department said in the original lawsuit that UMR denied claims for at least 2,136 self-funded health plans and sought reimbursement for the plan participants. United Health Group told the publication that the settlement involves administrative processes that are no longer in place. “We have been in ongoing negotiations with the DOL and have now reached a resolution that we believe is in the best interest of the plans and enrollees that we support,” the company said in a statement.
NY doctor convicted of $24M Medicare fraud scheme
A New York doctor was found guilty this week by a federal jury for causing the submission of over $24 million in fraudulent claims to Medicare for medically unnecessary laboratory tests and orthotic braces.
Alexander Baldonado, M.D., 69, of Queens, received tens of thousands of dollars in illegal cash kickbacks and bribes in exchange for ordering laboratory tests, including expensive cancer genetic tests, that were billed to Medicare by two related laboratories located in New York.
As part of the scheme, Baldonado authorized hundreds of cancer genetic tests for Medicare beneficiaries who attended COVID-19 testing events at assisted living facilities, adult day care centers, and a retirement community in 2020. Baldonado did not treat any of the patients who attended the testing events and, in many cases, did not speak to or examine the patients prior to ordering cancer genetic tests and other laboratory tests for them. Baldonado also billed Medicare for lengthy office visits that he never provided to these patients. Several Medicare patients for whom Baldonado ordered cancer genetic tests and billed for office visits testified at trial that they did not know who Baldonado was and had never met or spoken to him. Baldonado did not contact the patients after the testing events to review the results of the cancer genetic tests, and, in some cases, the patients never received the test results.
In addition to the laboratory testing scheme, Baldonado also received illegal cash kickbacks and bribes from the owner of a durable medical equipment supply company in exchange for ordering medically unnecessary orthotic braces for Medicare and Medicaid beneficiaries. The evidence presented at trial showed Baldonado on an undercover video receiving a large sum of cash in exchange for signed prescriptions for orthotic braces.
The medically unnecessary laboratory tests and orthotic braces that Baldonado ordered in exchange for illegal kickbacks and bribes caused Medicare to be billed more than $24 million. Medicare paid more than $2.1 million to the laboratories and the durable medical equipment supply company involved in the schemes.
Baldonado was found guilty of one count of conspiracy to commit health care fraud; six counts of health care fraud; one count of conspiracy to defraud the United States and to pay, offer, receive, and solicit health care kickbacks; one count of conspiracy to defraud the United States and to receive and solicit health care kickbacks; and one count of solicitation of health care kickbacks. Following his conviction on the 10 counts, Baldonado was remanded to the custody of the U.S. Marshals Service. He is scheduled to be sentenced on June 26 and faces a maximum penalty of 10 years in prison on each count of conspiracy to commit health care fraud, health care fraud, and solicitation of health care kickbacks and five years in prison on each count of conspiracy to defraud the United States and to pay, offer, receive, and solicit health care kickbacks and conspiracy to defraud the United States and to receive and solicit health care kickbacks.
KFF: End of ACA Medicaid expansion match could cut Medicaid spending by $1.9T, end coverage for 20M people
A new KFF analysis finds that a congressional proposal to significantly cut federal spending on the Affordable Care Act’s (ACA) Medicaid expansion could reduce total Medicaid spending by up to nearly one-fifth, or $1.9 trillion, over a 10-year period, and end Medicaid coverage for as many as 20 million people.
The impacts could effectively reverse and end the Medicaid expansion in most or all states that have adopted it.
The analysis shows state-by-state estimates for two scenarios if Congress eliminates the ACA provision under which the federal government picks up 90 percent of the cost of covering the Medicaid expansion population and instead reimburses states at their traditional match rate, which ranges from 50 percent to 77 percent.
- The first scenario assumes that all states would maintain their Medicaid expansion by replacing lost federal dollars with increased state spending, meaning no enrollees would lose coverage. That would result in a decrease in federal Medicaid spending of 10 percent, or $626 billion, across all states over a 10-year period, and a corresponding increase in collective state Medicaid spending of 17 percent (also $626 billion) over that time, according to the analysis.
- The second assumes that states would not make up the funding shortfall resulting from federal spending reductions and drop the ACA Medicaid expansion. This would result in a 25 percent decrease in federal Medicaid spending, or $1.7 trillion, and a 5 percent decrease in state Medicaid spending, or $186 billion, across all states over a 10-year period. All told, total Medicaid spending would decline by nearly one-fifth, or $1.9 trillion, and 20 million people would lose coverage.
Eliminating the Medicaid expansion match is one of several options under consideration by Republicans in Congress to reduce Medicaid spending to help pay for an extension of the 2017 tax cuts. Medicaid provides health coverage to low-income Americans and accounts for nearly $1 out of every $5 spent on health care in the U.S.