Radiotherapy Clinics of Georgia, a radiation oncology practice located in Decatur, Ga., and its affiliates have agreed to pay $3.8 million to settle claims that they violated the False Claims Act after allegedly billing Medicare for medical treatments that were unnecessary or went beyond what is permitted by Medicare rules, according to the U.S. Justice Department.
The House Energy and Commerce Committee, chaired by Rep. Fred Upton (R-Mich.), has approved the Medicare Decisions Accountability Act (HR 452), which repeals the controversial Independent Payment Advisory Board, passed by voice vote without any recorded opposition.
A tentative deal is in place that will continue to hold off the 27.4 percent cut in Medicare physician payment rates, though it will be paid for with cuts to other federal healthcare funding.
The American Medical Association, along with a group of other healthcare trade associations, wrote a letter to House Ways and Means Committee Chairman Rep. Dave Camp (R-Mich.), encouraging him to push for the repeal of the sustainable growth rate (SGR) to allow for the formation of more accurate Medicare spending estimates while also suggesting that excess baseline projections for Overseas Contingency Operations be used to help offset necessary Medicare baseline changes.
Most programs in the two broad categories of value-based payment demonstrations and disease management and care coordination demonstrations from the Centers of Medicare & Medicaid Services (CMS) have not reduced Medicare spending, according to a January issue brief from the Congressional Budget Office (CBO).
Although the final regulations regarding the shared savings program (SSP) between Medicare and accountable care organizations (ACOs) addresses shortcomings in earlier proposed regulations that may have made ACO entry too difficult for providers, participation in ACOs and the SSP still may not appeal to providers.
The Centers for Medicare & Medicaid Services (CMS) has issued a final rule regarding section 10332 of the Patient Protection and Affordable Care Act (PPACA), which allows for the release of Medicare claims data to qualified entities as a quality measurement tool, and specifically addresses the requirements organizations must meet in order to be considered a qualified entity.
Since the American Hospital Association (AHA) began tracking data related to the Centers for Medicare & Medicaid Services’ (CMS) Recovery Audit Contractors (RAC) program in 2010, 2,127 hospitals have reported a total of $355 million in denied claims.
The Centers for Medicare & Medicaid Services (CMS) could be flipping the script on the requirements that hospitals and critical access hospitals must meet to participate in the Medicare and Medicaid programs. The agency released a notice of proposed rulemaking stating that “these proposed changes are an integral part of our efforts to reduce procedural burdens on providers.”
As questions mount over the role of the Independent Payment Advisory Board and political pressure to repeal it as an element of healthcare reform increases, the board will no longer fly under the public radar, according to an article published in the October issue of the Journal of the American College of Radiology.
National Imaging Associates, a subsidiary of Magellan Health Services, has started a two-year demonstration study to assess the appropriate use of advanced imaging for Medicare Fee-for-Service beneficiaries. The research will examine the impact of physician decision support tools on mitigating the inappropriate use of MRI, CT and nuclear medicine.
Nearly 20.5 million people with Medicare coverage reviewed their health status at a free annual wellness visit or received other preventive services with no deductible or cost sharing this year, according to the Centers for Medicare & Medicaid Services (CMS).
"While the American College of Physicians (ACP) appreciates that Medicare Payment Advisory Commission (MedPAC) has put forward a comprehensive proposal to eliminate the sustainable growth rate with the intent of protecting access to primary care for Medicare beneficiaries, we have very substantial concerns that preclude us from supporting it," Virginia L. Hood, MPPS, MPH, president of ACP, wrote in a letter in response to MedPAC’s recent proposal to fix the SGR.
In an analysis of Medicare data, researchers determined that hospitals faced lower financial risks for treating patients with hip fractures and joint replacements in a pilot program on bundled payment, which also assessed congestive heart failure and stroke. Increasing the episode length captured more costs and readmissions but did not add an equivalent amount of financial risk, they concluded in a study published in the September issue of Health Affairs.
Starting July 1, the Centers for Medicare & Medicaid Services (CMS) will begin using predictive modeling technology from Nothrop Grumman, a provider of advanced information tools, to fight Medicare fraud.
There is a widely held expectation that higher numbers of clinicians will lead to patients receiving more effective primary care. However, a May 25 study in the
Journal of the American Medical Association shows that the key to better outcomes might be more primary care physicians trained in ambulatory care.
