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OIG issues Special Fraud Alert on laboratory payments to referring physicians

The Health and Human Services Office of the Inspector General (OIG) recently issued a Special Fraud Alert on laboratory payments to referring physicians. Specifically, the alert is concerned with Specimen Processing...more

7/9/2014 - Anti-Kickback Statute Clinical Laboratories Fraud OIG Physicians Risk Alert

CMS seeks to update payment rates and eligibility certification requirements in proposed rule for Medicare home health services

On July 7, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule updating Medicare’s Home Health Prospective Payment System payment rates for 2015....more

7/8/2014 - CMS Healthcare Home Health Care Medicare

A “virtual merger” is underway between Chicago-area Alexian Brothers Health System and Adventist Midwest Health

Chicago-area Alexian Brothers Health System and Adventist Midwest Health signed a non-binding letter of intent to form a joint operating company, a collaboration commonly referred to as a virtual merger. As Alexian brings...more

6/26/2014 - ACOs Adventist Midwest Health Alexian Brothers Health System Healthcare Hospitals Letters of Intent Virtual Merger

Quantifying and addressing improper payments for Medicare evaluation and management services

A review of Medicare Part B claims for evaluation and management (E/M) services conducted by the Office of the Inspector General (OIG) has found that the program paid $6.7 billion in improper payments in 2010. This figure...more

6/3/2014 - CMS Evaluation and Management Services Healthcare Healthcare Professionals Medicare Medicare Part B OIG Overpayment Physicians

Proposed modifications to EHR Incentive Programs

Last year, HHS revised policies and definitions surrounding what constitutes certified EHR technology—required for meaningful use incentive program payment eligibility—from the 2011 Edition criteria to the 2014 Edition...more

5/28/2014 - CMS Data Protection EHR Healthcare HHS HIPAA PHI

In Michigan, CHE Trinity Health and Ascension Health Network come together in Together Health Network

Competitors CHE Trinity Health Michigan and Ascension Health Michigan recently announced the Together Health Network, LLC—a separate and jointly owned, statewide, clinically integrated health network....more

5/20/2014 - Healthcare Hospitals Networks

Innovation Health: A joint venture approach to payer-provider integration in Virginia

In 2012, Aetna and Inova, a not-for-profit health system in Virginia, formed a joint venture health plan: Innovation Health. The health plan is an entirely new entity owned jointly by both organizations. Its network...more

4/30/2014 - Healthcare Joint Venture

Has New York State Failed its Hospitals?

According to New York’s Department of Health Commissioner, “nearly half [of] New York’s 227 hospitals are financially distressed.” What then is the future for New York’s hospitals, especially in light of healthcare...more

4/28/2014 - Equity Financing Healthcare Healthcare Reform Hospitals

Oscar, a new, venture-backed health insurance company, seeks to compete against industry giants

The Affordable Care Act is driving innovation at all levels of the healthcare system, creating opportunities for small start-ups to compete with industry giants. One such start-up is Oscar, a venture-backed health insurance...more

4/24/2014 - Affordable Care Act Healthcare Innovation Startups

New Data Shows Higher Healthcare Costs in Second Half of 2013 – Is this A Result of the Affordable Care Act?

Will insurance expansion and industry consolidation result in higher healthcare costs, at least in the short term, and further stress the economy and the healthcare industry? That highly political question is being asked now...more

4/22/2014 - Affordable Care Act Health Insurance Healthcare

HHS releases new software for updating (but not replacing) HIPAA security risk assessment toolkits

Last week, the Department of Health and Human Services (HHS) released a new, free, downloadable tool to assist small and medium-size health care provider offices to conduct security risk assessments (SRA)....more

4/15/2014 - Healthcare Professionals HHS HIPAA Physicians Security Risk Assessments Software

New Approaches – and Increasing Oversight – for Medicaid Managed Long Term Services and Support

Approximately one-third of Medicaid spending, $136 billion, is on long-term services and supports (LTSS). While the majority of Medicaid LTSS takes place in institutional settings, such as nursing facilities and mental...more

4/4/2014 - Healthcare Long-Term Care Medicaid

New York State budget negotiations contemplate private equity investment into hospitals…again

Should private equity play a bigger role in New York State healthcare facilities? This is the question facing New York State legislators for the second year in a row....more

3/18/2014 - Healthcare Hospitals Private Equity State Budgets

Colorado pilots an integrated model for the Medicare and Medicaid dual-eligible population

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that Colorado is joining its Financial Alignment Initiative to pilot a managed fee-for-service model for people enrolled in both Medicare and Medicaid...more

3/12/2014 - CMS Fee-for-Service Healthcare Medicaid Medicare

New Budget Deal Can Bring Extension of Medicare Sequestration Cuts

While many in Washington, D.C. are celebrating today the unusual display of bipartisan budgetary comity as the new budget deal is announced, there is a direct and immediate adverse effect for hospitals and physicians. As...more

12/12/2013 - Federal Budget Medicare Sequestration Spending Cuts

Obama Administration Delays ACA's Employer-Coverage Mandate Until 2015

The Obama Administration announced on Tuesday that it is delaying implementing a key component of the Affordable Care Act for a year following complaints from the private sector about reporting requirements. The so-called...more

7/8/2013 - Affordable Care Act Deadlines Delays Employer Mandates Healthcare Pay or Play Shared Responsibility Rule Tax Penalties U.S. Treasury

CMS Announces Participants in Bundled Payments for Care Improvement Initiative

The Centers for Medicare & Medicaid Services (CMS) recently announced that over 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative. The large number of participating...more

3/1/2013 - ACOs Bundled Payments CMS Medicaid Medicare

Thinking Ahead - Opinions About Trends and Challenges in Today's Health Care Industry: What Next for WellPoint After the CEO...

This week brought the announcement that WellPoint Inc. selected Joseph Swedish to become its next Chief Executive Officer. Swedish will leave his position as CEO of nonprofit Catholic health system Trinity Health, which has...more

2/18/2013 - Board of Directors CEOs Healthcare Hospitals SEC WellPoint

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