The Medicare Payment Advisory Commission's annual report offers five payment recommendations including reforms for two post-acute care providers, a 10 percent cut to drug payments for safety-net hospitals and changes to Medicare Advantage diagnosis coding.
Federal regulators have revised their policy for automatically reducing star ratings for Medicare Advantage and Part D plans operating under immediate sanctions, a decision that will benefit health plans that have been hit by enforcement actions.
A recently released list of financial penalties imposed on Medicare Part C and Part D plan sponsors shows that the government is increasingly coming down hard on health plans that violate federal regulations.
Last week's report from the Government Accountability Office made waves after the agency characterized enrollment fraud detection within the federal Affordable Care Act marketplace as "passive," a word that many latched on to as way of denouncing the president's landmark healthcare legislation. Although the GAO pointed out some valid criticisms of ACA fraud detection, this submissive approach to fraud prevention seems to reflect a widespread systemic issue among government-run programs dating back to the inception of Medicare and Medicaid.
Presidential candidates on both sides of the aisle, including both winners of last night's New Hampshire primary, have supported allowing Medicare to negotiate drug prices. But a brief from the Kaiser Family Foundation says the financial windfall may be limited.
Part D fraud remains "a top area of concern" for the Office of Inspector General following a 136 percent increase in Part D spending between 2006 and 2014, according to a new enforcement video released by the agency.
Federal regulators have banned Cigna from selling new Medicare products because of issues with its Part C and Part D plans that increased enrollees' out-of-pocket expenses which led to delays or denials in receiving medical services and prescription drugs.
A psychiatrist indicted for illegally selling prescriptions for nearly 10,900 pain pills has a history of illegal prescribing practices and Medicare fraud dating back 30 years, according to lohud.com.
Daniel Suarez, 24, will spend the rest of his twenties and early thirties in prison for stealing $21 million from Medicare Part D as part of pharmaceutical fraud scheme that began when he had barely turned 18. Suarez spent his money on luxury cars, while attempting to launder the stolen funds through FedEx trucks. His youthful exuberance conjures up comparisons the Martin Shkreli, now facing securities fraud charges after drawing in his own brand of attention.
Health insurers concerned about the rising cost of prescription drugs now will have access to a new tool that lets them--and the public at large--analyze spending trends on the medicines that cost the country's largest payer the most.