Compliance & Legal

Between online marketplaces for Social Security numbers and data hijackings at Sony and critical access hospitals, catching and preventing fraud has never been more important or dependent on technology.

The number of accountable care organizations in Medicare's Shared Savings Program will grow by 89 in January 2015, the Centers for Medicare and Medicaid said this week, boosting the total participants to 405. Medicare ACOs will now serve more than 7.2 million patients.

There are two ways of thinking about, and therefore measuring, the rate of hospital readmissions, and they often lead to quite different results and quite different decisions on Medicare penalties.

Here's a look at some more recent headlines in the world of healthcare finance.

As CMS moves to encourage more participation in its flagship ACO program, those who generated savings and met quality standards in Year 1 scored multimillion-dollar payments.

Independent Bill Walker, who won election last month in a governor's race so tight the results weren't known a week after the voting was over, campaigned on the promise that he'd expand Medicaid as one of his first orders of business.

Earlier this month, CMS published a final rule that expands the circumstances under which it may deny or revoke the Medicare enrollment of entities and individuals on program integrity grounds. Here are the details.

More than 50 accountable care organizations across the United States took in millions in incentive payments in 2014 after exceeding savings benchmarks set by the Centers for Medicare and Medicaid Services.

The Centers for Medicare & Medicaid Services intends to ramp up oversight of providers and to save taxpayers money, according to CMS Administrator Marilyn Tavenner, who announced new anti-fraud measures Wednesday.

Do it or else. Increasingly, that's the approach taken by employers who are offering financial incentives for workers to take part in wellness programs that incorporate screenings that measure blood pressure, cholesterol and body mass index, among other things.