The Federal Trade Commission (FTC) won an appeal to the 7th U.S. Circuit Court of Appeals in October to issue a preliminary injunction to block the merger of Advocate Health Care and NorthShore University HealthSystem in Chicago.
The Centers for Medicare and Medicaid Services (CMS) finalized payment rates and updated policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for 2017. CMS estimates that the updates in the final rule would increase OPPS payments by 1.7% and ASC rates by 1.9% in 2017.
The United States Court of Appeals for the Third Circuit in Philadelphia blocked the proposed merger of Penn State Hershey Medical Center (Hershey) with Pinnacle Health System (PHS), finding the merger would violate antitrust statutes. The court awarded a preliminary injunction to the Federal Trade Commission (FTC), reversing the lower court ruling.
An audit released in September by the Department of Health and Human Services’ Office of the Inspector General (HHS-OIG) shows California as among a majority of audited states that overpaid doctors and hospitals their Medicaid meaningful use incentive payments. The total cost of California’s overpayment was calculated by the OIG as $22 million.
North American Health Care, Inc. (NAHC), board chairman John Sorenson, and Senior Vice President of Reimbursement Analysis Margaret Gelvezon, agreed to pay a total of $30 million to resolve allegations they violated the False Claims Act by submitting false claims to government healthcare programs for medically unnecessary rehabilitation services provided to residents at NAHC’s skilled nursing facilities (SNFs).
The Centers for Medicare & Medicaid Services (CMS) announced recently the participants in the Part D Enhanced Medication Therapy Management (MTM) model announced last fall. The Enhanced MTM model is an opportunity for basic stand-alone Part D Prescription Drug Plans (PDPs) to offer innovative MTM programs aimed at improving quality of care and reducing costs.
America’s growing obesity problem continues to cause serious health complications. Recently, 45 international medical and scientific societies, including the American Diabetes Association, called for bariatric surgery to become a standard option for diabetes treatment . The procedure costs up to $26,000 — not including the cost of post-op visits or complications. Nearly 17% of bariatric surgery patients experience complications.
Thirty-one percent of accountable care organizations (ACOs) qualified for bonuses from the Medicare Shared Savings Program (MSSP) based on their 2015 performance – the highest number to date, according to the Centers for Medicare & Medicaid Services (CMS).
Thirty-five out of 37 Government Accountability Office (GAO) audits reveal that some private Medicare Advantage plans fraudulently billed the federal government, according to data obtained by the Center for Public Integrity (CPI).
In response to insurance companies pulling out of Affordable Care Act (ACA) exchanges, CMS published policy changes to support the insurance companies who have concerns about high-cost enrollees and risk adjustment.