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...
The Government Accountability Office (GAO) recommended in a recent report that the Internal Revenue Service (IRS) step up its enforcement of tax collections for Medicaid providers, finding that providers in three selected states owed nearly $800 million in unpaid taxes. In particular, the GAO suggested the IRS collect taxes...
The Centers for Medicare and Medicaid Services (CMS) is working to help state Medicaid programs get the best deal possible when purchasing prescription drugs. The second phase of CMS’s Medicaid retail drug price survey will poll pharmacies on a monthly basis to create a National Average Drug Acquisition Cost...
In deciding whether to expand Medicaid eligibility under the Affordable Care Act (ACA), governors and state legislatures face a complex, politically and fiscally challenging choice.  The decision on Medicaid eligibility expansion is already a hot topic in state capitals and state election campaigns.  Expect the politics and policy of...
Medicaid directors have been pushed to find cost savings in their programs in the midst of recent budget shortfalls, often using blunt instruments such as cuts in benefits, provider rates, and eligibility. But Medicaid directors are also evaluating and implementing more sustainable reforms to ensure Medicaid continues to provide...
So far, federal guidance has fallen short of what states need to implement the Affordable Care Act’s Medicaid expansion, according to a recent report by the Government Accountability Office (GAO). State officials questioned for the report said delays of meaningful direction from the Centers for Medicare and Medicaid Services (CMS),...
Much attention has been paid to the federal deficit, and a great deal of this discussion has centered on Medicare and Medicaid spending. As a means for controlling what has been considered “out of control” health care costs, some have pushed for major program restructuring, most notable premium support...
Medicaid financing is extremely complex.  Federal upper payment limits on hospitals, nursing facilities, and other healthcare providers are a case in point.  Here is a quick primer. Origins of Upper Payment Limit: The Upper Payment Limit (UPL) is a federal limit placed on fee-for-service reimbursement of Medicaid providers.  Specifically, the Upper...
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...
A new federally mandated tax on health insurers will increase costs for state Medicaid programs and Medicaid health plans. In an excellent new report, PPACA Health Insurer Fee Estimated Impact on State Medicaid Programs and Medicaid Health Plans, Milliman, retained by the Medicaid Health Plans of America (MHPA), conducted an independent...

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