Reimbursement

The co-owners of a Dallas-based home health business as well as two nurse employees have been charged with conspiracy and fraud for allegedly submitting false claims to Medicare for $13.4 million dollars, according to the FBI.

Men are getting more screening colonoscopies since the health law reduced how much Medicare beneficiaries pay out of pocket for the preventive tests, a recent study found. The change, however, didn't affect women's rates.

Finding the path to success in the post-Affordable Care Act world of healthcare represents a great opportunity and challenge for payer organizations. Part of that journey is changing the relationship dynamic between payers and providers.

The Patient Access and Medicare Protection Act, which was recently passed, will hold Medicare reimbursement rates steady for freestanding radiation oncology centers. Additionally, two providers listed as B3 stable, 21st Century Oncology and Vantage Oncology, will see their 2016 rates hold steady for 2017-18, according to a report from Moody's Investor Service.

UnitedHealth Group subsidiary Optum will buy the administrative support services for ProHealth Physicians, one of Connecticut's largest independent physician groups.

Close to 6 million people selected plans through Healthcare.gov, a marked increase over last year when an estimated 3.4 million signed up, according to the Centers for Medicare and Medicaid Services. That includes a notable uptick in enrollment for those under 35.

Earlier this year, the Centers for Medicare and Medicaid Services released the results of the first year of the reinsurance and risk adjustment provisions of the Patient Protection & Affordable Care Act.

Two professional organizations representing emergency doctors warn that a new federal rule could lead to higher out-of-pocket costs for consumers when they need emergency care outside their health plan's network of providers. But consumer advocates and health policy experts say the groups' proposed solution doesn't adequately protect consumers.

Despite advice to shop around before selecting a plan, consumers may find that getting answers about drug coverage can be an exercise in frustration, despite a federal health law requirement that insurers provide lists of the prescription medications included in their plans.

As prescription drugs prices continue to drive up healthcare spending, the Centers for Medicare and Medicaid Services is creating a new online dashboard to increase transparency and address affordability.