Among publicly and privately insured children in the sample, respectively, 11% and 9% received unnecessary services at least once in 2014.
Category: Healthcare Finance News
Of $3 billion DOJ recovered in fraud, $2.6 billion attributable to healthcare
Over $2.1 billion arose from lawsuits filed by whistleblowers under the qui tam provisions of the False Claims Act.
‘Hotspotting’ in healthcare has little to no effect on patient outcomes
About 5% of patients in the U.S. account for half the nation’s healthcare costs; the challenge is to reduce their spending.
ACOs in the MSSP model head into future risk
While numbers for MSSP participation starting this month are yet known, the figures will be an important measure of ACO willingness to take downside risk.
Molina to acquire NextLevel Health Partners for $50 million, expanding footprint in Illinois
The deal will allow Molina to serve 50,000 new Medicaid and Managed Long-Term Services and Supports members in Cook County.
Significant underreporting in safety data found on Nursing Home Compare website
Just 57.5% of falls were accounted for in the Nursing Home Compare’s Minimum Data Set, which is self-reported by nursing homes.
Department of Justice claims Community Health Network fraudulently billed Medicare
CHN allegedly received referrals from physicians in violation of the Stark Law and submitted Medicare claims knowing they were ineligible.
Bright Health to expand Medicare Advantage market into California through purchase of Brand New Day
The expansion will bring the health plan’s national footprint to a total of 34 markets in 13 states.
Price transparency rule could lead to narrower networks, experts say
For capitalism to continue in healthcare, negotiations need to continue behind closed doors, one expert said.
Former Anthem executive Brad Smith named CMMI director
Smith co-founded Aspire Health, which Anthem acquired in 2018.
