COVID-19/coronavirus

Federal report finds telehealth fraud during pandemic cost Medicare $128 million

The federal government eased telehealth requirements at the beginning of the COVID-19 pandemic so more Americans could get remote care with fewer obstacles.
 
A report released last week by federal government investigators found that nearly $128 million in telehealth claims submitted during the first year of the pandemic may have been fraudulent (Source: “'Guardrails' needed? Telehealth fraud cost Medicare $128M in first year of COVID pandemic, feds say,” USA Today, Sept. 11).
 
Investigators said less than 1% of the 742,000 Medicare-certified doctors and other providers of telehealth services submitted roughly a half million problematic claims. Yet the billings are concerning enough that government investigators urged the Biden administration to tighten oversight to ensure millions of Americans can access remote care while safeguarding taxpayer dollars.
 
Before 2020, Medicare largely restricted telehealth to people who accessed medical care via video and audio connections set up in rural clinics. Amid the pandemic, Medicare allowed recipients in cities and suburbs to get care remotely, often from their home, via a phone call or a video chat. Medicare also more than doubled the types of services eligible for reimbursement to make it easier for people to get care without the risk of COVID-19 exposure during a visit to a clinic or hospital.


Following COVID missteps, CDC plans major overhaul

Following a series of missteps in the COVID-19 pandemic and monkeypox outbreak, the Centers for Disease Control and Prevention will undergo an “ambitious” overhaul, its director announced Wednesday (Source: “In an effort to address its missteps during Covid, CDC plans an ‘ambitious’ agency overhaul,” STAT News, Aug. 17).

In an email to staff, CDC Director Rochelle Walensky said the renewal effort will focus on making the agency more nimble and responsive to needs that arise in health emergencies. The priority will be to gather data that can be used to rapidly dispense public health guidance, rather than craft scientific papers.

Walensky also said the agency needs to acknowledge the flaws of its response to Covid-19. Those mistakes date to the earliest days of the pandemic, when a test designed by CDC scientists to detect the new disease failed to work on the ground — leaving the country blind to how quickly the SARS-CoV-2 virus was transmitting at a critical juncture when aggressive measures could have slowed Covid’s spread.

“For 75 years, CDC and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said in the email, sent to the agency’s 11,000-person staff.  “My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness.”


Study: Cognitive deficits remain elevated years after COVID infection

COVID survivors remain at higher risk of psychotic disorders, dementia and similar conditions for at least two years, according to a study that highlights the mounting burden of chronic illness left in the pandemic’s wake (Source: “Covid’s Harmful Effects on the Brain Reverberate Years Later,” Bloomberg, Aug. 17).

While anxiety and depression occur more frequently after COVID than other respiratory infections, the risk typically subsides within two months, researchers at the University of Oxford found. In contrast, cognitive deficits known colloquially as “brain fog,” epilepsy, seizures and other longer-term mental and brain health disorders remained elevated 24 months later, according to a large study published Wednesday in the journal Lancet Psychiatry.

The findings, based on the records of more than 1.25 million patients, add to evidence of the virus’s potential to cause profound damage to the central nervous system and exacerbate the global burden of dementia -- which cost an estimated $1.3 trillion in the year the pandemic began. Oxford researchers showed in March that even a mild case is associated with brain shrinkage equivalent to as much as a decade of normal aging. 


In rural areas, COVID hits Black, Hispanic communities hardest, although gap appears to be narrowing

At the peak of the Omicron wave, Covid killed Black Americans in rural areas at a rate roughly 34% higher than it did white people, new research has found, although the gap appears to be narrowing in recent months (Source: “In Rural America, Covid Hits Black and Hispanic People Hardest,” New York Times, July 28).

Across the small towns and farmlands, new research has found, Covid killed Black and Hispanic people at considerably higher rates than it did their white neighbors. Even at the end of the pandemic’s second year, in February 2022, overstretched health systems, poverty, chronic illnesses and lower vaccination rates were forcing nonwhite people to bear the burden of the virus.

In towns and cities of every size, racial gaps in Covid deaths have narrowed. That has been especially true recently, when major gains in populationwide immunity have tempered the kind of pressure on health systems that appears to hurt nonwhite Americans the most.


Faulty oxygen readings added to COVID-19 disparities, study finds

Covid-19 care, including distribution of lifesaving therapies, was significantly delayed for Black and Hispanic patients due to inaccurate oxygen readings from devices that can work poorly in darker-skinned individuals, according to a new study (Source: “Faulty oxygen readings delayed Covid treatments for darker-skinned patients, study finds,” Stat News, May 31).

Widely used pulse oximeters, which measure oxygen levels by assessing the color of the blood, have been under increasing scrutiny for racial bias because they can overestimate blood oxygen levels in darker-skinned individuals and make them appear healthier than they actually are. A 2020 study comparing oxygen levels measured by the devices with readings taken from “gold standard” arterial blood samples found pulse oximeters were three times less likely to detect low oxygen levels in Black patients than in white patients. Two months after that report, the Food and Drug Administration issued a safety communication alerting patients and clinicians that the devices could be erroneous in those with dark skin.

