KFF Health News has sued the U.S. Department of Health and Human Services Office of Inspector General to compel it to release a range of Medicare Advantage health plan audits and other financial records.
The suit, filed Nov. 12 in U.S. District Court in San Francisco under the Freedom of Information Act, or FOIA, seeks documents from the HHS inspector general’s office, which acts as a watchdog over federal health insurance programs run by the Centers for Medicare & Medicaid Services.
The suit asks for correspondence and other records of contact between HHS officials or their representatives and Medicare Advantage organizations concerning overpayment audit findings and potential financial penalties.
It also seeks records reflecting communication between HHS and CMS officials regarding the government’s policies for recovering overpayments discovered during Medicare Advantage audits, including a controversial decision in January 2023 to limit dollar recoveries for audits dating back a decade or more.
Additionally, the suit seeks copies of government contracts awarded to outside firms that have conducted Medicare Advantage audits, including budgets and performance evaluations, dating to 2020. In these audits, reviewers take a sample of 200 patients from a health plan and determine whether medical records support the diagnoses the government paid health plans to treat.
KFF Health News requested the records in August, but, more than two months later, “no documents, responsive or otherwise, have been produced,” the suit says.
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Sam Cate-Gumpert, an attorney with Davis Wright Tremaine, which is representing KFF Health News pro bono in the case, said the information is “critically important to public oversight of government misspending.”
According to the suit, the inspector general’s office has audited the Medicare Advantage program more than three dozen times since 2019, revealing billions of dollars in overpayments.
But government officials have not recouped the overcharges, according to the suit.
The HHS Office of Inspector General “has left taxpayers footing the bill for billions of dollars in overpayments — even though HHS OIG’s primary purpose is to combat fraud and waste in Medicare and other federally funded health programs,” the suit alleges.
“In fact, taxpayers have been forced to pay for the Medicare Advantage program’s wasteful spending twice — first, because of the program itself, and second, because of the costs of the audits, which the government spends millions of dollars to conduct,” according to the suit.
Medicare Advantage, mostly run by private insurance companies, has enrolled more than 33 million seniors and people with disabilities, more than half of people on Medicare.
But the program has faced criticism that it costs billions of dollars more than it should with research showing that many health plans exaggerate how sick patients are to boost payments.
A FOIA lawsuit filed by KFF Health News in September 2019 prompted CMS to release summaries of 90 Medicare Advantage audits revealing millions of dollars in overpayments. As part of a settlement, CMS paid $63,000 in KFF Health News’ legal fees, though it did not admit to wrongfully withholding the records.
The HHS Office of Inspector General had no immediate comment on the suit.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Jason Farned and his team at the San Gabriel Valley Mosquito and Vector Control District had spent years preparing for the likely arrival of dengue, a dangerous virus typically found in tropical climates outside the mainland United States.
They’d watched nervously as invasive Aedes mosquito species that can carry the virus appeared in Los Angeles about a decade ago and began to spread, likely introduced by international trade and enticed to stay by a warming climate that makes it easier for mosquitoes to thrive.
Then, in October 2023, an email came from the Pasadena Public Health Department: A person in the city had contracted California’s first-known case of dengue from a local mosquito.
“When it happens in real time, real life, you know, it is very different,” Farned said. “There’s no room for error here. We have to be quick and effective in identifying the most at-risk areas and responding.”
Across California, public health and pest control authorities are facing a new reality as the Aedes mosquitoes bring the threat of dengue and potentially other tropical diseases, such as chikungunya, Zika, and yellow fever, that were once of concern only to international travelers.
So far this year, authorities have identified at least 13 cases of locally acquired dengue, up from two in 2023, with 11 in Los Angeles County and two in the San Diego area. The Aedes mosquitoes spread the disease by biting an infected person and then biting a previously uninfected person.
Mosquito-borne viral illnesses, chiefly malaria, have long been a scourge in many tropical regions, and preventive measures focus mainly on controlling the mosquitoes. The Aedes mosquitoes, known for their aggressive, daytime biting, are now present in at least 24 California counties. They breed in water, in as little as a capful.
“When these locally acquired cases occur, … we want to act on them pretty quickly so that it does not become an endemic infection in our region,” said Aiman Halai, director of the Los Angeles County Department of Public Health’s Vector-Borne Disease Unit.
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California officials are hoping to beat back dengue by expanding mosquito surveillance, developing detailed response plans for mosquito outbreaks and human infections, and improving data sharing across agencies. They’re also going door to door in neighborhoods to remove standing water sources and apply pesticides. Residents are advised to wear bug repellent and long-sleeved clothing and control mosquitoes around their homes to prevent biting and infection.
Some vector control districts — local agencies charged with managing disease-bearing insects and other animals — are even growing their own sterile mosquitoes to release into the wild to reduce local Aedes populations.
Outside of California, locally acquired dengue cases have occurred in Arizona, Florida, Hawaii, and Texas. In March, Puerto Rico declared a public health emergency after a spike in cases there, where dengue is endemic. Meanwhile, worldwide dengue cases are on track to more than double this year, with 12.3 million documented through August, up from 6.5 million in 2023, according to the World Health Organization.
Most people who get dengue have no symptoms, but about 1 in 4 become ill. A mild case can feel like the flu and usually dissipates within a week, but about 5% of those infected with dengue become very sick, with symptoms that can include internal bleeding, shock, and organ failure, and the most severe cases can be fatal. People infected a second time are at especially high risk.
There is no specific medication to treat dengue. Japanese pharmaceutical company Takeda developed a vaccine that has won approval in Europe and elsewhere, though it withdrew an application to the FDA last year, saying it could not provide data requested by the agency. A vaccine developed in Brazil could soon be approved for use in that country. But the only FDA-approved vaccine is authorized only for children in narrow circumstances and will soon go out of production.
At the San Gabriel Valley Mosquito and Vector Control District, one of five agencies tasked with mosquito control across Los Angeles County, public health workers have put together an Aedes and dengue response plan based on updated guidance from the state.
When they discover a case, they identify all the properties and public spaces within 150 meters — roughly the distance an Aedes mosquito can fly — and then go door to door, removing standing water, where mosquitoes can breed; applying pesticides from backpacks or trucks; and educating residents about the risk of dengue and how to protect themselves. District officials also set traps to catch mosquitoes so they can figure out their prevalence and test them for dengue.
Since local dengue cases began to appear, the district has gotten more efficient in implementing its response plan, district manager Farned said. All full-time and seasonal staff members — about 40 people — have been trained in a variety of tasks, such as door-to-door education and coming in during off-hours to answer phones, Farned said.
