Medicare & Medicaid

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.

In the first year, there is a zero percent discount; the second year, a one percent price cut; and in the third, fourth and fifth years, the two percent price cut goes into effect.

The five-year mandatory model would give healthcare providers a standard set of quality measures, including measures for complications and readmissions.

CMS plans to cut payment for 60-day care episodes by nearly $81, or 1.72 percent. The agency said the proposed rule would save the government $380 million.

The Government Accountability Office believes Congress should slash the financial incentives the government pays hospitals in the 340B drug program, it said in a new report, over concerns that disproportionate share hospitals are prescribing more than other facilities.

The multimillion dollar fine is more than the hospital's annual revenue and is believed to be the largest ever applied to a community hospital.

CMS is proposing that physicians be able to make case-by-case exceptions to the rule, classifying certain short stays as inpatient so that they would be paid under Medicare Part A.

Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, the National Ambulatory Medical Care Survey found.

The dedicated litigation team will focus on the smaller entities such as individual physicians and executives in civil penalties and exclusion cases.