The new study, published in May in JAMA Internal Medicine, found that  the inaccuracies in oxygen measurement occurred at higher rates not only in Black patients, but also in Hispanic and Asian patients, compared to white patients. Those inaccuracies had real-world consequences. The study provided evidence that undetected low oxygen levels led to delays in Black, Hispanic and Asian patients receiving potentially lifesaving therapies such as the drugs remdesivir and dexamethasone, and in many cases, led to patients not receiving treatment at all.


Ohio set for rollout of COVID vaccines for children younger than 5

With federal approval of pediatric COVID-19 vaccines expected soon, vaccine providers in Ohio have begun placing orders for vaccines for children less than 5 years old, and the first deliveries are expected on Monday, state health officials said (Source: “Ohio ready for rollout of pediatric COVID-19 vaccines when approved, state health official says,” Cleveland.com, June 16).

“The one group that has still been waiting has been our youngest children, those less than 5 years of age and now that appears likely to change,” Ohio Department of Health director Dr. Bruce Vanderhoff said Thursday in a press briefing.

The vaccine advisory committee to the U.S. Food and Drug Administration recently voted unanimously to recommend approval of Pfizer’s application for a vaccine for those ages 6 months through 4 years old. Moderna has applied for a COVID-19 vaccine for ages 6 months through 5 years old.

Next, FDA leadership is expected to issue its approval. On Friday and Saturday, the U.S. Centers for Disease Control and Prevention advisory committee will meet to make recommendations for the vaccines’ uses. The CDC director must then approve the committee’s recommendations.


Schools slow to use federal COVID funding to improve indoor air quality

Despite billions of dollars in federal covid-relief money available to upgrade heating and air-conditioning systems and improve air quality and filtration in K-12 schools, U.S. public schools have been slow to begin projects that have the potentional to improve the overall health of students (Source: “Covid Funding Pries Open a Door to Improving Air Quality in Schools,” Kaiser Health News, June 13).

According to a report released this month from the Centers for Disease Control and Prevention, fewer than 40% of public schools had replaced or upgraded their HVAC systems since the start of the pandemic. Even fewer were using high-efficiency particulate air, or HEPA, filters in classrooms (28%), or fans to increase the effectiveness of having windows open (37%).

Both the CDC and White House have stressed indoor ventilation as a potent weapon in the battle to contain covid. And a wealth of data shows that improving ventilation in schools has benefits well beyond covid.

Good indoor air quality is associated with improvements in math and reading; greater ability to focus; fewer symptoms of asthma and respiratory disease; and less absenteeism. Nearly 1 in 13 U.S. children have asthma, which leads to more missed school days than any other chronic illness.


Weekly COVID cases drop in Ohio for first time since March

After nearly two months of coronavirus cases increasing, cases declined in Ohio last week (Source: “COVID cases decline in Ohio after climbing for weeks,” Dayton Daily News, June 3).

The state recorded 17,530 COVID-19 cases in the past week, down from 19,546 reported last Thursday, according to the Ohio Department of Health (ODH). It was the first time in eight weeks cases dropped.
 
Hospitalizations have also declined slightly after climbing over the past four weeks. There were 482 cases reported in the last week compared to 506 the previous week, according to ODH. As of Thursday, there were 753 people hospitalized with COVID.


Graphic of the week

MedicaidBasics_COVIDUpdate_Fig2_StandAlone
HPIO analysis of Ohio Medicaid data has found that Medicaid enrollment increased by more than 580,000 enrollees between March 2020 (the beginning of the COVID-19 pandemic) and March 2022, an increase of about 20.5%.

As indicated in the graphic above, Medicaid enrollment grew most significantly between April 2020 and August 2020. This is likely because unemployment was highest during the early months of the pandemic, when an economic recession occurred. Since August 2020, growth in Ohio Medicaid enrollment has stabilized, averaging 0.6% growth per month.

The graphic is included in HPIO's fact sheet that was released last month, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic.”


Year after federal funds announced to fight COVID disparities, states still not moving forward

A year after the Biden administration announced $2.25 billion would be sent to states to address COVID health disparities, little of the money has been used (Source: “States Have Yet to Spend Hundreds of Millions of Federal Dollars to Tackle COVID Health Disparities,” Kaiser Health News, May 16).

The Biden administration in March 2021 announced it was allocating the money to address COVID health disparities, the largest federal funding initiative designed specifically to help underserved communities hardest hit by the virus.

Two months later, the Centers for Disease Control and Prevention awarded grants to every state health department and 58 large city and county health agencies. The money is intended to help limit the spread of COVID-19 among those most at risk in rural areas and within racial and ethnic minority groups, as well as improve their health. The CDC initially said the grant had to be spent by May 2023, but earlier this year told states they could apply to extend that time.

A year after the funding was announced, little of the money has been used, according to a Kaiser Health News review of about a dozen state and county agencies’ grants (Ohio was not included in the analysis).