While vector control teams respond to cases, separate teams from the Los Angeles County Public Health Department go door to door in the affected neighborhood when they determine that a dengue case was locally acquired, surveying residents and offering free dengue testing to try to identify others who may be infected.
Additionally, the department has been sending alerts to local health providers, advising them to be on the lookout for possible dengue cases and test for it when suspected, even among patients who haven’t traveled to a place where dengue is endemic. This advice follows a national alert put out by the Centers for Disease Control and Prevention in June. Health authorities are also emphasizing that people who travel to locations with dengue should continue to wear mosquito repellent when they get home, to reduce the risk of spreading the disease to local mosquitoes.
As happened during the covid-19 pandemic, mistrust of public health authorities can make outreach challenging for health and pest control teams in some neighborhoods, officials said.
Pest control officers can seek a warrant to enter and treat a property for mosquitoes if a homeowner refuses to give access, said Jeremy Wittie, a former president and the legislative committee chair for the Mosquito and Vector Control Association of California, which represents the more than 70 mosquito and vector control agencies in California. This is easier in districts such as his, the Coachella Valley Mosquito and Vector Control District, that have warrants giving officials standing permission to enter a property after 24 hours without needing to ask a judge.
In counties such as Santa Clara, where Aedes mosquitoes first appeared in 2022 but have yet to establish themselves, officials hope to suppress the threat with stepped-up surveillance, speedy eradication efforts, and more public outreach. Santa Clara County Vector Control District Manager Nayer Zahiri said the aim was to eliminate Aedes but acknowledged the climate conditions that encourage the mosquitoes’ spread are “totally out of our control.”
In some counties with pervasive mosquito problems, including San Diego, San Joaquin, and Stanislaus, officials have sprayed pesticides from planes or helicopters to address spikes in local mosquito populations, Wittie said. These sprayings typically aim to control the larvae of a different type of mosquito, Culex, that can spread West Nile virus and which — unlike the Aedes species, which thrive in urban habitats — are found in harder-to-reach rural environments, Wittie said.
Aerial spraying hasn’t been deployed to address the recent dengue outbreaks, which are in more urban environments where spraying from trucks is a better option, Wittie said. Drones are another option that some vector control authorities are exploring.
Some districts are experimenting with the decades-old sterile insect technique, commonly used for other pests such as fruit and screwworm flies, in which males are sterilized with radiation and then released to mate, resulting in eggs that don’t hatch. (Female mosquitoes are separated from the males before sterilization and not released. Only the females bite).
Ultimately, the public will have to take the mosquito threat more seriously and contribute to prevention efforts, Wittie said. “This mosquito is going to be here to stay, unfortunately. I hope it kind of wakes people up and pushes them to be part of that solution.”
Donald Hammen, 80, and his longtime next-door neighbor in south Minneapolis, Julie McMahon, have an understanding. Every morning, she checks to see whether he’s raised the blinds in his dining room window. If not, she’ll call Hammen or let herself into his house to see what’s going on.
Should McMahon find Hammen in a bad way, she plans to contact his sister-in-law, who lives in a suburb of Des Moines. That’s his closest relative. Hammen never married or had children, and his younger brother died in 2022.
Although Hammen lives alone, a web of relationships binds him to his city and his community — neighbors, friends, former co-workers, fellow volunteers with an advocacy group for seniors, and fellow members of a group of solo agers. McMahon is an emergency contact, as is a former co-worker. When Hammen was hit by a car in February 2019, another neighbor did his laundry. A friend came over to keep him company. Other people went on walks with Hammen as he got back on his feet.
Those connections are certainly sustaining. Yet Hammen has no idea who might care for him should he become unable to care for himself.
“I’ll cross that bridge when I come to it,” he told me.
These are fundamental questions for older adults who live alone: Who will be there for them, for matters large and small? Who will help them navigate the ever more complex health care system and advocate on their behalf? Who will take out the garbage if it becomes too difficult to carry? Who will shovel the snow if a winter storm blows through?
American society rests on an assumption that families take care of their own. But 15 million Americans 50 and older didn’t have any close family — spouses, partners, or children — in 2015, the latest year for which reliable estimates are available. Most lived alone. By 2060, that number is expected to swell to 21 million.
Beyond that, millions of seniors living on their own aren’t geographically close to adult children or other family members. Or they have difficult, strained relationships that keep them from asking for support.
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These older adults must seek assistance from other quarters when they need it. Often they turn to neighbors, friends, church members, or community groups — or paid help, if they can afford it.
And often, they simply go without, leaving them vulnerable to isolation, depression, and deteriorating health.
When seniors living alone have no close family, can nonfamily helpers be an adequate substitute? This hasn’t been well studied.
“We’re just beginning to do a better job of understanding that people have a multiplicity of connections outside their families that are essential to their well-being,” said Sarah Patterson, a demographer and sociologist at the Institute for Social Research at the University of Michigan.
The takeaway from a noteworthy study published by researchers at Emory University, Johns Hopkins University, and the Icahn School of Medicine at Mount Sinai was this: Many seniors adapt to living solo by weaving together local social networks of friends, neighbors, nieces and nephews, and siblings (if they’re available) to support their independence.
Linda Camp, a former administrator with the city of St. Paul, Minnesota, has written several reports about solo agers. But she was still surprised by how much help she required this summer when she had cataract surgery on both eyes. Camp was fortunate — she has a sizable network of former co-workers, neighbors, and friends. “What I tell people when I talk about solos is that all kinds of connections have value,” she says.(Lifetouch LLC)
Still, finding reliable local connections isn’t always easy. And nonfamily helpers may not be willing or able to provide consistent, intense hands-on care if that becomes necessary.
When AARP surveyed people it calls “solo agers” in 2022, only 25% said they could count on someone to help them cook, clean, get groceries, or perform other household tasks if needed. Just 38% said they knew someone who could help manage ongoing care needs. (AARP defined solo agers as people 50 and older who aren’t married, don’t have living children, and live alone.)
Linda Camp, 73, a former administrator with the city of St. Paul, Minnesota, who never married or had children, has written several reports for the Citizens League in St. Paul about growing old alone. Yet she was still surprised by how much help she required this summer when she had cataract surgery on both eyes.
A former co-worker accompanied Camp to the surgery center twice and waited there until the procedures were finished. A relatively new friend took her to a follow-up appointment. An 81-year-old downstairs neighbor agreed to come up if Camp needed something. Other friends and neighbors also chipped in.
