Consumer Health Digest #18-31
Your Weekly Update of News and Reviews
August 5, 2018
Consumer Health Digest is a free weekly e-mail newsletter edited by William M. London, Ed.D., M.P.H., with help from Stephen Barrett, M.D. 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. Its primary focus is on health, but occasionally it includes non-health scams and practical tips.
Problems with Medicare-certified hospice care reported. Hospice services, which attempt to provide comfort and alleviate suffering, are available through Medicare to patients with critical illness who are expected to die within six months and agree to forego further curative treatment. The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services has issued a report addressing poor quality care and fraudulent billing by Medicare-certified hospices along with recommendations for reform. [Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity: An OIG Portfolio. OEI-02-16-00570, July 2018] The report found:
- Hospice use has grown steadily over the past decade. In 2016, Medicare paid $16.7 billion for hospice care of 1.4 million beneficiaries.
- According to an OIG report from 2009, hospices provided fewer services than outlined in the plans of care for 31% of claims of beneficiaries residing in nursing facilities.
- Hospices provided inadequate nursing, physicians, or medical social services in 9% of general inpatient stays in 2012.
- Hospices did not meet requirements of plans of care in (a) 85% of general inpatient care stays in 2012, and (b) 63% of claims in nursing facilities several years earlier.
- The number of hospices providing only the lowest of four levels of hospice care—routine home care—increased from 429 in 2011 to 665 in 2016. The neglected higher levels of care are general inpatient care for pain control or symptom management that cannot be addressed in other settings, continuous home care during brief periods of crisis, and inpatient respite care to provide care normally provided by an informal caregiver.
- Inappropriate billing by hospices costs Medicare hundreds of millions of dollars. Hospices frequently bill Medicare for a higher level of care than the beneficiary needs. Medicare sometimes pays twice for physician services and drugs for hospice patients. Physician services and drugs are part of the Medicare Part A hospice benefit and should not also be billed through Medicare Part B (medical insurance) and Part D (drugs).
- Common fraud schemes include: (a) paying recruiters to target beneficiaries who are not eligible for hospice care, and (b) physicians falsely certifying beneficiaries as terminally ill.
- The Hospice Care Web site launched by the U.S. Centers for Medicare & Medicaid Services does not include critical information about the quality of care provided by individual hospices and offers no information about complaints filed against individual hospices.
- Hospices often provide families and caregivers of beneficiaries incomplete or inaccurate information on election statements that would enable them to understand what care beneficiaries are entitled to receive and what Medicare service coverage is waived with the election of hospice care.
- The current payment system creates incentives for hospices to minimize their services and seek beneficiaries who have uncomplicated needs. An example is that payments to hospices are based on time spent in care, not services provided.
- Hospices typically provide less than 5 hours of visits per week and seldom provide services on weekends.
- Hundreds of hospices, especially for-profit companies, target beneficiaries in settings such as assisted living and nursing facilities where patients are already receiving personal care services and who require less complex care than patients with cancer typically require. From 2007 to 2012, the median hospice payment in assisted living facilities was twice the median hospice payment for home care.
Australian chiropractor deregistered over cancer cure ads. The New South Wales Civil and Administrative Tribunal has canceled the registration to practice of Hance Limboro a chiropractor in Sydney, Australia whose articles on the Cancer Cure Sydney Web site included "Chiropractic Treatment as a Cancer Cure" and "Cancer Prevention with Regular Chiropractic Treatment." The Tribunal also prohibited Limboro from providing any health service for two years. Last year, the Australian Health Practitioner Regulation Agency prosecuted Limboro for misleading advertising. He was convicted of 11 counts of false and misleading advertising and two counts of using testimonials to advertise a regulated health service and fined $29,500. [NSW chiropractor who claimed cancer cure convicted in landmark case. Chiropractic Board of Australia news release, Feb 15, 2017]
Warning issued about devices in vaginal 'rejuvenation' procedures. The U.S. Food and Drug Administration (FDA) has warned that safety and effectiveness have not been established for radiofrequency and laser devices used for vaginal "rejuvenation" and/or cosmetic vaginal procedures. Although the FDA has cleared or approved energy-based devices for treating a few serious conditions such as the destruction of abnormal or pre-cancerous cervical or vaginal tissue, as well as condylomas (genital warts), the agency has not cleared or approved such device for vaginal "rejuvenation," cosmetic vaginal procedures, or for treating vaginal symptoms related to menopause, urinary incontinence, or sexual function. Vaginal "rejuvenation" is sometimes used to describe non-surgical procedures intended to treat symptoms and or/conditions such as vaginal laxity, atrophy, dryness, or itching; pain during sexual intercourse or urination; and decreased sexual sensation. [FDA warns against use of energy-based devices to perform vaginal 'rejuvenation' or vaginal cosmetic procedures: FDA safety communication. July 30, 2018] Patients who have undergone vaginal "rejuvenation" and experienced a complication are encouraged to file a report through MedWatch, the FDA Safety Information and Adverse Event Reporting Program.
Essure sales to end. Following a series of actions that the FDA took to address reports of serious adverse events associated with the Essure, Bayer has notified the FDA that the permanent birth control device will no longer be sold or distributed after December 31, 2018. [Statement from FDA Commissioner Scott Gottlieb, M.D., on manufacturer announcement to halt Essure sales in the U.S.; agency's continued commitment to postmarket review of Essure and keeping women informed. July 20, 2018]
TINA renews attack on GOOP advertising. Truth in Advertising (TINA) has sent a follow-up letter to the District Attorneys of Santa Clara and Santa Cruz Counties after having alerted them last year about the need investigate the marketing claims at the Goop wellness site and take appropriate regulatory action. TINA notes that one of the inadequate disclaimers at the Goop site is "For Your Enjoyment: There probably aren't going to be peer-reviewed studies about this concept, but it's fun and there's real merit in that." [Amid Goop's mixed signals, tina.org repeats call for regulatory action. TINA.org, July 3, 2018]
This page was posted on August 5, 2018.