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From Report on Medicare Compliance - What started as a whistleblower complaint by an employee at another hospital chain ended in Tenet Healthcare Corp. paying $513 million in civil and criminal fines and entering a three-year non-prosecution agreement with the Department of Justice over a kickback scheme with a maternity clinic. Read more

From Health Plan Week - More health insurers told the federal government by a Sept. 23 CMS deadline that they would not be participating in public exchanges for 2017, leaving Wall Street concerned those carriers left behind may absorb more sick and costly enrollees from exiting plans. At the same time, CMS on Sept. 27 unveiled a new program to entice younger and healthier millennials to the marketplaces as part of an outreach effort with… Read more

From AIS's Value-Based Care News - Hospitals that treat medically complex joint replacement patients may wind up penalized under Medicare’s new mandatory Comprehensive Care for Joint Replacement (CJR) program, and this could lead to reduced access to care for chronically ill patients, says a new study that recommends risk adjustment mechanisms in CJR and in future bundled payment programs. “Our simulation revealed that hospitals with medically complex patients will be penalized financially,” says study lead author Chandy… Read more

From Medicare Advantage News - In an effort to encourage beneficiaries to be more engaged with their primary care providers and make better decisions about their own health, Medicaid managed care organizations are equipping members with tools ranging from rewards and health savings account-like funds to smartphones. And according to several plans presenting at the Medicaid Health Plans of America (MHPA) annual conference, held Sept. 21-23 in Washington, D.C., the initiatives they’ve used to test… Read more

From Specialty Pharmacy News - Community oncology clinics continue to close down, and the rate at which this is occurring is increasing, according to a new report from the Community Oncology Alliance (COA). Also rising is the number of practices acquired by hospitals and the number that have merged or been acquired by a corporate entity. The 2016 Community Oncology Practice Impact Report, which is the sixth COA has issued, covers the period from January 2008… Read more

From Report on Medicare Compliance - If they desire, hospitals again will be able to get paid soon for their disputed patient-status cases instead of waiting months or years for a decision on their appeals. CMS said Sept. 28 it will do a second round of the hospital appeals settlement process, known the first time around as the 68% solution. “CMS has decided to once again allow eligible providers to settle their inpatient status claims currently under… Read more

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