Medicare Contractors Lacked Controls To Prevent Millions in Improper Payments for High Utilization Claims for Home Blood-Glucose Test Strips and Lancets
This report summarizes the results of our individual reviews of the 4 contractors that processed claims for home blood-glucose test strip and/or lancet supplies (test strips and lancets) for Jurisdictions A through D, which included all 50 States, 5 territories, and the District of Columbia. Medicare Part B covers test strips and lancets that physicians prescribe for diabetics. The quantity of test strips and lancets that Medicare covers depends on the beneficiary’s usual medical needs.For calendar year 2007, based on our analyses of our individual samples of the four contractors, we estimated that the contractors improperly allowed for payment a total of approximately $271 million in claims that we identified as high utilization claims for test strips and/or lancets. Of this amount, we estimated that the contractors improperly paid a total of approximately $209 million to suppliers.Of the 400 sampled claims for test strips and/or lancets that we reviewed at the 4 contractors, 303 claims (76 percent) had 1 or more deficiencies, including:
(1) The quantity of supplies that exceeded utilization guidelines was not supported with documentation that specified the reason for the additional supplies, the actual frequencies of testing, or the treating physicians’ evaluation of the patients’ diabetic control within 6 months before ordering the supplies;
(2) There was no supporting documentation that indicated refill requirements had been met;
(3) Physician orders were missing or incomplete; or
(4) Proof-of-delivery records were missing.We recommended that CMS:
(1) Ensure that contractors implement system edits recommended in our individual reports,
(2) Ensure that contractors are enforcing Medicare documentation requirements for claims for test strips and/or lancets, and
(3) Consider the results of our reviews when developing and evaluating coverage and reimbursement policies related to test strips and lancets.CMS concurred with all of our recommendations.
Individuals differ in the response to regular exercise. Whether there are people who experience adverse changes in cardiovascular and diabetes risk factors has never been addressed.
An adverse response is defined as an exercise-induced change that worsens a risk factor beyond measurement error and expected day-to-day variation. Sixty subjects were measured three times over a period of three weeks, and variation in resting systolic blood pressure (SBP) and in fasting plasma HDL-cholesterol (HDL-C), triglycerides (TG), and insulin (FI) was quantified.1 The technical error (TE) defined as the within-subject standard deviation derived from these measurements was computed. An adverse response for a given risk factor was defined as a change that was at least two TEs away from no change but in an adverse direction. Thus an adverse response was recorded if an increase reached 10 mm Hg or more for SBP, 0.42 mmol/L or more for TG, or 24 pmol/L or more for FI or if a decrease reached 0.12 mmol/L or more for HDL-C. Completers from six exercise studies were used in the present analysis: Whites (N = 473) and Blacks (N = 250) from the HERITAGE Family Study; Whites and Blacks from DREW (N = 326), from INFLAME (N = 70), and from STRRIDE (N = 303); and Whites from a University of Maryland cohort (N = 160) and from a University of Jyvaskyla study (N = 105), for a total of 1,687 men and women. Using the above definitions, 126 subjects (8.4%) had an adverse change in FI. Numbers of adverse responders reached 12.2% for SBP, 10.4% for TG, and 13.3% for HDL-C. About 7% of participants experienced adverse responses in two or more risk factors.
Adverse responses to regular exercise in cardiovascular and diabetes risk factors occur. Identifying the predictors of such unwarranted responses and how to prevent them will provide the foundation for personalized exercise prescription.
