Insurance

Medicare and Medicaid billing fraud scams-upcoding and unbundling schemes, double and triple billing, phantom billing and illegal kickback schemes -cost the United States an estimated $100 billion annually, inflating the size of government, escalating healthcare costs and burdening taxpayers.

An immunotherapy developed by Amgen and approved by the FDA for the treatment of acute lymhoblastic leukemia in December 2014 has now received coverage assurance from Medicare, following an initial rejection.

A recent Kaiser Family Foundation survey found 70% of Americans prefer that Medicare's benefit structure remain intact.

For many US community cancer centers, keeping the doors open has often meant making the difficult decision to consolidate with hospitals and large hospital systems. Site neutrality is a critical step in the journey toward better healthcare for all Americans and a healthy future for Medicare.

The approach for assessing hospital penalties under the Hospital-Acquired Condition Reduction Program might need to be reconsidered in order to achieve the intended goal of the program.

The top stories in managed care, including what providers really think about the use of quality metrics, readmission rates for Medicare patients, and preventing drug-resistant infections.

The study presented at the ADA Scientific Sessions found that raising out-of-pocket costs for diabetics with Medicare could reduce adherence and ultimately raise healthcare spending.

Defining what is "medically necessary" is a judgment call, and patients may lack access to the criteria insurers use to make coverage decisions.

In the fourth year of the Hospital Readmissions Reduction Program, which makes hospitals pay closer attention to their patients after discharge, half of the nation's hospitals will be penalized by Medicare because of their readmissions.

The diagnosis and management of patients with dementing illnesses can be challenging, but the cost of misdiagnosing dementia as Alzheimer's disease can be as high as $14,000 a year, according to a study published in Alzheimer's & Dementia.

The announced price for alirocumab, the first PCSK9 inhibitor approved for use in the US, was the top story in managed care this week. Also, HHS announced $100 million available to combat substance abuse, and Medicare and Medicaid turn 50 years old.

Proposed mergers of Aetna and Humana, and Anthem and Cigna, raise questions of whether consumers will continue to see competition in health insurance markets.

Fifty years ago today, President Lyndon B. Johnson signed the law that created Medicare and Medicaid, setting in motion not only the greatest change in healthcare in the nation's history at that point, but also a lasting change for society.

Healthcare spending growth between 2014 and 2024 is projected to be substantially lower than the 3 decades prior to 2008, according to a new report from CMS. In addition, the average premium for a basic Medicare Part D prescription plan will remain stable in 2016.

All-cause mortality and hospitalization rates and inpatient expenditures among Medicare fee-for-service beneficiaries decreased from 1999 to 2013.

The HHS Secretary told the National Governors Association that she needed their help in fighting substance abuse and in moving the healthcare system from a volume-based to a value-based system.

The potential of nurse practitioners is not being fully realized in primary care medical practices. Consequently, cost and quality gains are not being achieved.

CMS' shift to value-based payments has also shifted diabetes care models from cost-centered systems to cost-savings centers, according to Robert A. Gabbay, MD, PhD, chief medical officer and senior vice president of Joslin Diabetes Center.

Recent surveys have found that public sentiment on drug costs runs high and crosses the political divide. A move this week by the nation's leading oncologists to rein in therapy pricing may be a sign that this is the breakthrough issue of the presidential campaign.

The study has policy implications since Americans 65 and older are eligible for Medicare, and trustees reported this week that the hospital fund will only be solvent until 2030.

This article describes a study of an intervention to engage Medicare Part D beneficiaries in obtaining a comprehensive medication review.

A leading voice on diabetes care asks why Medicare still will not cover CGM technology.

Instead of making patients suffering from life-limiting illnesses choose between hospice care and curative care, CMS will test coverage that allows individuals to receive palliative and curative treatment concurrently.

A new blog post at RAND argues that Medicare's plans to reimburse providers for advance care planning has been a long time coming.

The top story was Marilyn Tavenner became the nation's top healthcare lobbyist when she was named the new president and CEO of America's Health Insurance Plans, plus the controversial new guidelines that called for more Americans to take statins were validated, according to the results of a new study.

Long-term acute care hospitals provide better outcomes and more cost-effective care when treating critically ill and medically complex patients.

Approximately 9 million Medicare beneficiaries are considered "complex care" and they often incur high out-of-pocket costs. As lifespans lengthen, it becomes important for Medicare to adapt to serve these complex care beneficiaries.

Nearly 50 years after President Johnson signed the law that created them, Medicare and Medicaid have become part of the fabric of the US healthcare system. A Kaiser Family Foundation poll finds little support for proposals to alter the basic structure of the programs.

The link between getting patients to take medication correctly and keeping down healthcare costs is strong enough that adherence is being tied to reimbursement for healthcare providers. A study published recently in The American Journal of Managed Care examines connections at the health plan level between good plan-level adherence, lower rates of disease complications, and lower medical spending.