Medicare and Medicaid Fraud: Voluntary Self-Disclosure of Potential Fraud by Hospitals, Physicians, and Other Providers
Kip Piper -0
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...
Medicare and Medicaid Compliance: OIG Advice for Operating an Effective Compliance Program
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...
Medicaid Fraud and Abuse: Investigations, Prosecutions, Spending, and Staffing by State Medicaid Fraud Control Units in 2010
Kip 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),...
Compliance Challenges of Health Reform: Questions Compliance Professionals Should Ask as They Prepare for Health Care Reform
Kip 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...
Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation, by Marc Bard and Mike Nugent
Kip Piper -
Are you ready to be an Accountable Care Organization (ACO)?
Significant new opportunities and challenges face health systems, hospitals, and physician practices as they decide whether to participate in the new Medicare Shared Savings Program and join together to form an Accountable Care Organization.
Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation is...
Medicare Payment Reform and Quality Improvement: MedPAC Recommendations to Congress on Medical Imaging and Poor Quality Providers
Kip Piper -
The Medicare Payment Advisory Commission (MedPAC) has made 10 new recommendations to Congress regarding Medicare payment accuracy and financial incentives for medical imaging and other diagnostic testing, and quality improvement, targeting the worse performing Medicare providers for intensive technical assistance.
MedPAC – an advisory agency to Congress with a 17-member...
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...
National Advisory Council Subcommittee Identifies Core Set of Health Quality Measures for Medicaid-eligible Adults
Kip Piper -
The AHRQ released its background report, National Advisory Council Subcommittee: Identifying Health Care Quality Measures for Medicaid-Eligible Adults. Required by the Affordable Care Act, this report identified a recommended core set of quality measures for Medicaid-eligible adults. Also aimed at providing states with insight into health care quality for...
Comparative Effectiveness Research: How Agency for Healthcare Research and Quality Spent $474 Million in ARRA Funds
Kip Piper -
As part of the $1.1 billion provided to the Department of Health and Human Services (HHS) earmarked for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act (ARRA or Recovery Act) of 2009, $474 million went to HHS’s Agency for Healthcare Research and Quality (AHRQ) to support...
Medicare Fee-for-Service Benefits: Impact of Medicare Cost Sharing Changes on Beneficiaries and Budget
Kip Piper -
Several Medicare reform proposals have concentrated on realigning financial incentives within Medicare’s provider payment and delivery system to improve program cost-effectiveness and quality, a key health policy challenge. There have been calls to modernize Medicare’s fee-for-service (FFS) benefit design and address other beneficiary incentive issues as a means of...