Medicare & Medicaid
The former medical director of a now-defunct healthcare provider in Miami, along with three therapists formerly employed there, have been convicted for their roles in fraudulently billing Medicare and Florida Medicaid for more than $63 million, according to the Department of Justice.
Amputees against proposed changes to Medicare coverage that would result in less expensive, but inferior, prosthetics being given to patients gathered in Baltimore Wednesday to ask officials to strike down the proposal.
Another Pioneer ACO participant, Beacon Health in Maine, is considering exiting the Centers for Medicare and Medicaid Services program after being hit with millions in penalties two years in a row.
Memorial Hermann ACO, Palm Beach Accountable Care and PMO lead pack in generating millions in savings, though the bulk of organizations in the program failed to generate enough savings. See the full performance data in the table below.
While many accountable care organizations in Medicare's Shared Savings Program generated enough savings in 2014 to merit financial incentives, more than two-thirds fell below the payment threshold, the Centers for Medicare and Medicaid Services said on Tuesday.
Illinois-based RSA Medical provides analytics to health and life insurance companies that enables plans to identify medical conditions and other risk factors among enrollees and direct them to proper care.
A new report published in the American Journal of Managed Care found that just over half of MSSP ACOs shared plans on how they'll allocate savings.
State officials had requested hospitals receiving payments and health plans reimbursing hospital providers to certify none of the contractual arrangements are above 120 percent of the Medicaid fee schedule, the allowable limit.
CMS on Thursday said 360 organizations have directly entered into bundled payment agreements with the agency, and an additional 1,755 providers have partnered with those organizations as of July. But CMS acting administrator Andy Slavitt in June said there were more than 7,000 providers in the "at-risk" stage of the BPCI model.
CenseoHealth accused of targeting those MAO plan members who were likely to yield the most serious diagnoses, and more likely to generate higher capitation payments.