Insurance

The United States loses approximately $100 billion to healthcare fraud annually. Up to $20 billion dollars are due to fraudulent practices in the mental health sector. One of the largest healthcare fraud cases in US history occurred in behavioral health -- one of healthcare’s smallest sectors.

What we're reading: California's assisted suicide law will take effect June 9; a majority of drugs in Medicare Part D require coinsurance; and Senate passes opioid abuse bill 94-1.

Patterns of meeting the minimum number of minutes to qualify for higher reimbursement rates were seen in 4 states: Texas, Mississippi, Arkansas, and Indiana. CMS said it will refer this matter to auditors for review.

Several healthcare organizations have sent a letter to HHS urging withdrawal of this reimbursement model.

CMS has announced its plans to evaluate a new value-based payment model for prescription drugs covered under the Part B program. This is yet another move by the federal body to ensure quality care for Medicare enrollees.

The idea to let Medicare negotiate drug prices has been kicked around for years, but a number of forces have prevented any legislation from being passed, explained Tricia Neuman, ScD, director of the Kaiser Family Foundation's Program on Medicare Policy and the Project on Medicare's Future.

Results of the study in JAMA underscore the importance of advance care planning.

Senators Amy Klobuchar (D-MN) and Jeanne Shaheen (D-NH) have sent a letter to the FDA urging the regulatory body to find efficient ways to distribute expensive cancer drugs.

Despite various attempts to increase the vaccination rate among adults, Medicare beneficiaries are still susceptible to extensive cost-sharing for recommended vaccines, according to a study by Avalere.

The health insurance marketplace’s application/verification process is vulnerable to fraud, found a report from the US Government Accountability Office.

The average cost per episode dropped $6708 from the first year of the pilot to the third year.

Keynote speaker Dr Julie Vose said the oncologist faces many administrative burdens in the transition to value-based care. Solving them is essential to spending more time with the patient.

Primary care physicians correctly estimate medication adherence of their Medicare patients only half of the time and usually overestimate adherence rates, according to a new study.

The pharmaceutical industry needs to rethink its approach to packaging cancer drugs into a one-size vial to avoid drug wastage and save over $1.7 billion in 2016.

The report found that in 2013 the price for the average therapy rose 9.4%, while inflation only rose 1.5%. Social Security benefit increases are pegged to overall inflation, not drug prices.

The event saw participation by patient advocacy groups, health economists, health policy researchers, and patient advocacy groups-the primary interest of the participants was to identify the healthcare-associated economic hardships faced by patients and their caregivers across therapeutic areas and discuss potential solutions that could help alleviate some of this burden.

New research indicates that spending is relatively higher when care is initiated in the hospital outpatient department setting compared with the physician's office or an ambulatory surgical center.

What we're reading, February 29, 2016: hospital readmission declines tied to Obamacare program; Medicare negotiating powers may not have a large impact; and Aetna is on board with Affordable Care Act exchanges again.

While the cost of the widely used stroke clot-busting drug alteplase has more than doubled over the past decade, Medicare and Medicaid reimbursement has remained far behind.

Payment reform in the US is progressing considerably, but more transparency is necessary in order to change payment for the better in the United States, said Elizabeth Mitchell, president and CEO of the Network for Regional Healthcare Improvement.

Experts and biological researchers aren’t completely convinced with the president's cancer moonshot initiative and the released budget.

While smart cards would stop about 20% of fraudulent act, it wouldn't catch acts in which providers or beneficiaries are complicit, such as billing for unnecessary services.

To improve access for beneficiaries, CMS has proposed a plan to increase the availability of preferred cost-sharing pharmacies in Medicare.

CMS proposes increasing payments to Medicare Advantage plans by an average of 1.35% in 2017 in contrast to proposed cuts in recent years.