Camp was fortunate — she has a sizable network of former co-workers, neighbors, and friends. “What I tell people when I talk about solos is all kinds of connections have value,” she said.
Michelle Wallace, 75, a former technology project manager, lives alone in a single-family home in Broomfield, Colorado. She has worked hard to assemble a local network of support. Wallace has been divorced for nearly three decades and doesn’t have children. Though she has two sisters and a brother, they live far away.
Michelle Wallace, a former technology project manager, lives alone in a single-family home in Broomfield, Colorado. She describes herself as happily unpartnered. “Coupling isn’t for me,” she says. “I need my space and my privacy too much.” Instead, Wallace has cultivated relationships with several people she met through local groups for solo agers. Many have become close friends.(Michelle Wallace)
Wallace describes herself as happily unpartnered. “Coupling isn’t for me,” she told me when we first talked. “I need my space and my privacy too much.”
Instead, she’s cultivated relationships with several people she met through local groups for solo agers. Many have become her close friends. Two of them, both in their 70s, are “like sisters,” Wallace said. Another, who lives just a few blocks away, has agreed to become a “we’ll help each other out when needed” partner.
“In our 70s, solo agers are looking for support systems. And the scariest thing is not having friends close by,” Wallace told me. “It’s the local network that’s really important.”
Gardner Stern, 96, who lives alone on the 24th floor of the Carl Sandburg Village condominium complex just north of downtown Chicago, has been far less deliberate. He never planned for his care needs in older age. He just figured things would work out.
They have, but not as Stern predicted.
The person who helps him the most is his third wife, Jobie Stern, 75. The couple went through an acrimonious divorce in 1985, but now she goes to all his doctor appointments, takes him grocery shopping, drives him to physical therapy twice a week and stops in every afternoon to chat for about an hour.
She’s also Gardner’s neighbor — she lives 10 floors above him in the same building.
Jobie Stern, Gardner Stern’s ex-wife, lives 10 floors above him in the same condominium complex. She goes to all of his doctor appointments, takes him grocery shopping, drives him to physical therapy twice a week, and stops in every afternoon to chat for about an hour. (Judith Graham for KFF Health News)
Gardner Stern (right) lives alone in a Chicago condominium complex. He never planned for his care needs in older age. He just figured things would work out, one way or another. Joy Loverde, an elder-care specialist, lives in the same building and is Stern’s “tell it like it is” friend. Loverde helped Stern decide to give up driving and persuaded him to have a walk-in shower with a bench installed in his bathroom. (Joy Loverde)
Why does she do it? “I guess because I moved into the building and he’s very old and he’s a really good guy and we have a child together,” she told me. “I get happiness knowing he’s doing as well as possible.”
Over many years, she said, she and Gardner have put their differences aside.
“Never would I have expected this of Jobie,” Gardner told me. “I guess time heals all wounds.”
Gardner’s other main local connections are Joy Loverde, 72, an author of elder-care books, and her 79-year-old husband, who live on the 28th floor. Gardner calls Loverde his “tell it like it is” friend — the one who helped him decide it was time to stop driving, the one who persuaded him to have a walk-in shower with a bench installed in his bathroom, the one who plays Scrabble with him every week and offers practical advice whenever he has a problem.
“I think I would be in an assisted living facility without her,” Gardner said.
There’s also family: four children, all based in Los Angeles, eight grandchildren, mostly in L.A., and nine great-grandchildren. Gardner sees most of this extended clan about once a year and speaks to them often, but he can’t depend on them for his day-to-day needs.
For that, Loverde and Jobie are an elevator ride away. “I’ve got these wonderful people who are monitoring my existence, and a big-screen TV, and a freezer full of good frozen dinners,” Gardner said. “It’s all that I need.”
As I explore the lives of older adults living alone in the next several months, I’m eager to hear from people who are in this situation. If you’d like to share your stories, please send them to [email protected].
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Newswise — Online e-cigarette retailers are not consistently adhering to laws aimed at preventing the sale of vaping products to minors, including regulations on age verification, shipping methods and flavor restrictions, report researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego.
In a study published online on Nov. 11, 2024 in JAMA, researchers asked 16 people to purchase flavored vape products online and have them delivered to their homes in the County of San Diego, then analyzed the results of these attempted purchases. Of 156 attempted transactions 73% were processed and 67% were delivered.
As of March 21, 2024, sale restrictions on flavored tobacco have been enacted in eight U.S. states and 392 cities or counties, but some of these do not cover e-commerce. For example, the 2022 California Senate Bill (SB) 793 prohibited the sale of flavored tobacco products but left e-commerce restrictions ambiguous.
Due to the ambiguity in California law, the researchers aimed to test differences in compliance with local tobacco e-commerce ordinances. Eight buyers were from the City of San Diego, where an ordinance restricts the sale of flavored tobacco products, including online sales. The other eight were from other County of San Diego communities, which do not have the same restrictions. Delivery did not differ significantly between buyers in these two jurisdictions.
In addition to violations of flavor restrictions, the online purchases violated the Preventing Online Sales of E-Cigarettes to Children Act, a federal law prohibiting the use of the United States Postal Service (USPS) to ship vaping products and requires both age verification and scanning identifications upon delivery.
“There are longstanding surveillance systems in place that help implement laws at brick-and-mortar stores, but we do not have a system in place for online retailers,” said Eric Leas, Ph.D., M.P.H., an assistant professor at the Herbert Wertheim School of Public Health and Human Longevity Science. “The results of this study highlight the need for greater oversight and enforcement of online tobacco retailers.”
Key findings include:
1% of buyers had their IDs scanned
81% of deliveries were made via the USPS
9% arrived via couriers with policies restricting shipping tobacco, including: 4.0% via UPS, 3.0% via FedEx 3.0% and 1.8% via DHL
78% of buyers reported no interaction with delivery personnel
15% of buyers spoke with delivery personnel but did not have their IDs checked
6% of buyers had their IDs checked but not scanned
“Online sales of e-cigarettes are the largest and fastest growing sector of the tobacco. We need to evaluate tobacco retail policies and ensure they cover e-commerce and monitor the market to improve implementation,” said Leas, who is also director of the Tobacco E-commerce Lab.
In a 2023 study published in Tobacco Control, Leas reported that following the implementation of SB-793, online shopping queries were 194% higher than expected for cigarettes and 162% higher than expected for vape products.
As a result, to strengthen state tobacco oversight programs, including online sales of flavored tobacco products, California lawmakers recently approved SB-1230, citing Leas’ Tobacco Control study. The law will go into effect on Jan. 1, 2025.
