Medicare & Medicaid
Six groups who represent a wide swath of biologic-prescribing physicians are urging Congress to press the Centers for Medicare and Medicaid Services to make unique codes for biosimilar medicines for billing and payment purposes.
The Department of Health and Human Services has issued guidance to states seeking a 1332 waiver to about every major component of the Affordable Care Act as the deadline for the new program approaches.
As the deadline for January health care coverage nears, California's insurance exchange is intensifying efforts to sign people up in pockets of the state with exceptionally high numbers of uninsured residents. Covered California is targeting such "hot spots" as San Francisco's Mission district, and Oakland's Fruitvale neighborhood, officials said.
This week Connecticut's leaders had to close a $350 million hole in the state's budget. One place they cut is hospital funding, and that's making hospital executives furious.
Republican presidential candidate Ben Carson this week released his healthcare platform, a plan for reform that he said would fix the relationship between physician and patient by providing tax-sheltered accounts and giving Medicare patients the onus to buy their own plans.
The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what's known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders.
The Justice Department raked in more than $3.5 billion in 2015 in settlements and judgements from civil cases under the False Claims Act, including $1.9 billion in healthcare fraud settlements.
Ten former employees of Progressive Counseling Services LLC, which is based in Virginia Beach, have been convicted and sentenced for their roles in a scheme to defraud the state's Medicaid program by submitting fake claims for mental health services, according to the Norfolk Division of the FBI.
Prescription drug spending was fueled largely by new medicines, particularly for specialty drugs such as those used to treat hepatitis C.
CMS said by the end of next year, 85 percent of all traditional Medicare payments to quality or value and 30 percent of traditional Medicare payments should be tied to alternative payment models.