RISE summarizes recent regulatory-related headlines and reports.
Health care execs guilty in multimillion-dollar health care fraud conspiracy
Two executives from Vivature, a health care billing company in Texas, pleaded guilty to s multimillion-dollar wire‑fraud conspiracy involving COVID‑19 testing and an athletic‑training billing scheme.
Mouzon Bass III, the company’s owner, and senior executive Lance Wilson face up to 20 years in federal prison, along with potential fines and restitution, according to the Department of Justice. A sentencing date has yet to be scheduled. The maximum statutory sentence is up to 20 years in federal prison, a potential fine, and restitution.
Sen. Bill Cassidy releases report to modernize FDA
Sen. Bill Cassidy, M.D., (R-La.), chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a report outlining legislative and regulatory reforms to modernize the FDA.
The proposals aim to speed reviews, expand access to low‑cost generics, strengthen the Human Foods Program, streamline clinical trials, and bolster the agency’s workforce. Cassidy said the reforms are intended to reduce bottlenecks and ensure faster access to lifesaving treatments.
Illinois erases more than $1.1B in medical debt for residents
Illinois has erased more than $1.1 billion in medical debt for over 500,000 residents through the state’s Medical Debt Relief Program.
Gov. JB Pritzker said recipients saw an average of $1,200 forgiven, with some receiving up to $300,000.
The program was funded with roughly $10 million and run in partnership with Undue Medical Debt, a national nonprofit that purchases bundled medical debts. The program provides relief to Illinois households at or below 400 percent of the federal poverty level or whose medical bills exceed 5 percent of their income.
CDC advisory vaccine panel meeting postponed
The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices will reschedule its planned February meeting, according to The Hill. The delay of February 25-27 meeting comes in the wake of the trial over the American Academy of Pediatrics’ lawsuit to prevent the upcoming meeting and revise the CDC’s decision to reduce the childhood and adolescent immunization schedule.
UnitedHealthcare's new MA specialty care policy raises concerns
Members of UnitedHealthcare HMOs or HMO point-of-service Medicare Advantage plans will be required to get a primary care provider’s referral before seeing certain specialists beginning May 1. Claims for specialist services without a referral will be denied after that date and are considered a provider liability. Enrollees must not be balanced billed for services without a valid referral. But MedPage Today reports that patient advocates are concerned the policy will create confusion. Wendell Potter, a former executive with two large health insurers whose whistleblower revelations in 2009 disclosed insurers' unethical practices of denying care, told the publication that it may lead to older patients not getting timely care they need.
Study: Expanded ACA subsidies drove marketplace enrollment across key groups
A study from the Johns Hopkins Bloomberg School of Public Health and published by the Journal of Health Care for the Poor and Underserved, found that expanded Affordable Care Act (ACA) subsidies implemented in March 2021 increased marketplace enrollment by 27.5 percent among eligible individuals.
The study found enrollment gains were especially strong among:
- Non-Hispanic Black individuals: Enrollment went from 10.3 percent prior to the subsidies to 31 percent after implementation.
- Hispanic individuals: Enrollment increased from 13.3 percent to 23.4 percent.
- Rural residents: Enrollment more than doubled, from 12.6 percent to 25.6 percent.
- Children 18 and under: Enrollment nearly doubled, from 18 percent to 35.8 percent.
- Part-time workers: Enrollment increased from 20.2 percent to 34.5 percent.
“Lowering premium costs translated into higher enrollment, particularly for populations that have historically faced greater barriers to coverage,” said study author, Paul Jacobs, Ph.D., an associate scientist in the Bloomberg School’s Department of Health Policy and Management, in the study announcement. “The enhanced subsidies meaningfully improved affordability and access—which suggests that their recent expiration will likely reverse these gains.”
Telehealth visits for non-mental health conditions on the rise, study finds
Nearly half of telehealth visits among U.S. Medicare patients are for non‑mental health conditions such as diabetes and high blood pressure, according to a new University of Utah Health study published in Annals of Internal Medicine.
Researchers analyzed data from a nationally representative sample of nearly 15,000 Medicare beneficiaries from 2021–2023. Mental health accounted for about 31 million annual telehealth visits, while non‑mental health conditions were close behind at 29 million.
People with greater medical challenges were more likely to use telehealth, suggesting it may help reduce barriers to care. “We were surprised at the number of non‑mental health conditions…commonly addressed through telehealth,” said study lead author Terrence Liu, M.D., assistant professor of internal medicine at University of Utah Health, in a study announcement.
Researchers aid that knowing who uses telehealth, and why, can help guide informed decisions about how health systems provide care, which may help lead to more certainty for patients about how their care will be delivered and covered on an ongoing basis.