The Health Care Policy Blog is a forum for health care policy professionals and Bloomberg BNA editors to share ideas, raise issues, and network with colleagues.
October 4, 2013
by James Swann
If you're thinking of appealing a denied Medicare claim, you might want to ready yourself for some disappointment, especially if it's a Medicare Part A claim. Only 24 percent of appealed Medicare...
October 2, 2013
by Steve Teske
The shutdown of the federal government due to the fiscal impasse over the budget threatens to derail action on a permanent Medicare physician pay fix, and might even jeopardize a short-term fix,...
A Senate Finance Committee staffer said the committee will be focused on operational issues surrounding the health insurance exchanges for the remainder of 2013, during a session I attended at...
I blogged yesterday about the rise in provider self-disclosures related to overpayments, and for today's installment we're going to turn to the corresponding increase in provider Stark law...
October 1, 2013
\ Voluntary self-disclosures of overpayments are up as providers look to avoid government action, a DOJ official said at a conference I attended Monday. Margaret Hutchinson, chief of the civil...
September 27, 2013
The Centers for Medicare & Medicaid Services Sept. 27 approved an unusual Medicaid expansion proposal request from Arkansas that will allow the state to provide coverage for new enrollees via...
September 25, 2013
Medicare Advantage plans will soon be introduced to their new RAC, a CMS official said at the AHIP Medicare conference I attended this week. Sonja Brown, a CMS health insurance specialist, said the...
September 20, 2013
If you're operating a skilled nursing facility (SNF), you can expect an increase in medical record reviews from a myriad of government agencies and contractors, according to a webinar I recently...
You won’t see this happen too often in the world of health care, but spending on a health care sector—in this case prescription drugs--actually fell in 2012 . In its annual report on national health...
by Nathaniel Weixel
FDA releases long-awaited unique device ID rule.
September 19, 2013
Are you looking for help enrolling in the new health insurance marketplaces? Well, a program designed to do just that may be prone to fraud and abuse, according to a report from the House...
by Sara Hansard
Faced with greater-than-expected opposition from states to setting up their own online health insurance marketplaces under the Affordable Care Act, the Department of Health and Human Services has...
September 13, 2013
Keep a close watch on your personal medical records, because if they get stolen, you could be on the hook for $19,000, a recent survey said. The Ponemon Institute survey said 36 percent of...
September 12, 2013
If Medicare could save $3 billion, wouldn't that be a big deal? According to a recent report from the OIG, Medicare could have saved as much as $3.1 billion in 2011 by requiring pharmaceutical...
September 11, 2013
Four health information technology contractors working on the online health insurance marketplaces that will be run by the federal government testified Sept. 10 at a congressional hearing that...
September 9, 2013
After three-plus years in charge of program integrity efforts for Medicare and Medicaid, Peter Budetti is retiring. An internal e-mail from CMS Administrator Marilyn Tavenner said Budetti's last...
September 5, 2013
CMS got a rap on the knuckles in a recent OIG report , which said the agency is not evaluating the success of corrective actions it has taken to close Medicare vulnerabilities to improper payments....
August 30, 2013
As the Obama administration heads into the final stretch before the online health insurance marketplaces open for enrollment Oct. 1 under the Affordable Care Act, agencies released a final flurry of...
August 29, 2013
Congress is leaving $450 million in deficit savings on the table by not fully funding the Health Care Fraud and Abuse Control (HCFAC) account, according to a recent report from the Office of...
August 28, 2013
Medicare spending growth has slowed considerably in recent years. CBO just doesn't know why.
While certainly not an everyday occurrence, sometimes Congress actually gets things done. As an example, a congressional request has led the OIG to conduct a limited, four-state review of...
A weakened claims-processing system combined with limited oversight may have cost Medicare $425 million in inappropriate claims payments in 2011 to diabetes-test strip (DTS) suppliers, according to...
August 27, 2013
A national campaign to cut the use of antipsychotic drugs in nursing homes appears to be working, the Centers for Medicare & Medicaid Services said Aug. 27. Nursing homes are using...
August 23, 2013
New CMS policy leaves medical residents unable to admit patients.
Differing standards and requirements among four Medicare program integrity contractors are leading to some major headaches for providers and reducing the overall efficiency of postpayment claims...
