Reimbursement
During the 2009 and 2010 fiscal years, 92 percent of the $95 million Alabama received in enrollment bonuses for the Children's Health Insurance Program was "not allowable in accordance with federal requirements," according to the U.S. Department of Health and Human Services' Office of the Inspector General.
Spurred by current regulatory trends, large North American healthcare organizations can expect to pay $34.5 billion for health IT next year.
The University of Pittsburgh Medical Center and health insurer Highmark have been engaged in contentious litigation for some time, amid a contract set to end in 2014, and now a series of advertising campaigns has brought Pennsylvania's governor into the debate.
Is it realistic to expect Accountable Care Organizations to achieve their cost-reduction targets in the first year of their programs? The experience of the original 32 Pioneer ACOs is suggestive.
Some of Alabama's bonus payments for CHIP deviated from federal requirements and should be repaid, according to the U.S. Department of Health and Human Services' Office of the Inspector General.
A 25 percent cut in the Medicare physician payment rate, driven by the "sustainable growth rate" formula, looms Jan. 1 unless Congress takes action to avert. The American Medical Association's president believes a permanent solution is on the horizon.
Defensive medicine has contributed to the rising cost of healthcare in the U.S. But two recent reports suggest the true scope of the problem may be somewhat exaggerated, and the solution not too complex.
More than 75 percent of healthcare costs are due to chronic conditions. Although chronic diseases are more common among older adults, they affect people of all ages and are now recognized as a leading national health concern. While we know that chronic disease is most effectively managed through frequent, near-continuous monitoring, there are pervasive problems with the quality of chronic disease care.
Accountable care organizations (ACOs) may actually be the unicorns we've been waiting for, spreading their cost-saving magic throughout the health system.
The CEO of Mobile Doctors, a Chicago-based service offering house calls in six states, was arrested on charges of fraudulently overbilling Medicare. One of the company's physicians was also arrested for making false statements about health benefits.