Government: Page 147
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Centene goes rogue in expanding ACA exchange plans
Among news of other payers pulling out of the exchanges, the company says it is “well positioned” to expand services.
By Les Masterson • June 13, 2017 -
Deep Dive
DOJ sends warning shots on Medicare Advantage overpayments
Recent claims against UnitedHealth Group highlight the federal government's effort to recoup what it says is billions in overpayments.
By Les Masterson • June 13, 2017 -
Trendline
Labor
Hospitals are navigating persistent labor shortages with the need to cut costs — a source of contention that could leave patients caught in the middle.
By Healthcare Dive staff -
HHS wants help identifying 'burdensome' ACA regs
The department says it wants to identify regulations that interfere with job growth, impose costs exceeding benefits, create serious inconsistency or are simply outdated, unnecessary or ineffective.
By Shannon Muchmore • June 12, 2017 -
AHIP17: Payers, providers disagree on value-based care preparedness
More than half of surveyed health plans said providers have the tools they need to support value-based care, but 43% of physicians said they are still lacking these tools, according to a new Quest Diagnostics study.
By Ana Mulero • June 12, 2017 -
Conn. lawmakers aim to mandate e-prescribing to curb opioid epidemic
The legislation also increases the ability of state agencies to share data on opioid abuse and caps prescriptions for children at five days.
By Meg Bryant • June 9, 2017 -
Price remains mum on CSRs, AHCA details at budget hearings
With less than two weeks until the deadline for participating in the ACA exchanges, it’s getting too late for promises on cost-sharing payments to matter.
By Shannon Muchmore • June 9, 2017 -
Medicare Advantage premiums steady as membership grows
One-third of Medicare beneficiaries are covered by a Medicare Advantage plan.
By Les Masterson • June 8, 2017 -
Nevada legislature passes Medicaid for all
Gov. Brian Sandoval has yet to say whether he will sign the bill, and there are plenty of other outstanding questions such as the plan design and cost.
By Les Masterson • June 6, 2017 -
Supreme Court upholds ERISA exemption for faith-based hospitals
The ruling allows religious-affiliated hospitals to avoid federal pension requirements under the “church plan” exemption.
By Meg Bryant • June 6, 2017 -
Study: Housing assistance associated with improved healthcare access
Poor housing stability is associated with adverse health outcomes such as increased rates of infectious and chronic disease, injuries, mental health issues and poor nutrition, researchers stated.
By Les Masterson • June 6, 2017 -
Single-payer healthcare system in California still a long way from reality
The state Assembly needs to finalize the bill to add more specifics about the proposed system and how the state would fund it.
By Les Masterson • June 5, 2017 -
Provider groups ask Medicare Advantage be counted as APM under MACRA in 2019
The groups requested that the agency include MA for the 5% Quality Payment Program bonus in 2019 and 2020.
By Les Masterson • June 5, 2017 -
eClinicalWorks false claims settlement could kick off more EHR investigations
It’s clear the federal government wanted to make a statement on the accountability of EHR vendors.
By Les Masterson • June 2, 2017 -
EHR vendor eClinicalWorks to pay $155M in False Claims Act case
This is the first time an EHR vendor has been held accountable by the government "for failing to meet federal standards designed to ensure patient safety and quality patient care,” a partner at Phillips & Cohen said.
By Meg Bryant • June 1, 2017 -
Study: Improving quality reduces readmissions, but doesn't lead to consistent savings
Cedars-Sinai researchers found quality improvement programs saved health systems an average $972 per heart failure patient but lost a net average $169 per person for other patients.
By Les Masterson • June 1, 2017 -
Freedom Health agrees to pay $31.7M to settle Medicare Advantage whistleblower case
The DOJ said the organization submitted or caused others to submit unsupported diagnosis codes to the CMS and made “material misrepresentations to CMS regarding the scope and content of its network of providers."
By Les Masterson • May 31, 2017 -
Latest on the AHCA is mostly talk
Republican Senate aides are said to be drafting the upper chamber’s version of the bill to replace the ACA this week, but there is no indication that progress is being made on sticking points such as Medicaid funding and coverage for people with pre-existing conditions.
By Shannon Muchmore • May 31, 2017 -
Elizabeth Regan/Healthcare Dive
Skyrocketing chronic diseases will cause major healthcare spending spike
The annual cost of someone with five or more chronic diseases is $45,000, according to a report from the Partnership to Fight Chronic Disease.
By Les Masterson • May 31, 2017 -
Deep Dive
Children's hospitals — and their patients — caught in the crosshairs with planned federal cuts
The proposed funding cuts would increase the rate of uninsured children and burden children’s hospitals with more uncompensated care.
By Les Masterson • May 30, 2017 -
CMS: New Medicare cards combat fraud and illegal use
The cards will use a randomly-assigned Medicare Beneficiary Identifier number instead of a Social Security number.
By Les Masterson • May 30, 2017 -
Blues prep opposite plans for ACA exchanges in Mo., NC
Blue Cross NC plans an average 22.9% rate increase if CSRs are not paid, but could also still opt out of the ACA exchanges by the fall. Meanwhile, Blue KC will pull out of the market entirely.
By Les Masterson • May 25, 2017 -
Taylor McKnight/Healthcare Dive
CBO: Amended AHCA would still leave 23M uninsured
The agency found that premiums for single policyholders buying in the nongroup market would increase by an average of about 20% in 2018 and 5% in 2019.
By Shannon Muchmore • May 24, 2017 -
Deep Dive
Trump's policies are pressing doctors to speak out
"I think a lot of providers are really beginning to understand that these policies are a direct threat to the patients we serve,” says Dr. Manik Chhabra, a primary care physician in Philadelphia.
By Meg Bryant • May 24, 2017 -
CMS delays bundled payment expansion, again
The cardiac and joint bundled payment programs will now become effective on Jan. 1, 2018.
By Jeff Byers • May 24, 2017 -
California single-payer plan could cost $400B annually
The California Senate Committee on Appropriations said the plan still has uncertainties but would undoubtedly be "an unprecedented change in a large healthcare market."
By Les Masterson • May 23, 2017
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