August 22, 2013
If you're thinking about committing Medicaid fraud in Illinois, you might want to think again. Thanks to newly signed legislation (Public Act 098-0354), the Illinois Department of Healthcare and...
While more young adults are taking advantage of an Affordable Care Act provision allowing them to remain on their parents' health insurance plans until they are 26, there is a long way to go before...
As Congress prepares to take further action to create a new Medicare physician payment system, the Department of Health and Human Services says physician participation in Medicare is growing. HHS...
August 16, 2013
With less than seven weeks before the crucial online health insurance marketplaces are set to open under the Affordable Care Act, the Department of Health and Human Services Aug. 15 announced $67...
If Congress were to get rid of certain exemptions for critical access hospital, the vast majority of critical access hospitals (CAHs) would not have been in compliance with location requirements...
August 13, 2013
House Ways and Means Health Subcommittee ranking minority member Jim McDermott (D-Wash.) has asked the Centers for Medicare and Medicaid Services to submit a written plan for revising its...
August 9, 2013
A new Medicare policy is intended to curb the use of observation status. But will it solve the problem? Hospitals and patient advocates don't think so.
by John T. Aquino
Attorneys are often asked, “Do you think I’ll win?” In answer, they could cite a June 4, 2013 , court of appeal ruling to show that even members of Congress, at a hearing I attended five years...
August 7, 2013
The Department of Health and Human Services is ramping up efforts to help expand the use of health care information technology among providers. HHS Aug. 7 released a new comprehensive health care...
August 2, 2013
Self-referring providers have dramatically expanded their use of an expensive prostate cancer treatment over the last few years, and Medicare costs have been rising as a result, according to a...
July 29, 2013
Fixing Medicare's physician payment system will receive attention from the House and Senate this week. The Senate Finance Committee will hold an informal meeting of its members July 31st to discuss...
What do Miami, Chicago, and Houston have in common? As of July 30, the three cities and some surrounding counties will all be under a six-month moratorium from CMS for the enrollment of certain...
July 26, 2013
Mid-sized companies that are subject to the Affordable Care Act’s large “shared responsibility” payments face the greatest challenges, Senate Small Business Committee Chairman Mary Landrieu (D-La.)...
July 25, 2013
Results from the first year of the Pioneer ACO program are decidedly mixed.
July 24, 2013
Congress July 23 took another step toward eliminating Medicare's current physician payment system when the House Energy and Commerce Health Subcommittee approved draft legislation that would repeal...
July 23, 2013
Senior citizens continue to be an effective bulwark against fraud, as Senior Medicare Patrol activities led to $72,000 in actual Medicare and Medicaid recoveries in 2012, a 279 percent increase...
July 19, 2013
President Obama used the disbursement of $500 million in "medical loss ratio" (MLR) refunds to show that the Affordable Care Act "is working the way it was supposed to for middle-class Americans" at...
July 17, 2013
Self-referring providers in 2010 referred biopsy services at a higher rate than non self-referring providers, resulting in an additional $69 million in Medicare payments, according to a GAO report...
July 10, 2013
With the click of a mouse, physicians and other types of providers will now be able to self-disclose potential fraud, thanks to OIG's July 8 launch of an online self-disclosure form . The new form...
July 3, 2013
CMS contractors reported uncollected Medicare overpayments of $543 million in fiscal year 2010, but detailed overpayment information was only available for seven out of the 39 affected contractors,...
July 2, 2013
Can a court decision about an Alzheimer’s disease patent owned by an important U.S. biopharma company be virtually ignored because it is too long? The answer is yes, attorneys told me. On June...
July 1, 2013
House GOP leaders have taken another step toward repealing the sustainable growth rate formula feature of Medicare’s current physician payment system and replacing it with one based on quality of...
June 28, 2013
In ever growing numbers, physicians are embracing electronic health records (EHR) and incorporating more sophisticated technology into their practices, according to a recent report to Congress....
June 27, 2013
People who can not afford to buy health insurance, or those who are ineligible for Medicaid based on a state's decision not to expand its program under the health care reform law, will not be fined...
A bipartisan group of House and Senate lawmakers are touting a new bill that they say for the first time would allow Medicare to reward seniors for improving their health. The Medicare Better...
June 26, 2013
Massage therapists, athletic trainers, and dieticians share one thing in common: they cannot order Medicare Part D prescription drugs. Unfortunately, that message has not registered with Medicare,...
