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June 21, 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

Compliance Risks of Licensure Take Center Stage in Settlement With Sleep Centers
Reprinted from Report on Medicare Compliance

Monitoring licensure is not as cut and dried as running names through the Medicare exclusion database, but providers are vulnerable to overpayment recoupment or false claims lawsuits if they bill for services performed by employees who lack the right credentials or act outside their scope of practice .... Read Full Story


From the AIS Blogs

Nothing Says Loving Like High-Priced Acquisitions

A funny thing happened on the way to what industry critics saw as the coming death spiral of Medicare Advantage plans under health reform. One well-regarded MA plan stands to get a whopping price — reportedly $14,815 per covered life — in a new acquisition deal ... Read more


Quote of the Day

“Every 1% increase in the generic fill rate results overall in about a 1.5% decrease in pharmacy spend. For some of our plan sponsors, that can be almost 20% of their spend, if not more.”

— Steven Goldberg, M.D., vice president and chief of medical affairs at Express Scripts, Inc., told AIS’s Drug Benefit News.

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared. (Free for DBN subscribers; $17 for non-subscribers).


Today's Datapoint

$944 … can be the reduction in health care costs over 18 months when patients with high cholesterol regularly take their cholesterol-lowering medications, according to a study published in the June 1 issue of the American Journal of Cardiology.



FierceHealthPayer News from our partner FierceMarkets

Experts share regulatory strategies for justifying rate increases

Health plans better get used to justifying their rate increases now that the Obama administration wants to review premium increases of 10 percent or more, Lynn Shapiro Snyder, senior member of EpsteinBeckerGreen, warned during the AHIP Institute conference last week in San Francisco ... Read more


Today from Washington

People on the Move

The American Society of Clinical Oncology named Robert Hauser, Pharm.D., senior director of ASCO's quality department. Hauser was director of operations and informatics at the International Oncology Network....EHIM appointed Jeffrey Lewis chief operating officer. Lewis was chief of staff for the Heinz Family Philanthropies.


Today's Featured Health Business Job Opening

Confidential Managed Healthcare Services Company
Director, Internal Audit
Metro N.Y./N.J. Area

Place Your Ad Here

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Medical Loss Ratio Regs: What 2010 Data Suggest About Potentially Huge Rebates in 2011
Thursday, June 23, 2011

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Commercial ACO Results and Strategies: A Case Study in Three-Way Risk Sharing
Thursday, June 30, 2011

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Accounting for HIPAA Disclosures in EHRs: How to Comply with Onerous New HHS Rules
Thursday, July 7, 2011

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Health Plans vs. Drug Coupons: Tactics to Combat Brand-Name Drug Promotions
Wednesday, July 13, 2011

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Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, July 14, 2011

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Report on Medicare Compliance
AIS's Health Business Daily