CMS showing confidence in managed care plans’ fraud-prevention efforts
By
John Hall
Jun 01, 2015
Medicaid managed care plans would be limited to fraud prevention expenditures of 0.5% of premium revenue when calculating medical loss ratios, signaling high confidence from federal regulators that such...
CVS pays $22 million to settle painkiller prescription allegations
By
John Hall
May 28, 2015
While the long-term care industry continues seeking internal solutions to stem drug diversion and over-prescribing of powerful painkillers and opioids, federal and state law enforcement agencies are beginning...
Supreme Court whistleblower rulings a mixed blessing for providers
By
John Hall
May 28, 2015
A Supreme Court ruling in a whistleblower suit in Iraq could have far-reaching implications for healthcare providers, legal observers say.
New CMS Medicaid managed care rule introduced
By
John Hall
May 27, 2015
An ambitious and comprehensive policy-making effort that promises to completely transform and radically overhaul the Medicaid managed care marketplace has passed White House Office of Management and Budget...
Heightened calls to curb painkiller-related hospitalizations and deaths on both sides of the aisle in Congress and the presidential campaign trail may make providers concerned about more restrictions on...
OIG report prods federal regulators to get tougher
By
John Hall
May 22, 2015
A Congressional watchdog group this week criticized the Department of Health & Human Services for failing to keep its improper payment rates low in its Medicare fee-for-service and Medicaid programs.
Providers fuming after MedPAC calls for cancellation of Medicare pay raise
By
John Hall
May 21, 2015
The nursing home industry’s largest trade group is pushing back hard against MedPAC’s recommendation that the Centers for Medicare & Medicaid Services forego its planned request for $500 million...
Sleep deprived, overweight shift workers at higher risk for diabetes: Study
By
John Hall
May 19, 2015
New university-based research claims employees such as nursing home caregivers, factory and shipping workers who work outside normal 9 a.m.-5 p.m. schedules could be suffering a disproportionate share...
PharMerica settles whistleblower complaint for $31.5 million
By
John Hall
May 19, 2015
National pharmacy services provider PharMerica said it has entered into separate agreements with the government and revised its controlled substances dispensing policies following a whistleblower lawsuit...
Nursing homes blamed for high opt-out rates in dual eligible demo
By
John Hall
May 18, 2015
Huge numbers of dual-eligible beneficiaries are leaving a demonstration project that hopes to improve payments for people eligible for both Medicare and Medicaid.