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From Report on Medicare Compliance - There’s a different flavor to the HHS Office of Inspector General’s Work Plan for 2015, and it may cause hospitals and other providers to tinker more than usual with their compliance monitoring plans. A lot of the items on the Work Plan — which is a roadmap for audits, evaluations and investigations for the fiscal year that began Oct. 1 — seem to be designed to give the OIG a bigger bang for its buck, experts say. Read more

From Health Plan Week - Health insurers and lawyers working in the field of subrogation say there is a sharper interest by carriers in exploring all options to recover money paid out in medical claims that should have been paid by other payers like auto insurance companies or an employer’s workers’ compensation issuer. A major health insurer estimates that 0.5% to 1% of all the medical claims it pays for auto accidents should be covered… Read more

From ACO Business News - Amid growing questions about the short- and long-term viability of the federal Medicare Pioneer initiative and Medicare Shared Savings Programs (MSSP) (ABN 10/14, p. 1), Sharp HealthCare stands out as a company that’s making accountable care work — but couldn’t make it work in the federal programs. Sharp’s results in Pioneer were good — excellent, in fact, says Alison Fleury, the provider’s vice president of business development. Read more

From Medicare Advantage News - There is no direct correlation between CMS star quality ratings that a Medicare Advantage plan receives and the actual performance of that plan in the agency’s MA program audits, according to the new annual audit and enforcement report for the MA and Part D programs released by CMS’s Medicare Parts C & D Oversight and Enforcement Group (MOEG). Read more

From Drug Benefit News - Contrave (naltrexone HCl and bupropion HCl) last month joined the growing category of anti-obesity medications available by prescription in the U.S. (DBN 10/24/14, p. 8). Read more

From Report on Medicare Compliance - Although Medicare accountable care organizations (ACOs) received another year of relief from fraud-and-abuse laws with the Oct. 17 extension of waivers from CMS and the HHS Office of Inspector General, they may be dropping the ball on the public disclosure and other requirements. At the same time, ACOs face additional challenges as they travel up the learning curve of the Medicare Shared Savings Program (MSSP). They must embed compliance into… Read more

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