News in Brief: Week of Feb. 11-15

This roundup includes the following news briefs:

According to a Feb. 11 joint news release from HHS and the Department of Justice, the federal government's health care fraud prevention and enforcement efforts recovered $4.2 billion in fiscal year (FY) 2012 from individuals and companies who attempted to defraud federal health programs serving seniors and taxpayers or who sought payments to which they were not entitled. That figure beats the previous year's high of $4.1 billion.

The findings were included in the Health Care Fraud and Abuse Control (HCFAC) Program's annual report (99-page PDF; About PDFs) for FY 2012.

As a result of the joint Justice Department and HHS initiative to coordinate federal, state and local law enforcement activities to fight fraud and abuse throughout the health care industry, about $4.2 billion was deposited with the U.S. Department of the Treasury and CMS, transferred to other federal agencies that administer health care programs, or paid to private individuals during FY 2012.

The HCFAC account has returned more than $23 billion to the Medicare trust funds since the program's inception in 1997.

The CDC has released a new pertussis infographic in an effort to help physicians and other health care professionals educate patients about pertussis.

The infographic shows three steps expectant parents can take to protect infants from pertussis, including the recent recommendation (2-page PDF; About PDFs) that pregnant women get a tetanus, diphtheria and acellular pertussis shot during every pregnancy.

The United States experienced a nearly 60-year record high number of pertussis cases in 2012, with more than 41,000 reported. Although pertussis can be serious for anyone, it can be deadly for infants, with roughly half of infants who contract whooping cough ending up in the hospital. The majority of pertussis deaths in 2012 occurred among infants younger than three months.

The CDC has no printed copies of the infographic and suggests that it not be printed on 8.5" x 11" paper because the image is 7-1/2" x 34-1/2" in size. Those who wish to print the image commercially can request a press-ready file.

The Association of American Medical Colleges (AAMC) has issued an updated version of a brochure developed in 1997 to help medical students, residents and advisers understand Medicare payment rules related to graduate medical education (GME).

"Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know" (11-page PDF; About PDFs) briefly describes how Medicare pays teaching hospitals for GME and discusses the possible impact of the payment system on residents.

The publication has been revised to reflect changes in the law and related regulations and to address the numerous queries AAMC has fielded on this topic.

According to a study (abstract) in the Journal of Clinical Endocrinology & Metabolism, birth order may have an effect on whether a child develops diabetes or other metabolic issues.

"Although first-borns were taller and slimmer, these children had reduced insulin sensitivity and increased daytime blood pressure compared to later-borns," the authors wrote in the study conclusion. "Thus, first-borns may be at a greater risk of metabolic and cardiovascular diseases in adult life. This finding may have important public health implications, in light of a worldwide trend toward smaller families."

The study, conducted out of the University of Auckland in New Zealand, looked at 85 healthy prepubertal children ages 4-11 years. Researchers assessed height, weight, fasting lipid and hormonal profiles, as well as dual-energy x-ray absorptiometry-derived body composition. The children also underwent 24-hour ambulatory blood pressure monitoring and frequently sampled intravenous glucose tests with Bergman's minimal model.

According to the study, insulin sensitivity was reduced by 21 percent among first-borns versus those in the later-born group.

CMS has issued guidance (5-page PDF; About PDFs) on a provision in the health care reform law that provides a 1 percent increase in the federal medical assistance percentage (FMAP) for state Medicaid programs that furnish a designated list of specified preventive services and adult vaccines without cost-sharing requirements.

The guidance, provided in the form of a letter to state Medicaid directors, says the specified preventive services include those assigned a grade of A or B by the U.S. Preventive Services Task Force (USPSTF) and vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).

To qualify for the enhanced FMAP payment, states are required to make preventive services and vaccines available in both the fee-for-service and managed care environments. Moreover, states seeking the 1 percent FMAP increase "should amend their state plans to reflect that they cover and reimburse all USPSTF grade A and B preventive services and approved vaccines and administration recommended by ACIP without cost-sharing," says the guidance.

States also should provide an additional assurance that they have a method to ensure that they can update their coverage and billing codes to comply with any revisions made to the USPSTF or ACIP recommendations, according to the guidance.