June 21, 2013
Some physicians may be abusing their prescribing powers, ordering unnecessary and even dangerous drugs for patients, a recent report from OIG said. The report identified 736 general-care...
June 20, 2013
More than 8.5 million health insurance consumers will get the benefit of over $500 million in rebates under the medical loss ratio (MLR) requirement of the Affordable Care Act, the Department of...
June 19, 2013
The public would have a chance to peek behind the curtain of Medicare claims data, if a recently introduced bill passes Congress. . The Medicare Data Access for Transparency and Accountability...
June 18, 2013
Physicians are concerned that the upcoming transition to ICD-10 is going to be too expensive, according to a June 13 study from the Medical Group Management Association. 95 percent...
June 17, 2013
Jackson Hewitt Tax Service is claiming credit for inducing the HHS June 14 to propose requiring health insurers to allow enrollees in the online marketplaces that open Oct. 1 to be able to pay for...
Consumer and industry opinions differ on what to include in a new FDA guidance on if a change to a device warrants a new marketing application.
The double-digit Medicare profit margins of skilled nursing facilities and home health agencies came under fire from three directions June 14, indicating program payments to the sectors could be...
June 14, 2013
An OIG report said Medicare could have saved $910 million in 2011 if clinical lab test payment rates had been reduced to the levels paid by Medicaid and Federal Employees Health Benefits (FEHB)...
June 12, 2013
Comments are coming into the House Energy and Commerce Committee about its plan to revamp Medicare’s physician payment system as the panel continues to refine its proposal in hopes of having...
A proposed regulation implementing a $101 billion health insurance fee imposed by the Affordable Care Act amounts to double taxation, health insurers told the Internal Revenue Service (IRS) in...
June 11, 2013
A bipartisan bill introduced June 10 in the Senate and House would strengthen penalties for medical identity theft and penalize Medicare and Medicaid contractors for excessive error and...
June 3, 2013
Medicare’s Trustees reported May 31 that the program’s Part A Trust Fund would be financially solvent until 2026, two years later than estimated last year, but the Acting Chief Actuary for the...
May 31, 2013
A recent final rule from OIG permitting MFCUs to use federal funds to pay for data mining technology may not end up having a huge impact on fraud prevention, according to an attorney I talked to...
Beneficiaries got a gift from the administration in the form of increased financial incentives for participating in wellness programs offered by their group health plans, part of a final rule from...
With the release May 28 of a third legislative draft that would revamp the Medicare physician payment system and repeal the sustainable growth rate formula, the House Energy and Commerce...
As the Affordable Care Act moves closer to being fully implemented, the concern among biopharmas that ACA will adversely affect the industry continues. At the “Affordable Care Act Is Here to Stay”...
May 24, 2013
House Republicans are moving closer to their goal of having a Medicare physician payment fix on the floor by the August congressional recess. House Energy and Commerce Health Subcommittee Chairman...
May 23, 2013
The Department of Health and Human Services has received more than 830 nonbinding letters of intent from organizations that plan to apply for $54 million in federal grants to be "navigators" helping...
Legislative modifications to the hospital inpatient prospective payment system (IPPS) have undermined its goals, according to GAO.
While reporting requirements under the Sunshine Act have yet to kick in, the payment transparency program is already facing allegations that a specific provision may violate the First Amendment. The...
May 20, 2013
A report that collects 10 articles that I wrote covering the BIO International Convention in Chicago last month is available by clicking on the highlighted...
May 17, 2013
Speakers at a webinar I attended this week said the Sunshine Act might chill legitimate R&D activities carried about by physicians and teaching hospitals. Meenakshi Datta, an attorney with...
May 10, 2013
I spoke with an OIG official this week who told me that updated special advisory bulletin on exclusions was intended to give providers more practical guidance than the original bulletin did when it...
Barring an unforseen twist, the Centers for Medicare & Medicaid Services is about to have its first Senate-confirmed administrator since 2006. The Senate the week of May 13 is expected to vote...
Congressional Budget Impasse Threatens Medicare Doc Fix, Lobbyist Says
Stark Self-Disclosures Are on the Rise
Providers Increasingly Self-Disclosing Overpayments
Medicare Appeal Success Rates Trending Down
Senate Finance Committee to Look at Health Insurance Exchanges