Consumer Health Digest #09-20

Your Weekly Update of News and Reviews
May 14, 2009

Consumer Health Digest is a free weekly e-mail newsletter edited by Stephen Barrett, M.D., and cosponsored by NCAHF and Quackwatch. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making.

Improper chiropractic billing is widespread. The U.S. Office of the Inspector General estimates that $178 million of the $466 million Medicare paid to chiropractors in 2006 should not have been paid. The Social Security Act requires payment only for necessary chiropractic services, which are limited to active/corrective manual manipulations of the spine to correct "subluxations." Chiropractic claims are required to include an acute treatment (AT) procedure code modifier to identify services that are active/corrective treatment and must document services in accordance with the Centers for Medicare & Medicaid Services’ Medicare Benefit Policy Manual. When further improvement cannot reasonably be expected from continuing care, the services are considered maintenance therapy, which is not medically necessary and therefore not payable under Medicare. Medical reviewers who evaluated a random sample of claims estimated that the inappropriate payments included $157 million for maintenance therapy, $11 million for miscoded services, and $46 million for undocumented services. These claims represented 47% of those for more than 12 visits that had been coded as "AT." A previous study found that 40% of claims allowed in 2001 had been for maintenance therapy. The new report concluded that efforts to stop such payments have been largely ineffective. [Inappropriate chiropractic payments for chiropractic services. Office of the Inspector General, May 2009]

Single-payer health care advocates arrested at Congressional hearing. Eight advocates for single-payer health care reform were arrested at a Senate Finance Committee meeting when they protested exclusion of their viewpoint in the discussion panel. The protesters, three of whom are medical doctors, explained their motivation this way:

The fact that a national health insurance program is supported by the majority of the public, doctors, and nurses apparently means nothing to Senator Baucus. The fact that thousands of people in America are dying every year because they can’t get health care means nothing. The fact that over 1 million Americans go into bankruptcy every year due to medical debt—even though most of them had insurance when they got sick—means nothing. And so, as the May 5 meeting approached, we prepared for another one of the highly scripted, well-protected events that are supposed to make up the “health care debate” using standard tools of advocacy. We organized call-in days and faxes to the members of the committee requesting the presence of one single-payer advocate at the table of 15. Despite thousands of calls and faxes, the only reply—received on the day before the event—was, “Sorry, but no more invitations will be issued.” [Flowers M. Why we risked arrest for single-payer health care. Physicians for a National Health Program (PNHP) Web site, May 8, 2009]

Single-payer advocates believe that private insurers consume health dollars on overhead, underwriting, billing, sales and marketing, as well as huge profits and exorbitant executive pay and that reform could realize enough administrative savings to cover the uninsured, and to eliminate co-payments and deductibles for all Americans. In a follow-up news release, PNHP stated that during the 2008 election cycle, Senator Baucus received over $1 million in donations from insurance companies and drug companies. [Doctors, nurses to demonstrate for single-payer health system outside Senate Finance Committee hearing. PNHP news release, May 11, 2009]

FDA orders General Mills to stop cholesterol-lowering claims for Cheerios. The U.S. Food and Drug Administration has ordered General Mills to stop making overly explicit disease-prevention claims for its Cheerios Toasted Whole Grain Oat Cereal. Because foods that contain dietary fiber can help lower cholesterol and may help prevent certain cancers as part of a healthful diet, food companies are permitted to make certain approved claims to that effect. However, the FDA objected that the company went beyond what is legally permissible by suggesting that blood cholesterol was likely to be lowered 4% in 6 weeks by including Cheerios in a person's diet. [Becoat WC. Warning letter to Ken Powell, May 5, 2009]

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This page was posted on May 15, 2009.