The CMS wants to launch a system to track enforcement actions against Medicare providers over questionable claims. Fraud costs the federal government an estimated $60 billion to $90 billion annually.
The CMS issued a wide-ranging proposed rule intended to modernize the regulation of Medicaid managed-care plans. The Medicaid managed-care population is growing rapidly, but the last regulation governing such plans was issued in 2002.
Nearly one-quarter of Medicare's top-prescribing physicians received consulting fees or other financial perks from manufacturers of the drugs they prescribed in 2013, renewing nagging questions about conflicts of interest in medical decisionmaking.
Modern Healthcare has documented every Medicare and Medicaid milestone and challenge since Crain Communications purchased the magazine in 1976. This section commemorates the programs' 50th anniversary by providing some history and an overview of their challenges.
Medicare and Medicaid evolved in dramatically different ways. Medicare, which provided health coverage for seniors, became the third rail of American politics. Medicaid, a state-based program that provided health coverage for the poor, existed in a political netherworld. All that is about to change.
Medicare and Medicaid have precipitated the vast expansion—and even the creation—of many profitable industry sectors including hospitals, physician groups, managed-care insurers, home health, drug manufacturers, devicemakers and others.
Providers and policymakers will explore implementation strategies for bundled-payment models and address physician concerns about the CMS' bundled-payment experiments at the Fifth National Bundled Payment Summit in Washington.
The CMS is about to release a sweeping proposed rule that could fuel a major expansion of Medicaid managed long-term care for elderly and disabled beneficiaries.
Oncologists have proposed a new payment model for cancer care using consolidated billing codes, bundled payments and care-management fees, which they hope will improve quality of care and reduce costs.
CVS is buying the pharmacy benefits provider Omnicare in a deal valued estimated at $12.7 billion.
The CMS is appearing to blink in its stare-down with Florida over Medicaid expansion. The agency informed state officials last week that it tentatively plans to renew a waiver that has provided Florida billions in supplemental Medicaid funding to help hospitals with uncompensated-care costs.
Before Medicaid was established, low-income Americans had limited access to healthcare, relying heavily on charity care and public hospitals. "To be old and poor and sick was to suffer and to die prematurely,” said Trish Riley of the National Academy for State Health Policy.