First cyclospora deaths reported in Michigan; Medicare Advantage provider to pay $14.1M over false diagnosis codes; five insurers cover half of Medicaid's children — Morning Medical Update

First cyclospora deaths reported in Michigan

Two patients with underlying conditions died as the state's count passed 11,000 cases.

Two people have died from cyclosporiasis in Michigan, the state health department said Monday, the first fatalities in one of the largest foodborne illness outbreaks in recent U.S. history. Both had significant underlying health conditions that may have been affected by the illness and related dehydration. Michigan reported 11,234 outbreak-linked cases and 193 hospitalizations Monday, up 461 cases from Friday. CNN has more.

The U.S. Centers for Disease Control and Prevention had recorded 6,707 laboratory-confirmed cases nationally as of July 28, plus more than 11,500 suspected cases awaiting confirmation. The federal count trails Michigan's because CDC reports only confirmed infections while states also count probable ones. The Food and Drug Administration has linked the outbreak, now in nine states, to iceberg lettuce from Taylor Farms operations in central Mexico. July diagnoses ran more than 11 times the eight-year average for the month, Reuters reported.

Medicare Advantage provider to pay $14.1M over false diagnosis codes

The Justice Department said the company prompted physicians to add unsupported codes.

Complete Health Partners Holdings, a Jacksonville, Florida, management services organization, has agreed to pay $14.1 million to resolve allegations it violated the False Claims Act by causing the submission of false diagnosis codes that inflated its Medicare Advantage payments, the Justice Department said. The company manages, owns or operates affiliated provider groups in Florida, Alabama and Colorado, and its contracts paid it a percentage of what the plans collected from Medicare.

The government alleges that from 2020 to 2023 the company submitted codes for drug and alcohol dependence (HCC 55) and major depressive, bipolar and paranoid disorders (HCC 59) that were not clinically valid or supported by the medical record, and that it distributed incorrect coding guidance and prompted physicians to add codes its coders had identified even when they were unsubstantiated. The case was brought by Karen Bowers, a former risk adjustment director at VIVA Health, who will receive about $2.47 million. The claims are allegations only, with no determination of liability.

Five insurers cover half of Medicaid's children

Plans owned by the largest firms showed lower behavioral health screening and more medication without therapy.

Millions of children and adolescents on Medicaid are enrolled in managed care organizations owned by one of five national firms, and their behavioral health care differs by which firm runs the plan, according to a study published in Health Affairs. Centene, Elevance Health, UnitedHealth Group, Molina Healthcare and CVS Health accounted for about half of Medicaid managed care enrollment by 2022, a market locally governed plans dominated as recently as 2006.

Oregon Health & Science University researchers analyzed 2022 Medicaid claims covering millions of youths. Plans owned by the five firms had consistently lower rates of the periodic screening Medicaid requires, enrollees in four of the five were more likely to receive a psychotropic prescription with no recorded psychotherapy visit, and most showed higher rates of emergency department visits for mental health conditions. "The concern isn't overprescribing so much as insufficient access to therapy," said lead author John McConnell, Ph.D., of the OHSU Center for Health Systems Effectiveness. The findings are associations and do not establish that ownership caused the differences.