Another whistleblower suit alleges Medicare Advantage fraud By Fred Schulte The Center for Public Integrity, October 29, 2014 A new whistleblower lawsuit accuses a California health care firm of diagnosing “false and fraudulent” medical conditions that several Medicare Advantage plans allegedly used to overcharge the federal government by $1 billion or more. The suit was […]
Correction: State No Longer Looking to Administer Medicare By Anne Galloway VTDigger, October 26, 2014 Two recent stories about the relationship between Medicare and Green Mountain Care, the state’s planned universal publicly financed health care program – often called single-payer – were inaccurate. The stories were based on statutes on the Legislature’s website that had […]
Section 1557 of the Patient Protection and Affordable Care Act U.S. Department of Health and Human Services Section 1557 is the civil rights provision of the Affordable Care Act. Section 1557 prohibits discrimination on the ground of race, color, national origin, sex, age, or disability under “any health program or activity, any part of which […]
Public Trust in Physicians — U.S. Medicine in International Perspective By Robert J. Blendon, Sc.D., John M. Benson, M.A., and Joachim O. Hero, M.P.H. The New England Journal of Medicine, October 23, 2014 One emerging question is what role the medical profession and its leaders will play in shaping future national health care policies that […]
Administrative Work Consumes One-Sixth of U.S. Physicians’ Working Hours and Lowers Their Career Satisfaction By Steffie Woolhandler and David U. Himmelstein International Journal of Health Services, Volume 44, Number 4 / 2014 Abstract: Doctors often complain about the burden of administrative work, but few studies have quantified how much time clinicians devote to administrative tasks. […]
Health Care Price Transparency and Economic Theory By Uwe E. Reinhardt, PhD JAMA, October 22/29, 2014 Citizens in most economically developed nations have health insurance coverage that results in only modest cost sharing at the time health care is used. Furthermore, physicians, hospitals, and other clinicians and entities that provide health care within most systems […]
CVS Smoke-Free Pharmacy Benefit Excludes Tobacco-Selling Rivals By Bruce Japsen Forbes, October 20, 2014 CVS Health (CVS) confirmed its Caremark pharmacy benefit management subsidiary would sell a smoke-free drugstore network to employers and health plans that would provide subscriber discounts for using “tobacco-free” pharmacies. The move, which would benefit CVS Health pharmacies given the company’s […]
When the Affordable Care Act (ACA) was being crafted, it was almost as if the designers thought that they were developing a relatively static system. They would simply cover the lowest-income individuals with Medicaid, make available subsidized private plans for moderately-low-income individuals, and then use individual and employer mandates, under threat of penalty, to force the rest of the uninsured into private plans. Although a limited amount of churning in and out of various plans and programs was expected, what they did not seem to understand was how unstable these categories actually are. The churning is massive.
The Affordable Care Act provides a 90 day grace period during which health care coverage through exchange plans is continued before insurers can cancel the plans for non-payment of premiums. However, the insurers must pay claims for only the first 30 days, whereas providers are not allow to collect from the patient during the remaining 60 days. After 90 days of nonpayment of premiums, the patient can be retroactively billed, though collection can be difficult since most of these patients do not have enough funds to pay their premiums, much less their health care bills.
The Effect of Malpractice Reform on Emergency Department Care By Daniel A. Waxman, M.D., Ph.D., Michael D. Greenberg, J.D., Ph.D., M. Susan Ridgely, J.D., Arthur L. Kellermann, M.D., M.P.H., and Paul Heaton, Ph.D. The New England Journal of Medicine, October 16, 2014 Emergency department care has been a particular focus of a new generation of […]
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