Introduction:Arab populations have many similarities and dissimilarities. They share culture, language and religion but they are also subject to economic, political and social differences. The purpose of this study is to understand the causes of the rising trend of diabetes prevalence in order to suggest efficient actions susceptible to reduce the burden of diabetes in the Arab world.Method:We use principal component analysis to illustrate similarities and differences between Arab countries according to four variables: 1) the prevalence of diabetes, 2) impaired glucose tolerance (IGT), 3) diabetes related deaths and 4) diabetes related expenditure per person. A linear regression is also used to study the correlation between human development index and diabetes prevalence.Results:Arab countries are mainly classified into three groups according to the diabetes comparative prevalence (high, medium and low) but other differences are seen in terms of diabetes-related mortality and diabetes related expenditure per person. We also investigate the correlation between the human development index (HDI) and diabetes comparative prevalence (R = 0.81).Conclusion:The alarming rising trend of diabetes prevalence in the Arab region constitutes a real challenge for heath decision makers. In order to alleviate the burden of diabetes, preventive strategies are needed, based essentially on sensitization for a more healthy diet with regular exercise but health authorities are also asked to provide populations with heath- care and early diagnosis to avoid the high burden caused by complications of diabetes.
A new report shows that adults (aged 18 and older) who had a mental illness in the past year have higher rates of certain physical illnesses than those not experiencing mental illness. According to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA), adults aged 18 and older who had any mental illness, serious mental illness, or major depressive episodes in the past year had increased rates of high blood pressure, asthma, diabetes, heart disease, and stroke.For example, 21.9 percent of adults experiencing any mental illness (based on the diagnostic criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) in the past year had high blood pressure. In contrast, 18.3 percent of those not experiencing any mental illness had high blood pressure. Similarly, 15.7 percent of adults who had any mental illness in the past year also had asthma, while only 10.6 percent of those without mental illness had this condition.Adults who had a serious mental illness (i.e., a mental illness causing serious functional impairment substantially interfering with one or more major life activities) in the past year also evidenced higher rates of high blood pressure, asthma, diabetes, heart disease and stroke than people who did not experience serious mental illnesses.Adults experiencing major depressive episodes (periods of depression lasting two weeks or more in which there were significant problems with everyday aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher rates of the following physical illnesses than those without past-year major depressive episodes: high blood pressure (24.1 percent vs. 19.8 percent), asthma (17.0 percent vs. 11.4 percent), diabetes (8.9 percent vs. 7.1 percent), heart disease (6.5 percent vs. 4.6 percent), and stroke (2.5 percent vs. 1.1 percent).
+ Full Report (PDF)
Ethnicity, Metabolism and Vascular Function: From Biology to Culture
We live in a multicultural society. Data from the US 2000 census illustrate that the population is quite heterogeneous: 75% of the population is of Caucasian origin, but look at the numbers for the other racial/ethnic populations. These numbers have now actually changed. The most recent data show that the Latino population now comprises 13.9% of the US population, followed by the African American population. And as you can see, there are other minority populations in the country.
Why is that relevant? It is relevant because we recognize that type 2 diabetes affects different populations in different ways. In this graph, you can see that the prevalence of type 2 diabetes is significantly higher in most of these minority groups in comparison to the white population. In this case, the European population represents what we usually see in this country in the white population. Keep in mind that these data are in people between the age of 45 and 74 years, and the rates of diabetes are 1.5, 2, 3 times higher than in the white population, with the highest prevalence of diabetes in terms of percentage of the population being demonstrated in the Pima Indians.
The Pima Indians are an American Indian group (most live in the state of Arizona) that has the highest rates of diabetes in the world: 70% of all Pima Indians above the age of 35 years have type 2 diabetes. They have a tremendous genetic risk for the disease, and they develop diabetes at very high rates. There is a very interesting natural “study” that occurred many years ago. The Pima Indians represented just a single group at some point in the past, but they divided into two groups: one that resides in the state of Arizona and another group that migrated to the northern part of Mexico (Sonora state). Although the populations are genetically identical, their rates for diabetes are very different.
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
Source: New England Journal of Medicine
In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Further study will be necessary to assess the durability of these results.
Fraud Alert for People with Diabetes
Source: U.S. Department of Health and Human Services, Office of Inspector General
Criminals who plot to defraud the Government and steal money from the American people have a new target: people with diabetes.
Although the precise method may vary, the scheme generally involves someone pretending to be from the Government, a diabetes association, or even Medicare, calling you. The caller offers "free" diabetic supplies, such as glucose meters, diabetic test strips, or lancets. The caller may also offer other supplies such as heating pads, lift seats, foot orthotics, or joint braces, in exchange for the beneficiaries’ Medicare or financial information, or confirmation of this type of personal information. Additionally, you may receive items in the mail that you did not order.
