Policy and Legislation
Prosecutors for the 10 regional strike forces currently in operation have charged over 3,700 defendants in connection to more than $14 billion in false billings, DOJ says.
Site-neutral clinic payments, 340B drug program policy, adding procedures to covered list for ambulatory surgery centers all hit hospital margins.
Some drug companies pay less than what they would otherwise owe by introducing a new drug formulation, HHS Secretary Alex Azar says.
Administrator Seema Verma says it's time for ACOs to take on downside risk, in a proposal that would save Medicare $2.2 billion over 10 years.
The 2018 benefit year will now determine risk adjustment payments to insurers, using the statewide average premium.
Starting in 2019, insurers may use step therapy to choose the least expensive drug first before moving on to another prescription.
CMS is finalizing the elimination the 25 percent threshold that reduces reimbursement for long-term hospitals.
Price increases have been the biggest driver, with medical costs, prescription drug costs and physician and clinical services all playing a part.
Some stakeholders say short-term plans will destabilize ACA market, but these plans are not expected to divert consumers already enrolled, HHS officials say
Announcement comes less than two months after a scathing report from the Office of the Inspector General showing skyrocketing Medicare Part D drug spending.