Medicare & Medicaid

Admissions and emergency-room care rose in centers that were part of the experiment compared with results in those that weren't.

Total Medicaid revenues for these MCOs soared 103 percent to $110.6 billion in 2014 from $54.6 billion in 2010, according to a study by Milliman.

Sadiq created fake patient files to fool a Medicare auditor by making it appear as if home health services were provided and medically necessary.

The Centers for Medicare and Medicaid Services is falling short in busting potential fraud by not verifying physician addresses and making sure they are currently licensed, according to a new Government Accountability Office report.

At the top end, the highest median amount paid for the procedure is $61,231 in the Sacramento, California metropolitan area. On the other hand, the Birmingham, Alabama region books the lowest cost paid at $15,494.

Medicare applied the new quality measure to more than 9,000 agencies based on how quickly visits began and how often patients improved while under their care.

A number of hospitals in North Carolina are suing the federal government over more than $2 million in disproportionate share payments they say they are owed due to changes to the Affordable Care Act.

Marilyn Tavenner, the former nurse, hospital executive and Medicare administrator, will succeed Karen Ignagni as the head of America's Health Insurance Plans, effective Aug. 24, the organization announced Wednesday.

The booming Medicaid managed care industry is in for new federal regulations and consolidation, presenting challenges and opportunities for health systems.

The Fraud Prevention System uses predictive analytics to identify questionable billing patterns in real time.