“This research is piloting a system for monitoring online compliance that local health departments could mimic as a routine surveillance system to strengthen the implementation of public health laws designed to reduce the sale of tobacco products to minors,” said Leas.
Co-authors include: Raquel M. Harati, Shannon E. Ellis, Nora Satybaldiyeva, and Tomas Mejorado, all of UC San Diego; Gustavo Benitez, California State University San Marcos; and Lisa Henriksen, Stanford University.
This research was funded, in part, by the California Tobacco Related Disease Research Program (T32IP4684).
Disclosures: The authors do not have any conflicts of interest to report.
Contact: Stacy A. Anderson Mount Sinai Press Office 347-346-3390 [email protected]
Mount Sinai Awarded Nearly $7 Million From National Institutes of Health to Create New York Coalition to Recruit for Highly Diverse Health Database Health System to serve as a lead site for the All of Us research program
(New York, NY – November 11, 2024) – The Mount Sinai Health System has been awarded nearly $7 million from the National Institutes of Health (NIH) to create and lead a New York coalition to contribute to one of the most diverse health databases in history, ultimately informing and guiding individualized treatment and care for a variety of diseases and health conditions. Mount Sinai will also work to increase the number of participants from various demographics, regions, and stages of opioid use disorder to address the public health crisis of rising overdose deaths.
The New York coalition will include academic medical centers and community partners with expertise in engaging, recruiting, and retaining participants often underrepresented in biomedical research in New York City—one of the most ethnically and culturally diverse enclaves in the world. Along with Mount Sinai, the group of collaborators includes Weill Cornell Medicine, New York City Health + Hospitals, the Institute for Family Health, and NYU Langone. The New York coalition will try to recruit more than 7,000 new participants across the tri-state area to join the NIH’s All of Us Research Program in the first year.
“This multi-institutional effort will fill a gap to significantly increase recruitment of participants in an area of the country with rich diversity,” said Principal Investigator Monica Kraft, MD, the Murray M. Rosenberg Professor of Medicine and Chair of the Department of Medicine at Mount Sinai Health System and the Icahn School of Medicine at Mount Sinai. “Our partnership encompasses dozens of hospitals and medical practices, longstanding collaborations, senior research investigators, and seasoned staff with experience in recruiting diverse populations. We will work closely with the All of Us consortium and key stakeholders, assess the impact of our activities, identify best practices, and share both our expertise and discoveries along the way. We look forward to continuing to build on our strong and robust IT, data science, clinical, data collection, and electronic health record infrastructures.”
The coalition will join the other All of Us regional hubs to also enroll 3,300 new participants with opioid use disorder, an epidemic that has affected thousands across the United States through increasing opioid use, addiction, and overdose deaths. The crisis has most recently involved a rise of synthetic opioids like fentanyl, which are significantly more potent and deadly than heroin and prescription opioids. There are distinct racial disparities among those with opioid use disorder, according to the Centers for Disease Control and Prevention: although opioid use is more common among white Americans, Black adults and teens experienced a steeper increase in the rate of fatal opioid overdoses than whites during the last decade.
Three Icahn Mount Sinai leaders join Dr. Kraft as Principal Investigators for the New York coalition: Bruce D. Gelb, MD, Dean for Child Health Research, the Gogel Family Professor and Director of The Mindich Child Health and Development Institute, and Director of the Center for Molecular Cardiology; Carol R. Horowitz, MD, MPH, Dean for Gender Equity in Science and Medicine, Director of the Institute for Health Equity Research, and Professor of Medicine, and Population Health Science and Policy; and Girish N. Nadkarni, MD, MPH, Irene and Dr. Arthur M. Fishberg Professor of Medicine, Director of The Charles Bronfman Institute of Personalized Medicine, and System Chief of the Division of Data-Driven and Digital Medicine.
“Our participation in the All of Us Research Program is a significant step towards revolutionizing health care through the power of multimodal data,” said Dr. Nadkarni. “This grant will enable us to harness cutting-edge technologies and integrate vast amounts of health information to uncover new insights and accelerate the development of personalized treatments. The world can leverage this comprehensive dataset to identify novel biomarkers, predict disease progression, and ultimately enhance clinical outcomes.”
Dr. Horowitz added: “Mount Sinai has a longstanding and deep commitment to health equity. Working in close partnership with expert clinicians, patients, and community advocates, we will ensure that our New York neighbors from more disadvantaged backgrounds and who have experienced health disparities are among the first to benefit from the advances in science and medicine that stem from All of Us.”
The investigators will harness insights from trusted networks and communities of ongoing research they currently lead, including The Charles Bronfman Institute for Personalized Medicine’s BioMe BioBank program, which supports rapid analysis from electronic medical information; the Mount Sinai Million Health Discoveries Program, which aims to carry out genetic sequencing of 1 million Mount Sinai patients within the next five years; and the NIH Researching COVID to Enhance Recovery (RECOVER) Initiative, which is examining the long-term effects of COVID-19.
The All of Us Research Program was created in 2015 to reflect the diversity of the United States and its territories, with a focus on precision medicine, or development of individualized plans for disease prevention and treatment. The national effort includes gathering data from 1 million or more diverse people, including those who are LGBTQ+ or Indigenous, with the goal of accelerating medical research and health breakthroughs. The comprehensive dataset is housed on a secure cloud-based platform and participating researchers can access information from surveys, genomic analyses, electronic health records, physical measurements, and wearables to study a range of factors that influence health and disease, including the environment, lifestyle, and genes. To date, more than 800,000 people have enrolled in the program.
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 11 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report’s® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2024-2025.
Contact: Stacy A. Anderson Mount Sinai Press Office 347-346-3390 [email protected]
Mount Sinai Awarded Nearly $7 Million From National Institutes of Health to Create New York Coalition to Recruit for Highly Diverse Health Database Health System to serve as a lead site for the All of Us research program
(New York, NY – November 11, 2024) – The Mount Sinai Health System has been awarded nearly $7 million from the National Institutes of Health (NIH) to create and lead a New York coalition to contribute to one of the most diverse health databases in history, ultimately informing and guiding individualized treatment and care for a variety of diseases and health conditions. Mount Sinai will also work to increase the number of participants from various demographics, regions, and stages of opioid use disorder to address the public health crisis of rising overdose deaths.
