Reimbursement

The perpetrators of an alleged Medicaid and Medicare fraud involving complimentary shoes and fake diagnoses could face 25 years in prison, as investigators across the country try to prevent or at least find fraud schemes that never seem to end.

Pennsylvania's largest insurer and newest integrated delivery network operator took a financial loss for the second year in a row, but that may actually help if scrutiny of its nonprofit status continues.

Uncertainty created by allowing the providers to go to court on reimbursement rates rather than petition the Center for Medicare and Medicaid Services would have been enough for states to block Medicaid expansion.

Can Anthem, the insurance giant famous for the for-profit Blues, "reconceive Medicaid as a care-delivery model rather than as an insurance program"?

Transparency mandates make it tricky for health systems, as a procedure’s cost and what patients pay is very different.

While reimbursement is still being determined, it’s estimated that lung cancer scans for eligible individuals could cost Medicare more than $9 billion for the scans, biopsies and treatments through 2020.

Armstrong v. the Exceptional Child Center Inc. ruling is a blow to healthcare providers who say they are losing money in seeing patients covered by Medicaid due to inadequate reimbursement.

Are exchange insurers failing to adequately cover mandated tobacco cessation at no cost-sharing, or just not explicitly highlighting the benefits?

Across the Mississippi River from a bankrupt cousin, a Midwestern cooperative insurer is entering year two with a sizable membership that will test its model of partnering with hospitals.

Health insurers in New Jersey are complaining of a cost crisis arising from regulations meant to protect patients receiving emergency healthcare and involuntary out-of-network treatment.