April 7, 2011

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.

Today's Featured Story

Hospital Deals With MDs for Ancillaries Are Risky; Fair-Market Value Is Paramount
Reprinted from Report on Medicare Compliance

When hospitals do business deals that are perceived as a cover for buying physician referrals or stifling competition, they may find themselves in an epic battle with whistleblowers, empowered by the False Claims Act and often partnered with the Department of Justice. Just ask Bradford Regional Medical Center in Pennsylvania, which must resolve false claims and kickback allegations now that a federal court has ruled its nuclear-camera lease with two physicians violated the Stark law .... Read Full Story


From the AIS Blogs

On Your Marks, Get Set...

It happens every year, but this year it figures to be a tougher race than ever. The final 2012 Medicare Advantage payment rates were unveiled by CMS on April 4. While the preliminary rates announced Feb. 18 showed CMS's direction, the final rates always contain some changes, and MA plans will have to rejigger their calculations after they see those rates. Once they're out, it's only two months till 2012 MA and Part D bids are due on June 6 ... Read more


Quote of the Day

“The Republicans are in full-opposition mode, as it seems that they believe that position is a winner and will do nothing to help make the [law] work better. At some point, if it seems that the bill is here to stay, I would hope that there will be an effort to iron out the wrinkles and govern instead of merely campaigning.”

— Henry Aaron, Ph.D., a senior fellow in economic studies at the Brookings Institution, who was speaking at a recent America's HEalth Insurance Plans Forum in Washington, D.C.

Click here to read the AIS'S HEALTH REFORM WEEK article in which this quote appeared. (Free for HRW subscribers; $17 for non-subscribers).


Today's Datapoint

8 … risk areas were audited simultaneously in the HHS Office of Inspector General’s first-ever “Medicare compliance review,” which found $341,000 in 2008 and 2009 overpayments to South Weymouth, Mass.’s South Shore Hospital.

Click here to read the REPORT ON MEDICARE COMPLIANCE article in which this datapoint appeared. (Free for RMC subscribers; $17 for non-subscribers).


FierceHealthPayer News from our partner FierceMarkets

High-Deductible Plans Linked to Fewer Preventive Services

High-deductible health plans are significantly decreasing health care spending, but they are also linked to patients cutting back on preventive healthcare services — such as childhood immunizations, cancer screenings and routine tests for diabetes ... Read more


Today from Washington

People on the Move

The National Community Pharmacists Association said Kathleen Jaeger has resigned as executive vice president and CEO. NCPA’s executive committee promoted Douglas Hoey to executive vice president and CEO. Hoey was senior vice president and chief operating officer....Steward Health Care System named John Polanowicz president of St. Elizabeth's Medical Center in Brighton, Mass. Polanowicz was president of Marlborough Hospital.


Today's Featured Health Business Job Opening

Catalyst Rx
Medicare Formulary Pharmacist
Anywhere in the U.S.

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Content questions or suggestions should be directed to BJ Taylor, editor of AIS's HEALTH BUSINESS DAILY, at bjtaylor@aishealth.com. If you are interested in sponsoring AIS's HEALTH BUSINESS DAILY, please contact Bailey Sterrett at bsterrett@aishealth.com.

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Upcoming Webinars

CMS’s New Past Performance Assessment: Steps MA and Part D Plans Must Take Now to Avoid Harsh Penalties
Thursday, April 14, 2011

Click here for details.

Outcomes-Based Contracts: Innovative Payer Deals to Improve Member Health and the Bottom Line
Tuesday, April 19, 2011

Click here for details.

Setting Out-of-Network UCR Rates: Evaluating FAIR Health’s New Benchmark Data and Other Alternatives for Insurers and Employers
Thursday, April 21, 2011

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New ACO Regulations: Discover the Opportunities and Pitfalls Ahead
Thursday, May 5, 2011

Click here for details.

Medicare Advantage Marketing for 2012: Steps to Take Now to Succeed Amid Reform-Driven Changes
Tuesday, May 10, 2011

Click here for details.

Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, May 12, 2011

Click here for details.

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