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Report on Medicare Compliance
Today’s issue is brought to you by AIS's Report on Medicare Compliance, the nation's leading source of news and strategic information on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers.

October 24, 2014

Today's Featured Story

Hospitals Face More Payment Losses, Risks from Pay-for-Performance Programs
Reprinted from Report on Medicare Compliance

While hospitals fend off claim denials in core compliance risk areas, they also face revenue losses from pay-for-performance programs and their sometimes counterintuitive consequences. At the same time, pay-for-performance programs may create compliance risks for hospitals under fraud and abuse laws, because of the temptation to reward physicians for improving quality of care and give free goodies to patients to improve their health. The risks mount as the pay-for-performance programs mature and penalties increase.... Read Full Story


From the AIS Blogs

Showdown at Highmark Noon: Insurer’s New Narrow-Network Product Prompts a Classic Duel

The health insurance industry’s equivalent of the feud between the Hatfields and the McCoys sprung up again this month, and the new battleground is Medicare Advantage (MA) products for 2015. Specifically, Highmark, Inc. on Oct. 1 unveiled a new MA product, Community Blue Medicare HMO, with both zero-premium, high-cost-sharing and high-premium, low-cost-sharing options available. And the network for the product does not include the providers of its fellow Pittsburgh-area giant and archrival UPMC.... Read more


Quote of the Day

“If there is a Republican-held Congress, I believe efforts will be taken to make sure that HHS does not have the money to fund the risk-corridor program. The risk-corridor payments are a big deal to the insurance carriers. If these payments are not available, you will likely see double-digit premium increases and/or insurance carriers dropping out of exchange markets in droves.”

— Chris Condeluci, a principal at CC Law & Policy in Washington, D.C., told AIS’s Inside Health Insurance Exchanges



Today's Datapoint

34,500 ... names of New Yorkers who are deemed too mentally unstable to carry a firearm are now included in the state’s database that was created following the 2012 tragedy at Sandy Hook Elementary School from information submitted by licensed mental health professionals, The New York Times reported on October 19.


Today from Washington

People on the Move

UCare appointed Julie Feirtag customer services director. She was previously vice president, enterprise operations at Allianz Life Insurance Co. of North America. UCare also named Dale Nasby behavioral health director and Gary Sikma project management office director. Nasby was most recently director of health services at Mayo Clinic Health at Mayo Clinic in Rochester, Minn. Sikma was previously project management office director at the Good Samaritan Society....The National Community Pharmacists Association appointed John Sherrer president. He co-owns Kenmar Pharmacy and Poole’s Pharmacy in Marietta, Ga....John McKew, Ph.D., joined aTyr Pharma as vice president of research. He was previously acting scientific director of the Division of Preclinical Innovation at the National Center for Advancing Translational Sciences.


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