The agency has concerns that such actions are resulting on issues on the federal exchanges.
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The Centers for Medicare and Medicaid Services said on Thursday it is investigating whether some providers or affiliated groups have improperly steered people who would be eligible for Medicare or Medicaid toward individual market plans.
In a prepared statement, the National Kidney Foundation said, “The (NKF) is concerned about allegations of dialysis patients potentially being steered into health insurance options that primarily benefit the provider; but may not necessarily be in the best interests of the patient”. For a hospital with a very sick, very poor patient, it would make more sense for the bottom line to pay that patient’s premium and keep him in a private plan-with higher reimbursements-than to see that person switch into Medicaid, where reimbursements are far lower.
Currently, third-party payment of premiums and cost sharing of qualified health plans in the individual market by healthcare providers such as physicians, medical facilities or affiliated nonprofit organizations are discouraged, but the ultimate decision about accepting those payments is left to health insurance companies.
However, in the wake of the UnitedHealth complaint, analysts questioned executives from American Renal Associates about their ACA plan revenues on the dialysis firm’s second quarter conference call.
“There is clearly concern that this practice is contributing to adverse selection and mounting losses on public exchanges”, Gupte said.
Today, not all providers see that as a first choice for their patients, according to the Centers for Medicare and Medicaid Services.
A US government health agency on Thursday said that it was considering new rules to prevent healthcare providers or related groups from steering patients into Obamacare individual insurance plans instead of Medicare or Medicaid in order to receive higher payments for medical services.
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Concerns about third-party premium support are not new. “It would appear that this practice may not be exclusively limited to dialysis providers as there also has been anecdotal evidence of extraordinary specialty drug spending on public exchanges that may be connected with similar third-party premium assistance”.
