Latest Headlines

Latest Headlines

Medicare faces huge backlog of claims appeals

Medicare officials must work through the program's huge backlog of appeals claims, which is currently taking more than 500 days, senators said during a hearing on Medicare audits and appeals Tuesday.

Recent improper billing activity tops $120 million in Georgia

More than $120 million in improper billing activity has taken place in Georgia over the past week. On Monday, a hospital settled allegations from federal prosecutors that it violated the False Claims Act by cutting a check for $20 million. Meanwhile, Centers for Medicare & Medicaid Services officials want the state's Medicaid program to return $100 million in overpayments to nursing homes.

President Obama: Let Medicare officials negotiate drug prices

In his recent 2016 budget request to Congress,  President Barack Obama expressed growing concerns over the high costs of Medicare prescription drugs. His solution to the problem: Let Medicare officials negotiate prices with drug manufacturers. Currently, federal law prohibits such negotiations.

As NFL players take hits, insurers collect cash

Last week, the National Football League approved a settlement that would issue payments to injured players after the league failed to properly investigate and respond to concussion-causing hits. However, a big slice of the payments will instead go to the players' health insurers.

Puerto Rico struggles with low levels of fed provider reimbursement

The federal government pays providers in Puerto Rico a fraction of what their counterparts in the United States receive--about 70 percent lower for Medicaid providers, creating a fiscal crisis.

What will the end of the SGR bring, besides more acronyms?

What do we know so far about Medicare's replacement for the Sustainable Growth Rate formula, the Medicare Access and CHIP Reauthorization Act of 2015? 

SGR repeal becomes reality

Despite industry concern that the reimbursement outlined in the Sustainable Growth Rate formula repeal law isn't enough to keep up with costs over time, medical groups cheered the Medicare Access and CHIP Reauthorization Act.

CMS unveils new rating system for hospitals

There are five-star hotels and restaurants, and soon there may be five-star hospitals. The Centers for Medicare & Medicaid Services has introduced a new hospital rating system for patient experience that will be based on a five-star scale.

Senate approves bill to repeal SGR

The Senate Tuesday night overwhelmingly passed a bill to do away with the controversial Sustainable Growth Rate formula, a mechanism used to calculate Medicare payments to physicians.

The return of the RAC

As 2016 budget discussions consume lawmakers on both sides of the aisle, Citizens Against Government Waste (CAGW), a has released its coyly-named report, "Prime Cuts," which identifies ways in which the federal government could save nearly $650 billion next year. Tucked amid a slew subsidy cuts and calls to end various government programs, CAGW advocates for the revival of one program: Recovery Audit Contractors (RACs). But the return of the RAC program requires a measured approach.