The New York coalition will include academic medical centers and community partners with expertise in engaging, recruiting, and retaining participants often underrepresented in biomedical research in New York City—one of the most ethnically and culturally diverse enclaves in the world. Along with Mount Sinai, the group of collaborators includes Weill Cornell Medicine, New York City Health + Hospitals, the Institute for Family Health, and NYU Langone. The New York coalition will try to recruit more than 7,000 new participants across the tri-state area to join the NIH’s All of Us Research Program in the first year.
“This multi-institutional effort will fill a gap to significantly increase recruitment of participants in an area of the country with rich diversity,” said Principal Investigator Monica Kraft, MD, the Murray M. Rosenberg Professor of Medicine and Chair of the Department of Medicine at Mount Sinai Health System and the Icahn School of Medicine at Mount Sinai. “Our partnership encompasses dozens of hospitals and medical practices, longstanding collaborations, senior research investigators, and seasoned staff with experience in recruiting diverse populations. We will work closely with the All of Us consortium and key stakeholders, assess the impact of our activities, identify best practices, and share both our expertise and discoveries along the way. We look forward to continuing to build on our strong and robust IT, data science, clinical, data collection, and electronic health record infrastructures.”
The coalition will join the other All of Us regional hubs to also enroll 3,300 new participants with opioid use disorder, an epidemic that has affected thousands across the United States through increasing opioid use, addiction, and overdose deaths. The crisis has most recently involved a rise of synthetic opioids like fentanyl, which are significantly more potent and deadly than heroin and prescription opioids. There are distinct racial disparities among those with opioid use disorder, according to the Centers for Disease Control and Prevention: although opioid use is more common among white Americans, Black adults and teens experienced a steeper increase in the rate of fatal opioid overdoses than whites during the last decade.
Three Icahn Mount Sinai leaders join Dr. Kraft as Principal Investigators for the New York coalition: Bruce D. Gelb, MD, Dean for Child Health Research, the Gogel Family Professor and Director of The Mindich Child Health and Development Institute, and Director of the Center for Molecular Cardiology; Carol R. Horowitz, MD, MPH, Dean for Gender Equity in Science and Medicine, Director of the Institute for Health Equity Research, and Professor of Medicine, and Population Health Science and Policy; and Girish N. Nadkarni, MD, MPH, Irene and Dr. Arthur M. Fishberg Professor of Medicine, Director of The Charles Bronfman Institute of Personalized Medicine, and System Chief of the Division of Data-Driven and Digital Medicine.
“Our participation in the All of Us Research Program is a significant step towards revolutionizing health care through the power of multimodal data,” said Dr. Nadkarni. “This grant will enable us to harness cutting-edge technologies and integrate vast amounts of health information to uncover new insights and accelerate the development of personalized treatments. The world can leverage this comprehensive dataset to identify novel biomarkers, predict disease progression, and ultimately enhance clinical outcomes.”
Dr. Horowitz added: “Mount Sinai has a longstanding and deep commitment to health equity. Working in close partnership with expert clinicians, patients, and community advocates, we will ensure that our New York neighbors from more disadvantaged backgrounds and who have experienced health disparities are among the first to benefit from the advances in science and medicine that stem from All of Us.”
The investigators will harness insights from trusted networks and communities of ongoing research they currently lead, including The Charles Bronfman Institute for Personalized Medicine’s BioMe BioBank program, which supports rapid analysis from electronic medical information; the Mount Sinai Million Health Discoveries Program, which aims to carry out genetic sequencing of 1 million Mount Sinai patients within the next five years; and the NIH Researching COVID to Enhance Recovery (RECOVER) Initiative, which is examining the long-term effects of COVID-19.
The All of Us Research Program was created in 2015 to reflect the diversity of the United States and its territories, with a focus on precision medicine, or development of individualized plans for disease prevention and treatment. The national effort includes gathering data from 1 million or more diverse people, including those who are LGBTQ+ or Indigenous, with the goal of accelerating medical research and health breakthroughs. The comprehensive dataset is housed on a secure cloud-based platform and participating researchers can access information from surveys, genomic analyses, electronic health records, physical measurements, and wearables to study a range of factors that influence health and disease, including the environment, lifestyle, and genes. To date, more than 800,000 people have enrolled in the program.
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 11 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report’s® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2024-2025.
Voters in three states — Arizona, Missouri, and Nevada — chose on Tuesday to advance protections for abortion rights in their state constitutions. Donald Trump, meanwhile, is likely to win all three states in his victorious bid for the White House.
It’s a conundrum for Democrats, who expected ballot initiatives on abortion rights in those states to boost the prospects of their candidates, including Vice President Kamala Harris. But data from VoteCast, a large survey of U.S. voters conducted by The Associated Press and partners including KFF, found that about 3 in 10 voters in Arizona, Missouri, and Nevada who supported the abortion rights measures also voted for Trump.
“We saw lots of people who voted in favor of abortion access and still voted for Donald Trump,” said Liz Hamel, director of Public Opinion and Survey Research for KFF, a health information nonprofit that includes KFF Health News.
VoteCast is a survey of more than 115,000 registered voters in all 50 states conducted between Oct. 28 and Nov. 5. It’s intended to be “the most accurate picture possible of who has voted, and why,” according to the AP.
About 1 in 4 of the polled voters said abortion was the “single most important” factor to their vote, though that number was higher among Democrats, young women, Black adults, and Hispanic adults.
Abortion rights referendums passed in seven states on Tuesday, including Missouri and Arizona, where state bans were overturned. Vice President Kamala Harris made reproductive rights a cornerstone of her campaign, but the VoteCast results reinforce earlier surveys that indicated economic concerns were the foremost issue in the election.
Tuesday’s was the first presidential election since the U.S. Supreme Court’s conservative majority overturned Roe v. Wade. During Trump’s first term as president, he nominated three Supreme Court justices who later joined the 2022 ruling that eliminated women’s constitutional right to abortion care.
Mike Islami, 20, voted for Trump in Madison, Wisconsin, where he’s a full-time student. He said abortion is “a woman’s right” that “was definitely in the back of my mind” when he cast his ballot.
“I don’t think much is going to change” about abortion access during Trump’s second term, he said. “I believe his policy is that he’s just going to give it back to the states and from there they could decide how important it was.”
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The survey found that the percentage of voters who said abortion was the most important factor in their vote was similar in states that had abortion measures on the ballot and states without them.
When voters cast their ballots, they were more motivated by economic anxiety and the cost of filling up their gas tanks, housing, and food, according to the survey results. Trump won those voters as much in hotly contested states such as Pennsylvania and Wisconsin as in reliably red states.
Glen Bolger, a Republican campaign strategist, said the 2022 election results demonstrated that Republican candidates are better off talking about the economy and the cost of living than they are about abortion.
