Kip Piper -
Fraud and abuse are common and persistent problems for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Combined federal and state spending now exceeds $1 trillion, with fraud and abuse likely costing taxpayers well over $100 billion annually. Together with state Medicaid agencies and state attorneys general, several federal offices, such...
States might find it useful to have a database replete with health care service claims data to identify Medicaid fraud, evaluate disease trends, establish cost and utilization rates, and share price information with consumers. Typically such comprehensive data is difficult to gather because it comes from various public and...
Medicaid Program Integrity: Federal Investigations, Audits, and Evaluations to Combat Medicaid Waste, Fraud, and AbuseKip Piper -
In its latest Medicaid Integrity Program Report, the HHS Office of Inspector General (OIG) outlines Medicaid program integrity activities for FY 2011, including Medicaid-related audits and evaluations and Medicaid-related legal and investigative outcomes. Funding was employed in 2011 to oversee the integrity of Medicaid activity from the Health Care Fraud...
Federal and state Medicaid spending currently exceeds $460 billion and, with this, accountability is necessary on all levels. To ensure Medicaid program integrity: Consistent incentives must be offered for better health outcomes. Services must be used appropriately. The program must be monitored on an ongoing basis. Programs must be managed efficiently. In an excellent new...
Kip Piper -
Comprehensive compliance programs are essential for all hospitals, health systems, physician practices, Medicare Advantage plans, Medicaid health plans, Medicare prescription drug plans, drug manufacturers, medical device makers, long-term care providers, and others doing business with Medicare, Medicaid, or other government health programs. To help prevent fraud, waste, and abuse in Medicare and...
Compliance Challenges of Health Reform: Questions Compliance Professionals Should Ask as They Prepare for Health Care ReformKip Piper -
With an array of payment reforms, quality and safety requirements, massive expansion of Medicaid, and creation of the new State Health Benefit Exchange marketplace, the Affordable Care Act (ACA) presents extraordinary new challenges for compliance, especially for health plans, physicians, hospitals and health systems, and drug and device manufacturers. In...
Medicaid Fraud and Abuse: Investigations, Prosecutions, Spending, and Staffing by State Medicaid Fraud Control Units in 2010Kip Piper -
Nearly every State has a Medicaid Fraud Control Unit (MFCU) to investigate and prosecute cases of Medicaid fraud and patient abuse and neglect. MFCUs are a key part of an array of federal and state agencies combating healthcare fraud and abuse, including State Medicaid agencies, the HHS Office of Inspector General (OIG),...
Medicare and Medicaid Fraud: Voluntary Self-Disclosure of Potential Fraud by Hospitals, Physicians, and Other ProvidersKip Piper -
Medicare and Medicaid program integrity efforts – coupled with complex coding and claiming procedures, ever-increasing program requirements, new payment methods, and the growing market share of taxpayer-funded programs – present significant compliance challenges for health plans, hospitals, physicians, pharmaceutical and biotechnology firms, medical device makers, and other providers and suppliers. The...
The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) created the Medicaid and CHIP Payment and Access Commission (MACPAC) to advise Congress on a wide range of Medicaid and CHIP issues. MACPAC will start operating in early 2010. MACPAC Membership and Staff: Modeled closely after the long standing and highly...
Management Challenges at Department of Health and Human Services: Implications for CMS and FDA AppointmentsKip Piper -
The incoming leadership at the U.S. Department of Health and Human Services (HHS) face a number of serious management challenges. These challenges, recently identified by the Office of the Inspector General (OIG), will require close, sustained attention by the Secretary's Office and the agency heads, particularly at CMS and...
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