These findings show that in these women, there is a positive association between rotating night shift work and the risk of developing type 2 diabetes. Furthermore, long duration of shift work may also be associated with greater weight gain. Although these findings need to be confirmed in men and other ethnic groups, because a large proportion of the working population is involved in some kind of permanent night and rotating night shift work, these findings are of potential public health significance. Additional preventative strategies in rotating night shift workers should therefore be considered.
United Health Foundation’s America’s Health Rankings® Finds Preventable Chronic Disease on the Rise; Obesity, Diabetes Undermining Country’s Overall Health
United Health Foundation’s America’s Health Rankings® Finds Preventable Chronic Disease on the Rise; Obesity, Diabetes Undermining Country’s Overall Health</strong>
Source: United Health Foundation
United Health Foundation’s 2011 America’s Heath Rankings® finds that troubling increases in obesity, diabetes and children in poverty are offsetting improvements in smoking cessation, preventable hospitalizations and cardiovascular deaths. The report finds that the country’s overall health did not improve between 2010 and 2011 – a drop from the 0.5 percent average annual rate of improvement between 2000 and 2010 and the 1.6 percent average annual rate of improvement seen in the 1990s.
For the fifth year in a row, Vermont is the nation’s healthiest state. States that showed the most substantial improvement include New York and New Jersey, both moving up six places, largely because of improvements made in smoking cessation. Idaho and Alaska showed the most downward movement. Idaho dropped 10 spots, from number nine to 19 in this year’s Rankings, and Alaska dropped five places.
Our results suggest that an extended period of rotating night shift work is associated with a modestly increased risk of type 2 diabetes in women, which appears to be partly mediated through body weight. Proper screening and intervention strategies in rotating night shift workers are needed for prevention of diabetes.
Trust for America’s Health Releases Healthier Americans for a Healthier Economy
Source: Trust for America
Trust for America’s Health (TFAH) released a new report, Healthier Americans for a Healthier Economy, featuring six case studies focused on the relationship between health and economic development. The report examines how health affects the ability of states, cities and towns to attract and retain employers, and how workplace and community wellness programs help improve productivity and reduce health spending.
“High rates of chronic diseases, like diabetes and heart disease, are among the biggest drivers of U.S. health care costs and they are harming our nation’s productivity,” said Jeff Levi, PhD, Executive Director of TFAH, and Chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. “Workplace wellness and community prevention programs are a win-win way to make a real difference in improving our health and bottom line all at once.”
According to the report, more than half of all Americans currently live with one or more chronic disease, including heart disease, stroke, diabetes and cancer. High rates of these diseases, which in many cases are preventable, are associated with increasing health care costs.
The case studies in the report feature first-hand accounts from business executives, elected officials and public health leaders in Minnesota, Texas, Nashville, Indiana, San Diego and Hernando, Mississippi, where employers and communities are making the connection between improving health and improving the economy.
Diabetes in Australia: A Snapshot, 2007-08
Source: Australian Bureau of Statistics
Diabetes mellitus is a chronic condition in which the body is deficient in producing or using insulin, a hormone that controls blood glucose levels . People with diabetes have difficulty converting glucose from foods such as breads and cereals into energy, which leads to high levels of blood glucose (also known as hyperglycaemia). Prolonged hyperglycaemia can result in a range of complications, including slow-healing cuts and sores, decreased vision and nerve damage causing cold or insensitive feet . If left undiagnosed or poorly managed, diabetes can lead to coronary heart disease, stroke, kidney failure, limb amputations or blindness. Diabetes has a significant impact on the well-being of individuals and their ability to fully participate in their community, and has the potential to reduce quality of life and life expectancy .