This year, Trump voters who supported abortion rights amendments may have decided to take Trump “at his word that he was not going to support a national ban,” Bolger said. In casting their vote for Trump, he said, those supporters may have thought, “Let’s elect him to deal with the cost of living and health care and gasoline and everything else.”
The VoteCast survey found stronger support for abortion ballot initiatives from female voters: 72% of women in Nevada, 69% in Arizona, 62% in Missouri.
Erica Wallace, 39, of Miami, voted for Harris and in favor of an abortion rights ballot measure in Florida, which fell just short of the 60% threshold needed to amend the state constitution.
“As a grown woman, you’re out and you’re working, living your life,” said Wallace, an executive secretary who lives in Miami. She said the state’s ban, which criminalizes abortion care before many women know they’re pregnant, amounts to unequal treatment for women.
“I pay my taxes. I live good,” she said. “I’m doing everything every other citizen does.”
Men were more likely to vote against protecting abortion rights. Men voted 67% in Nevada, 64% in Arizona, and 55% in Missouri for the abortion rights ballot initiatives.
The VoteCast survey found that, overall, voters believed Harris was better able to handle health care. That is consistent with the long-standing view that “Democrats traditionally have the advantage on health care,” Hamel said. Still, Trump outperformed Harris among more than half of voters who said they were very concerned about health care costs.
Family premiums for employer-sponsored health insurance rose 7% in 2024 to an average of $25,572 annually, according to KFF’s 2024 Employer Health Benefits Survey. On average, workers contribute $6,296 annually to the cost of family coverage.
“Everybody is impacted by high health-care costs, and nobody has a solution to it,” Bolger said. “That’s something voters are very frustrated about.”
Florence Robbins in Madison, Wisconsin, and Denise Hruby in Miami contributed to this report.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Health care might not have been the biggest issue in the campaign, but the return of Donald Trump to the presidency is likely to have a seismic impact on health policy over the next four years.
Changes to the Affordable Care Act, Medicaid, and the nation’s public health infrastructure are likely on the agenda. But how far Trump goes will depend largely on who staffs key health policy roles and on whether Democrats take a majority in the U.S. House, where several races remain uncalled.
This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs Zhang of Stat, and Alice Miranda Ollstein of Politico.
Panelists
Among the takeaways from this week’s episode:
As of Friday morning, it remained unclear which party will control the House next year. A Democratic-controlled House would offer a check against Republican policy changes and some control of key government oversight committees. A Republican House would give the party full control of Congress and the presidency. Either way, the party in control will have a slim majority.
Majorities of voters in eight states voted to protect abortion rights — though the ballot measures passed in only seven states. (More than half of voters in Florida voted for the abortion rights measure, but the state requires at least 60% support for ballot measures to pass.)
Robert F. Kennedy Jr. — now a key voice in the Trump transition team — is telegraphing big plans for health policy. Who ends up in Trump’s Cabinet will make a difference, as the president-elect is seemingly outsourcing much of his health policy planning in favor of focusing on issues such as the economy, immigration, and trade.
And conservative appointees throughout the judicial system are likely to remain friendly to Trump administration causes, which could open the door to more challenges to federal policies. Several important legal challenges are already winding through the courts.
Also this week, Rovner interviews KFF Health News’ Jackie Fortiér, who reported and wrote the latest KFF Health News-Washington Post “Bill of the Month” feature, about a 2-year old who had an expensive run-in with a rattlesnake. Do you have a medical bill that is exorbitant, baffling, infuriating, or all of the above? Tell us about it!
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
A new federal watchdog audit is ratcheting up pressure on government officials to crack down on billions of dollars in overcharges linked to Medicare Advantage home visits.
But so far, the Centers for Medicare & Medicaid Services has rejected a recommendation from the Health and Human Services Inspector General to limit payments stemming from house visits that don’t result in any medical treatment — a potential red flag that may signal overcharges.
In late October, the HHS watchdog found that the health plans pocketed $7.5 billion in 2023 from diagnosing health conditions that prompted no medical services — about $4.2 billion of it through health assessments done in patients’ homes. And court records show that for a decade or more, CMS officials have failed to act on their concerns that the home visits waste tax dollars and should be limited.
UnitedHealthcare, the largest Medicare Advantage contractor, accounted for about two-thirds of the payments tied to home visits and chart reviews, in which health plans mine patient medical files to add new diagnoses that can bring in additional revenue, according to the audit.
Assistant Inspector General Erin Bliss said the health plans are making billions without offering any treatment for medical conditions they flag during the visits, such as diabetes and major depression.
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CMS, which runs the Medicare program, disagrees.
In a statement to KFF Health News by spokesperson Alexx Pons, the agency said it “appreciates the OIG’s review in this area” and will continue to study the issue.
However, CMS disagreed with the OIG’s call to restrict use of home health assessments in computing how much to pay health plans. People on Medicare “should have access to care that is appropriately provided in the home setting,” CMS wrote in a written response included in the audit report.
“One would think that CMS would kick its regulatory oversight up a notch or two,” said Richard Lieberman, a Colorado health data analytics expert.
“In contrast, CMS appears to be unconcerned and is telling OIG to stay out of their lane,” he said.
UnitedHealthcare spokesperson Heather Soule said in a statement that the OIG had drawn “inaccurate conclusions” in the audit.
The home visits are “among the most comprehensive and thorough assessments of a patient’s health and physical environment available in the healthcare system, helping to identify and drive needed follow-on care for the vast majority of the patients with whom we engage,” according to the company.
No Care Provided
Government spending on Medicare Advantage, which is dominated by UnitedHealthcare and a handful of other health insurance companies, is expected to hit $462 billion this year.
The industry, whose more than 33 million members make up over half of people eligible for Medicare, argues that most enrollees are satisfied with the care they receive and typically pay less out-of-pocket than those on original Medicare.
Whether Medicare Advantage is a good deal for taxpayers is another matter, largely because many health plans exaggerate how sick patients are to boost their payments, multiple federal audits and other investigations have shown. Medicare pays the health plans higher rates for sicker patients.
For fiscal year 2023, CMS identified $12.7 billion in overpayments linked to diagnoses not supported by patients’ medical records.
The OIG audit tied $7.5 billion in payments to health conditions that prompted no treatment, including serious diseases such as diabetes, congestive heart failure, and major depression. That suggests that the medical condition either didn’t exist or that the health plan failed to treat it adequately, auditors said.
“These are serious conditions. You would think you would see additional care during that year,” said Jacqualine Reid, who led the OIG audit team. “We are asking CMS to step up its oversight.”
