In CMS
Jan 25th, 2019
There are big changes on the horizon for the Medicare Part D prescription drug model, and they’re going to affect medical coders. The current reimbursement system and payment model for Part D creates incentives for plans to push patients to the “catastrophic phase.” Once the patient reaches this “donut hole,” Medicare is responsible for 80 ...
In CMS
Nov 14th, 2018
Another opioid pill mill gets busted by the Medicare Fraud Strike Force. A “pain management clinic” in Hialeah, Florida, owned by David Bosch and Tania Sanchez, which operated under the name East Medical Office Inc., unlawfully distributed thousands of pills of oxycodone, during the period of April 2017-May 2018. It was a cash-only clinic, which remained ...
May 31st, 2018
Aetna, bruised by a PHI breach where letters detailing a lawsuit settlement were sent to HIV-positive members revealing their status, is now suing the plaintiffs in the original 2014 class action lawsuit  for $20 million, blaming a consumer advocacy group and law firm for their woes. Aetna demands $20 million and indemnification from any actions related to the breach. ...
In CMS
Jul 13th, 2017
The Office of Inspector General’s (OIG) combat on healthcare fraud, waste, and abuse of taxpayer’s money recovers $5 for every $1 spent on investigating, which gives them incentive to target more areas of fraud. The OIG’s latest and largest fraud takedown happened this month when opioid fraud was exposed with the help of state and federal law ...
Mar 9th, 2016
The Centers for Medicare & Medicaid Services (CMS) announced March 8 a proposed rule that, when finalized, would allow testing of new Medicare Part B prescription drug models. The federal agency is soliciting comments from stakeholders on six alternative payment models to help find one that would better align physician incentives to successful patient outcomes. The ...