Tactics used in the federal inquiry that led over 500 hospitals to settle charges they submitted false claims for implantable heart devices could shape how the government conducts future Medicare fraud investigations.
Insurers wonder if CMS' latest effort to drum up interest in the Comprehensive Primary Care Plus Initiative will overcome obstacles to participation in states that have laws prohibiting physician practices from taking on risk-based contracts.
Commentary: Medicare's 'big data' tools to fight and prevent fraud yield over $1.5 billion in savings
Taking “big data” mainstream has given the CMS the ability to better connect with public and private predictive analytics experts and data scientists, as well as collaborate more closely with law enforcement.
Lawmakers grilled a CMS administrator Tuesday as government watchdog groups released more damning reports on the federal agency's efforts at eliminating waste, fraud and abuse in Medicare and Medicaid.
The CMS threatened Monday to cut off Medicare and Medicaid funding to an Indian Health Service hospital in Rapid City—the third South Dakota hospital serving Native Americans that's been found to have serious deficiencies in recent months.
The nation's top healthcare leaders overwhelmingly back the Affordable Care Act and support its goal of pushing providers away from fee-for-service medicine and toward delivering value-based care, according to Modern Healthcare's second-quarter CEO Power Panel poll.
Experts are still studying the issue, but hospitals say Medicare must tweak how excess readmissions are measured to make sure penalties reflect quality, not demographics.
Data Points for the week of May 23, 2016, covered the following topics: Knee and hip replacements and bundled payments for them from Medicare and the number of Americans with knee and hip replacements.
Venture capitalists have opened up the funding spigot into a budding health insurance startup, Clover Health, that only enrolls seniors—reflecting a bet that new-age insurers will disrupt the Medicare program.
The bipartisan legislation put forward this week would also allow off-campus hospital outpatient departments currently under construction to continue receiving higher rates than similar facilities that aren't owned by hospitals.
The new model for Medicare reimbursement is still geared more toward acute care, skilled nursing and institutional care than long-term care provided in the community, advocates say.
The CMS has issued guidance on processing claims from accountable care organizations that use a waiver to send Medicare patients to skilled-nursing facilities faster as a way to avoid costly hospital visits and provide tailored care.