There are three main types of diabetes, Type 1, Type 2 and gestational diabetes. Type 1 diabetes is characterised by a severe lack of insulin produced in the pancreas, and is most commonly diagnosed from early childhood to the late 30′s. People with Type 1 diabetes need insulin replacement for survival. Type 2 diabetes is characterised by insufficient levels of insulin or the body’s ineffective use of insulin and develops most often in middle or older age. Gestational diabetes is characterised by higher blood glucose levels appearing for the first time during pregnancy in women not previously diagnosed with other forms of diabetes. This type of diabetes is generally short-term but may precede the development of Type 2 diabetes .
The number of people worldwide with diabetes is increasing, with an estimated two people developing diabetes every 10 seconds . The International Diabetes Federation (IDF) Diabetes Atlas estimates that diabetes prevalence for 2010 has risen to 285 million people, representing 6.6% of the world’s adult population. (The rate of diabetes in Australia (3.8%) is relatively low compared with North America and the Caribbean (10.2%), Middle East and North Africa (9.3%), and South East Asia (7.6%)). By 2030, around 438 million people worldwide are projected to have diabetes .
Early Releases of Selected Estimates From the National Health Interview Survey
Source: National Center for Health Statistics
From press release (PDF):
In this release, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) updates estimates for 15 selected health measures based on data from the January–March 2011 National Health Interview Survey (NHIS) and presents estimates from 1997 through 2010 for comparison. The 15 Early Release measures are being published prior to final data editing and final weighting, to provide access to the most recent information from NHIS. The estimates will be updated as each new quarter of NHIS data becomes available.
The 15 measures included in the present report are lack of health insurance coverage and type of coverage, having a usual place to go for medical care, obtaining needed medical care, receipt of influenza vaccination, receipt of pneumococcal vaccination, obesity, leisure-time physical activity, current smoking, alcohol consumption, human immunodeficiency virus (HIV) testing, general health status, personal care needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma.
+ Full Release (PDF)
Global status report on noncommunicable diseases 2010
Source: World Health Organization
Of the 57 million global deaths in 2008, 36 million, or 63%, were due to NCDs, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. As the impact of NCDs increases, and as populations age, annual NCD deaths are projected to continue to rise worldwide, and the greatest increase is expected to be seen in low- and middle-income regions.
While popular belief presumes that NCDs afflict mostly high-income populations, the evidence tells a very different story. Nearly 80% of NCD deaths occur in low-and middle-income countries and NCDs are the most frequent causes of death in most countries, except in Africa. Even in African nations, NCDs are rising rapidly and are projected to exceed communicable, maternal, perinatal, and nutritional diseases as the most common causes of death by 2030.
Assessment of Services to Reduce Diabetes-related Mortality
Source: Department of Health
This workbook was developed by the Health Inequalities National Support Teams (HINST) with 70 local authorities covering populations in England. Local areas could use this approach when analysing whether a population level improvements could be achieved from a set of best-practice and established interventions. This is offered as useful resource for commissioners.
+ Full Document (PDF)
Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update (PDF)
Source: Agency for Healthcare Research and Quality
Comprehensive information comparing benefits and harms of diabetes medications can facilitate personalized treatment choices for patients. Although the long-term benefits and harms of diabetes medications remain unclear, the evidence supports use of metformin as a first- line agent. Comparisons of two-drug combinations showed little to no difference in HbA1c reduction, but some combinations increased risk for hypoglycemia and other adverse events.
Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial
These findings indicate that intensified counseling on diet and physical activity is effective in controlling the birthweight of babies born to women at risk of developing GDM and encourages at least some of them to alter their lifestyle. However, the findings fail to show that the intervention reduces the risk of GDM because of the limited power of the study. The power of a study—the probability that it will achieve a statistically significant result—depends on the study’s size and on the likely effect size of the intervention. Before starting this study, the researchers calculated that they would need 420 participants to see a statistically significant difference between the groups if their intervention reduced GDM incidence by 40%. This estimated effect size was probably optimistic and therefore the study lacked power. Nevertheless, the analyses performed among adherent women suggest that lifestyle changes might be a way to prevent GDM and so larger studies should now be undertaken to test this potential primary prevention intervention.