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CMS finalizes rule bolstering its authority to combat fraud

September 9, 2019


CMS on Thursday finalized a rule that provides the agency with more authority to prevent fraud by rejecting or revoking a provider's or supplier's enrollment in CHIP, Medicare, and Medicaid if they are affiliated with organizations that have had their enrollment revoked because of fraud, waste, or abuse.

In the states: Judge approves deal to complete CVS-Aetna merger, North Carolina sues Juul for allegedly targeting children, and more

September 6, 2019


American Health Line rounds up the latest health care news in the states.

Medicare paid twice for about $161M in hospice drugs, report finds

September 5, 2019


Medicare Part D in 2016 unnecessarily spent an estimated $161 million on drugs that already were covered under Medicare Part A, according to an HHS Office of Inspector General report released last week.

Did California's provider payment rate-setting law work? It's complicated, research suggests.

September 5, 2019


A California law touted as a national model for addressing so-called "surprise" medical bills has led to fewer surprise bills for patients and lower payment rates for in-network and out-of-network physicians—but it might be driving physician group consolidation, according to recent research.

Hospitals are avoiding admitting Medicare patients to dodge financial penalties, study suggests

September 5, 2019


A study recently published in BMJ reinforces concerns that hospitals are treating Medicare patients in emergency departments and observation areas instead of admitting them to the hospital to avoid readmissions penalties.

This state is making 'the biggest bet yet' on value-based care

August 28, 2019


North Carolina and its largest private insurer recently have launched initiatives to move away from a fee-for-service model, toward value-based care, and several of the initiatives are showing early signs of success.

Purdue Pharma is looking to settle more than 2,000 opioid lawsuits, sources say

August 28, 2019


Purdue Pharma and its owners, the Sackler family, are in discussions with state and local governments to settle more than 2,000 lawsuits filed against the company over its alleged contribution to the U.S. opioid epidemic, according to individuals familiar with the negotiations.

Alaska governor cuts Medicaid funding (again)

August 22, 2019


Alaska Gov. Mike Dunleavy (R) on Monday vetoed $50 million in state Medicaid spending, $27 million in adult dental benefits, and more from the state Legislature's fiscal year 2020 operating budget, which hospitals in the state say will significantly cut Medicaid payments.

What it's really like to get dialysis at home

August 20, 2019


The Trump administration wants to shift most dialysis care to patients' homes—a practice that providers say can improve quality of life, but also can present hardships for older patients.

In the states: AMA leaves group that opposes 'Medicare for All,' shots fired at an Illinois VA hospital, and more

August 16, 2019


American Health Line rounds up the latest health care news in the states.

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