Homegrown
The in-home visits have sparked controversy for more than a decade. A June 2014 media investigation found that a sharp rise in home visits had inflated Medicare’s costs by billions of dollars. The visits, which typically last less than an hour, are often conducted by nurse practitioners, who do not treat the patient, but go over a checklist of possible health conditions.
Sabrina Skeldon, a Texas lawyer who advises physicians on billing issues, said problems arise when health plans fail to order necessary medical tests to confirm a diagnosis made during a home visit — and treat it.
Skeldon noted that The Cigna Group in 2023 paid $172 million to settle a whistleblower lawsuit that alleged its Medicare Advantage plan illegally collected payments for medical diagnoses that were based solely on in-home assessments.
The OIG audit comes as the Justice Department presses a civil fraud case that accuses UnitedHealth Group of cheating Medicare out of more than $2 billion by mining patient records to churn up diagnoses that boosted revenue, while ignoring evidence of overpayments. The company denies the allegations.
Court filings from the case show CMS officials were concerned years ago that home visits and chart reviews could needlessly drive up costs.
In April 2014, CMS backed off a proposal to restrict their use amid complaints from the industry that it would lose billions of dollars as a result. Similarly, CMS officials scrapped a proposal to tighten scrutiny on the chart reviews after what one official called an “uproar” from the industry.
CMS officials also had concerns that unchecked home visits might affect efforts to recover overpayments through billing reviews known as “RADV” audits.
Former CMS official Thomas Hutchinson, who ran the agency’s Medicare Plan Payment Group from September 2006 through June 2010, testified in a deposition that officials had “heard about various folks that figured out how they could RADV-proof things by doing in-home visits.”
In a confidential April 2015 slide presentation, CMS officials observed that health plans were “now conducting health risk assessments in beneficiaries’ homes. One purpose of the assessments is to identify conditions and create medical records documentation that substantiates diagnoses.”
And an October 2015 CMS memo circulated among senior agency staff cites “limitations around home visits” among the possible ways to “strengthen” the RADV audits.
In its statement to KFF Health News, CMS said it was “committed” to ensuring that diagnoses health plans submitted for payment were accurate. But the agency declined to answer written questions about the impact of home visits on its audit program, which has yet to complete reviews of payments dating back as far as 2011.
UnitedHealthcare had the lowest rates of unconfirmed diagnoses among five large Medicare Advantage organizations audited in 2011, according to court records.
Overall, the company ended up with underpayments of more than $261 million for 15 of its plans audited for 2011-2013, court records show. The audit findings for other Medicare Advantage firms are blacked out in court filings.
CMS audits payments to just 30 out of more than 700 contracts a year. That’s not enough to protect tax dollars, said Matthew Fiedler, a health policy researcher at The Brookings Institution.
“They should be auditing 10 times as many contracts,” he said. “Where we are now you are not likely to get caught.”
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
To discover how millions in opioid settlement funds are being spent in Idaho, you can visit the state attorney general’s website, which hosts 91 documents from state and local entities getting the money.
But many of those reports remain difficult, if not impossible, for the average person to decipher.
It’s a scenario playing out in a host of states. As state and local governments begin spending billions in opioid settlement funds, one of the loudest and most frequent questions from the public has been: Where are the dollars going? Victims of the crisis, along with their advocates and public policy experts, have repeatedly called on governments to transparently report how they’re using these funds, which many consider “blood money.”
Last year, KFF Health News published an analysis by Christine Minhee, founder of OpioidSettlementTracker.com, that found 12 states — including Idaho — had made written commitments to publicly report expenditures on 100% of their funds in a way an average person could find and understand. (The other 38 states promised less.)
But there’s a gap between those promises and the follow-through.
This year, KFF Health News and Minhee revisited those 12 states: Arizona, Colorado, Delaware, Idaho, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, Oregon, South Carolina, and Utah. From their reports, it became clear that some did not fulfill their promises. And several just squeaked by, meeting the letter of the law but falling far short of communicating to the public in a clear and meaningful manner.
Take Idaho, for instance. Jurisdictions there completed a standard form showing how much money they spent and how it fell under approved uses of the settlement. Sounds great. But in reality, it reads like this: In fiscal year 2023, the city of Chubbuck spent about $39,000 on Section G, Subsection 9. Public Health District No. 6 spent more than $26,000 on Section B, Subsection 2.
Cracking that code requires a separate document. And even that provides only broad outlines.
G-9 refers to “school-based or youth-focused programs or strategies that have demonstrated effectiveness in preventing drug misuse.” B-2 refers to “the full continuum of care of treatment and recovery services for OUD and any co-occurring SUD/MH conditions,” referring to opioid use disorder and substance use disorder or mental health conditions.
“What does that mean? How exactly are you doing that?” asked Corey Davis, a project director at the Network for Public Health Law, when he first saw the Idaho reports.
Does a school-based program involve hiring mental health counselors or holding a one-time assembly? Does treatment and recovery services mean paying for someone’s rehab or building a new recovery house?
Without details on the organizations receiving the money or descriptions of the projects they’re enacting, it’s impossible to know where the funds are going. It would be similar to saying 20% of your monthly salary goes to food. But does that mean grocery bills, eating out at restaurants, or hiring a cook?
The Idaho attorney general’s office, which oversees the state’s opioid settlement reports, did not respond to requests for comment.
“I don’t think it’s a high bar to let the public see at some reasonable level of granularity where their money is going,” says Corey Davis, a project director at the Network for Public Health Law, where he focuses on substance use policy. (Amy Lieberman)
Although Idaho and the other states in this analysis do better than most in having any reports publicly available, Davis said that doesn’t mean they get an automatic gold star.
“I don’t think we should grade them on a curve,” he said. It’s not “a high bar to let the public see at some reasonable level of granularity where their money is going.”
To be sure, many state and local governments are making concerted efforts to be transparent. In fact, seven of the states in this analysis reported 100% of their expenditures in a way that is easy for the public to find and understand. Minnesota’s dashboard and downloadable spreadsheet clearly list projects, such as Renville County’s use of $100,000 to install “a body scanner in our jail to help staff identify and address hidden drugs inside of inmates.” New Jersey’s annual reports include details on how counties awarded funds and how they’re tracking success.
There are also states such as Indiana that didn’t originally promise 100% transparency but are now publishing detailed accounts of their expenditures.
However, there are no national requirements for jurisdictions to report money spent on opioid remediation. In states that have not enacted stricter requirements on their own, the public is left in the dark or forced to rely on ad hoc efforts by advocates and journalists to fill the gap.
