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Healthcare Snapshot - February 2024

February 01, 2024

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ACOs Uncover Durable Medical Equipment (DME) Fraud in Medicare Claims

The Washington Post recently reported on fraudulent Medicare claims that have been identified dating as far back as late 2022. There are several companies that are billing for catheters for Medicare patients that do not need these catheters or actually receive them. These fraudulent claims were identified by the various ACOs across the nation who have worked with the National Association of ACOs (NAACOS) to bring this issue to light. NAACOS estimates that this issue has resulted in about $2 billion of fraudulent claims since mid-2022.

Read the Washington Post article here:

The New York Times also reported on this issue, noting the above graph of the fraudulent claims.

Read the New York Times article here:

PSW Represents Washington at Health Care Value Week

PSW CEO, Melanie Matthews, and Executive Director of ACOs, Jake Woods, joined various other Value-Based Care organizations at Health Care Value Week in Washington D.C. Groups met with Congressional Representatives to share stories on the impact of Value-Based Care across the nation. Melanie also moderated a panel at the Accountable for Health conference with patient advocacy groups.

Learn more about Health Care Value Week here:

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Patient Success Story

A PSW patient faced multiple health setbacks but emerged victorious with the dedicated support of our RN Care Manager. The patient's journey began with two recent hospitalizations, first due to sepsis and then for pneumonia, complicating her existing condition of congestive heart failure (CHF). Upon discharge, she returned home with assistance from Home Health but initially felt too weak to visit her primary care physician (PCP). Instead, she awaited the arrival of the Home Health Nurse.

The patient diligently adhered to her medication regimen, but her condition began to deteriorate. It was during a follow-up call from a PSW RN Care Manager that crucial symptoms came to light. Despite the patient's assurances of "doing well," the RN Care Manager identified signs of worsening health: a productive wet cough and increased swelling in her ankles, accompanied by more frequent use of her nebulizer.

Taking swift action, the RN Care Manager advised the patient and her caregiver to contact her PCP immediately. Additionally, she recommended logging daily weights and blood pressure readings to present to the PCP for a comprehensive assessment. Upon notification, the PCP promptly adjusted the patient's medication regimen, increasing her Lasix dosage.

Within just two days of the medication adjustment, the patient experienced a remarkable turnaround. Her weight decreased significantly, ankle swelling subsided, and her cough became less frequent. Thanks to this proactive intervention, the patient made a full recovery, steering clear of another potentially harrowing trip to the Emergency Department or a prolonged inpatient stay.

The patient's success story underscores the invaluable role of RN Care Management in ensuring timely interventions and holistic support for patients navigating complex health challenges. With personalized attention and proactive care coordination, we empower patients like her to reclaim their health and thrive in the comfort of their homes

PSW CEO, Melanie Matthews, Joins the Race to Value Podcast

Melanie recently sat down with Eric Weaver from the Race to Value Podcast to share the PSW story and discuss the changing landscape of Value-Based Care. 

Listen to the full podcast here:

Race To Value Podcast