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Sen. Ron Johnson, R-Wisconsin, led a hearing of the Senate Homeland Security and Government Affairs Committee where he explored whether Medicaid expansion is at least partially to blame for the rise in opioid addiction and overdose deaths. Federal data, however, shows those problem began more than a decade earlier.

Days after CMS first issued policy guidance on how states could require “able-bodied” Medicaid beneficiaries to work or face losing their coverage, Kentucky has become the first with an approved waiver to test out those requirements.

Major healthcare associations had a decidedly mixed reaction to the Medicare Payment Advisory Commission (MedPAC) recommending to Congress that the Merit-based Incentive Payment System (MIPS) be eliminated, with some stakeholders saying such a major change would be premature less than three years after the Medicare Access and CHIP Reauthorization Act (MACRA) was passed.

Full-year quality reporting will be required in the Merit-based Incentive Payment System (MIPS) for the first time in 2018, but clinicians haven’t received word from CMS on whether they’re eligible to participate, according to the Medical Group Management Association (MGMA).

Following up on criticisms of the Merit-based Incentive Payment System (MIPS) at recent meetings, the Medicare Payment Advisory Commission (MedPAC) formally voted to recommend scrapping the payment system, arguing the program replicates flaws from those it was meant to replace.

 

Recent Headlines

5 take-aways from latest congressional hearing on Medicare fraud

On Wednesday, representatives of the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) and the Government Accountability Office (GAO) were once again called upon by House republicans to explain what is being done to combat waste, fraud and abuse in Medicare. Their responses give a glimpse into the agencies current priorities, especially as they affect healthcare providers.

Is your clinical lab sending you illegal kickbacks?

A new Office of Inspector General (OIG) fraud alert warns of two arrangements with clinical laboratories that it considers illegal kickbacks for referrals — specimen processing arrangements and registry arrangements — that are subtle enough that not all ordering physicians who receive the payments may be aware that they are breaking the law.

Mishandled patient record drop off costs Parkview Health System $800,000

Indiana and Ohio non-profit Parkview Health System has reached a deal with the U.S. Department of Health and Human Services Office for Civil Rights (OCR) to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule that occurred when boxes of medical records were delivered to the home of a retiring doctor when she was not there.

Senate bill seeks to make patient socioeconomic status a factor in assessing readmission penalties

If enacted, the bi-partisan Senate bill would change Medicare’s Hospital Readmissions Reduction Program to avoid possibly unfairly penalizing hospitals that treat a greater percentage of poor, Medicare and Medicaid dual-eligible patients.

Court finds Washington State exceeded its authority in requiring a certificate of need for all hospital affiliations

A Thurston County Superior Court judge has invalidated a change in the Washington State Department of Health's Certificate of Need rules that would have required hospitals to first get approval from the state for all business relationships where there is “any change of control” in “any part” of a hospital.

Cantor loss changes picture for healthcare lobbying efforts

News media and pundits have largely focused on what House Majority Leader Rep. Eric Cantor’s Virginia Republican primary loss to David Brat means for immigration reform, but Cantor was also heavily involved in drafting the Republican alternative to the Affordable Care Act (ACA).

3 priorities of Burwell’s WalMart past that could inform her HHS future

Sylvia Mathews Burwell, President Obama’s pick to replace Kathleen Sebelius as Secretary of the U.S. Department of Health and Human Services (HHS) sailed through her Senate confirmation with a vote of 78 to 17 in favor of confirming her nomination.

AHA to Sebelius: Stop “Kafkaesque” OIG audits of hospital claims

Whether it is the heights of hyperbole or an accurate description may depend on your perspective, but Rick Pollack, executive vice president of the American Hospital Association (AHA) did not mince words in his 10-page letter to outgoing U.S. Department of Health and Human Services Secretary Kathleen Sebelius about the many problems with the Office of Inspector General (OIG) getting into the act of reviewing Medicare Part A payment claims for short-stay hospital admissions.

Study finds newly insured will not make up for ACA cuts to Disproportionate Share Hospitals

The expansion of health insurance under the Affordable Care Act (ACA) should mean fewer uninsured patients at Disproportionate Share Hospitals (DSHs), but estimates for just how many fewer such patients would need care might have been overly optimistic finds a new study on California hospitals appearing in Health Affairs.

OIG: Physicians make mistakes in more than half of E/M claims

According to the OIG’s review of a random sample of 657 evaluation and management (E/M) Medicare claims from 2010, more than half (55 percent) had coding and/or documentation errors. Of these, vastly more were upcoded rather than downcoded. If the sample’s findings hold true for all Medicare E/M claims, it means the government is probably overpaying for E/M services by around $6.7 billion, the OIG concluded.

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