Justice Department accuses Ontario-based hospital chain of cheating Medicare system

http://www.latimes.com/business/la-fi-prime-healthcare-20160525-snap-story.html

Centinela Hospital

The U.S. Justice Department has joined a whistle-blower case against Prime Healthcare Services, adding significant weight to allegations of widespreadMedicare overbilling at 14 of the company’s hospitals in California. A Los Angeles magistrate judge granted the agency’s request to intervene in the case Tuesday, one day after the government declared in a court filing that its investigation of the Ontario- hospital operator has “yielded sufficient evidence” that the facilities “submitted or caused the submission of claims to Medicare for unnecessary inpatient stays.”  Prime finds itself under federal scrutiny because of a whistle-blower complaint submitted in 2011 by Karin Berntsen, a registered nurse and director of quality and risk management at Alvarado Hospital in San Diego. Berntsen’s lawsuit accuses Prime of routinely making Medicare patients’ illnesses seem more severe than they really were in order to justify billing for additional services and increasing hospital admissions.

What to Look for in 2017 ACA Marketplace Premium Changes

What to Look for in 2017 ACA Marketplace Premium Changes

Health Insurance Exchanges2

Proposal to Reduce Medicare Drug Payments Is Widely Criticized

An Obama administration proposal to reduce Medicare payments for many prescription drugs has run into sharp bipartisan criticism, suggesting that it is easier to diagnose the problem of high prices than to solve it.

Healthcare Triage News: Pay for Performance in Medicine: It Doesn’t Work

Healthcare Triage News: Pay for Performance in Medicine: It Doesn’t Work

pay_for_performance

Pay-for-performance” is an umbrella term for initiatives aimed at improving the quality, efficiency, and overall value of health care. These arrangements provide financial incentives to hospitals, physicians, and other health care providers to carry out such improvements and achieve optimal outcomes for patients.

Two-midnight rule coming to an end; hospitals in line for one-time payment

http://www.revenuecycleinsights.com/news/two-midnight-rule-coming-end-hospitals-line-one-time-payment?mkt_tok=eyJpIjoiWkRJNFltRmlNakU0WlRnMSIsInQiOiJaM2RyZjVtN2dqeVFiYWl5VFBOZnBqTHBuUEROV0VkSXZ1aXdhT3hMZFltQzFoTXZrZlQxamRZUWxuM0VRMnEyMW1lekgyZW9lUVJzKzBuSmI4ZjAzaTdzbW5hU1p4N2YwdWlsc3YxaldyUT0ifQ%3D%3D

Hospitals instead will receive a one-time payment of 0.6 percent next year to offset the 0.2 percent reduction implemented from 2014 through 2016.

Medicare’s New Physician Payment System

http://www.rwjf.org/en/library/research/2016/04/medicare-s-new-physician-payment-system.html

Doctors meet in hallway of hospital.

Government and private-sector leaders have resolved to trans­form how physicians are paid in a way that holds them more accountable for the care they deliver.

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf428568

Harvard Pilgrim bullish on exchange business despite high-profile UnitedHealthcare exit

http://www.healthcarefinancenews.com/news/harvard-pilgrim-bullish-exchange-business-despite-high-profile-unitedhealthcare-exit?mkt_tok=eyJpIjoiWkRjM1pHWXhaamRtTjJJdyIsInQiOiIrNU1UM0tidlREYndvZ05BQ1hESEZUaFZUV3Jkd0lDVnZTRVhkaWQ3cTZ2ZHJIMk9SZ0ZSSEZGdDhKK3BJS3V4RkkzdDcrR2Y1MDd1K0FabllGQ1p2ZjdGanAybDlCUFJBRWo4eFVRK1IwRT0ifQ%3D%3D

Population health partnership key as New England insurer logs more and more enrollees.

CMS finalizes 85 percent medical loss ratio for Medicaid private managed care plans

http://www.healthcarefinancenews.com/news/cms-issues-final-rule-private-medicaid-plans?mkt_tok=eyJpIjoiWkRjM1pHWXhaamRtTjJJdyIsInQiOiIrNU1UM0tidlREYndvZ05BQ1hESEZUaFZUV3Jkd0lDVnZTRVhkaWQ3cTZ2ZHJIMk9SZ0ZSSEZGdDhKK3BJS3V4RkkzdDcrR2Y1MDd1K0FabllGQ1p2ZjdGanAybDlCUFJBRWo4eFVRK1IwRT0ifQ%3D%3D

Insurers must spend at least 85 percent of their Medicaid revenue on medical care to improve quality.

New Health Policy Brief: Medicare’s New Physician Payment System

http://healthaffairs.org/blog/2016/04/22/new-health-policy-brief-medicares-new-physician-payment-system/

Health Policy Brief

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=156

Competition suffers most if UnitedHealth exits Obamacare in 2017, analysis shows

http://www.healthcarefinancenews.com/news/competition-suffers-most-if-unitedhealth-exits-obamacare-2017-analysis-shows?mkt_tok=eyJpIjoiTjJZMU5UQXhNVFJsWWpSaSIsInQiOiJidFZ1RUN4NjdcLzdLK3VFQTVIeGdxSnNWZHZxdThQemM5a2RScVoxTGRtVmFYUjZkeTl0Rms1U1J0SFlDeW52WmUrWjcyODFvaFFXZkl6aUZZSFB2TGZcL3Y4a3ZrUVpwaFNOOUdjanhlNWZZPSJ9

More than 1 million consumers would be left with a single health plan option, analysis shows.