Wading Through Reports
When jurisdictions don’t publicly report their spending — or publish reports without meaningful details — the public is robbed of an opportunity to hold elected officials accountable, said Robert Pack, a co-director of East Tennessee State University’s Addiction Science Center and a national expert on addiction issues.
He added: People need to see the names of organizations receiving the money and descriptions of their work to ensure projects are not duplicating efforts or replacing existing funding streams to save money.
“We don’t want to burden the whole thing with too much reporting,” Pack said, acknowledging that small governments run on lean budgets and staff. But organizations typically submit a proposal or project description before governments give them money. “If the information is all in hand, why wouldn’t they share it?”
Norman Litchfield, a psychiatrist and the director of addiction medicine at St. Luke’s Health System in Idaho, said sharing the information could also foster hope.
“A lot of people simply are just not aware that these funds exist and that these funds are currently being utilized in ways that are helping,” he said. Greater transparency could “help get the message out that treatment works and treatment is available.”
Other states that lacked detail in some of their expenditure reports said further descriptions are available to the public and can be found in other state documents.
In South Carolina, for instance, more information can be found in the meeting minutes of the Opioid Recovery Fund Board, said board chair Eric Bedingfield. He also wrote that, following KFF Health News’ inquiry, staff will create an additional report showing more granular information about the board’s “discretionary subfund” awards.
In Missouri, Department of Mental Health spokesperson Debra Walker said, further project descriptions are available through the state budget process. Anyone with questions is welcome to email the department, she said.
Bottom line: The details are technically publicly available, but finding them could require hours of research and wading through budgetary jargon — not exactly a system friendly to the average person.
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Click Ctrl+F
New Hampshire’s efforts to report its expenditures follow a similar pattern.
Local governments control 15% of the state’s funds and report their expenditures in yearly letters posted online. The rest of the state’s settlement funds are controlled by the Department of Health and Human Services, along with an opioid abatement advisory commission and the governor and executive council.
Grant recipients from the larger share explain their projects and the populations they serve on the state’s opioid abatement website. But the reports lack a key detail: how much money each organization received.
To find those dollar figures, people must search through the opioid abatement advisory commission’s meeting minutes, which date back several years, or search the governor and executive council’s meeting agendas for the proposed contracts. Typing in the search term “opioid settlement” brings up no results, so one must try “opioid” instead, surfacing results about opioid settlements as well as federal opioid grants. The only way to tell which results are relevant is by opening the links one by one.
Davis, from the Network for Public Health Law, called the situation an example of “technical compliance.” He said people in recovery, parents who lost their kids to overdose, and others interested in the money “shouldn’t have to go click through the meeting notes and then control-F and look for opioids.”
James Boffetti, New Hampshire’s deputy attorney general, who helps oversee the opioid settlement funds, agreed that “there’s probably better ways” to share the various documents in one place.
“That doesn’t mean they aren’t publicly available and we’re somehow not being transparent,” he said. “We’ve certainly been more than transparent.”
The New Hampshire Department of Health and Human Services said it will be compiling its first comprehensive report on the opioid settlement funds by the end of the year, as laid out in statute.
Where’s the Incentive?
With opioid settlement funds set to flow for another decade-plus, some jurisdictions are still hoping to improve their public reporting.
In Michigan, the state is using some of its opioid settlement money to incentivize local governments to report on their shares. Counties were offered $1,000 to complete a survey about their settlement spending this year, said Laina Stebbins, a spokesperson for the Michigan Department of Health and Human Services. Sixty-four counties participated — more than double the number from last year, when there was no financial incentive.
In Maryland, lawmakers took a different approach. They introduced a bill that required each county to post an annual report detailing the use of its settlement funds and imposed specific timelines for the health department to publish decisions on the state’s share of funds.
But after counties raised concerns about undue administrative burden, the provisions were struck out, said Samuel Rosenberg, a Democrat representing Baltimore who sponsored the House bill.
Lawmakers have now asked the health department to devise a new plan by Dec. 1 to make local governments’ expenditures public.
Toni Torsch, a Maryland resident whose son Dan died of an overdose at age 24, said she’ll be watching to ensure the public gets a clear picture of settlement spending.
“This is money we got because people’s lives have been destroyed,” she said. “I don’t want to see that money be misused or fill a budget hole.”
After her son Dan died of an overdose at age 24 in 2010, Toni Torsch co-founded the Daniel Carl Torsch Foundation. She now advocates for policies to help families affected by the addiction crisis. That includes pushing for greater transparency on how her state of Maryland spends its opioid settlement funds. (Hanna Jones)
Methodology
In March 2023, KFF Health News published an analysis by Christine Minhee, founder of OpioidSettlementTracker.com, assessing states’ written commitments to report how they use opioid settlement dollars. That analysis determined that 12 states had promised to publicly report expenditures on 100% of their funds in a way an average person could track.
More than a year later, KFF Health News senior correspondent Aneri Pattani and Minhee revisited those 12 states’ reporting practices to determine if they had fulfilled their promises and to assess how useful the resulting expenditure reports were to the public.
Expenditure reports were gathered via state and local government websites, Google searches, and Minhee’s Expenditure Report Tracker. If Minhee and Pattani were unable to find public reports, they contacted state governments directly.
For expenditures to be considered “publicly reported,” they had to meet the following criteria: 1. Expenditures had to be expressed as specific dollar amounts. Descriptions of how the money was used without a dollar figure would not qualify. 2. The report passes the “Googleability test”: Could a typical member of the public reasonably be expected to find expenditure information by keyword-searching online? If people had to file a public records request, navigate lengthy budget or appropriations documents, or rifle through meeting minutes for the information, it would not qualify.
For an expenditure report to be considered “publicly reported with clarity,” it had to meet one additional criterion: 3. Reports had to contain some combination of vendor name (e.g., an individual or organization) that received the money and a description of the money’s use such that a typical member of the public could understand the specific service, product, or effort the money supported.
Each state divides opioid settlement funds into shares controlled by different entities. The majority of expenditures in each share were required to meet the above-listed criteria in order for that share to be classified as “publicly reported” or “publicly reported with clarity.”
For example, in Utah, 50% of opioid settlement funds are controlled by county governments. As of Oct. 9, less than half of all counties had reported expenditures in a manner that was easily accessible to the public. As such, that 50% share was not counted as “publicly reported.”
This analysis was conducted by Pattani and Minhee from July to October. Classifications were made based on states’ expenditure reports as of Oct. 9.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
