Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

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...
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...
The Centers for Medicare and Medicaid Services (CMS), charged with protecting Medicare’s fiscal integrity, works to recover payments made by Medicare that are the responsibility of non-group health plans. While CMS has not always been aware of all such situations in the past, 2007 legislation introduced mandatory non-group health...
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...
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...
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 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...

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