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Focusing on Medicaid Fraud
If you haven’t been paying attention to recent reports on Medicaid fraud enforcement, now is the time to start. In 2010, Medicaid Fraud Recovery Units (MCFUs) recovered more than $1.8 billion. And,...
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Using Predictive Modeling to Prevent Healthcare Fraud
In my last post, I discussed a few of the changes federal and state governments have made in their ongoing efforts to reduce Medicaid fraud. However, there are also significant changes you should be...
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Pfizer Fights to Keep Lipitor Market Share
Last week, Pfizer lost the patent protection on its popular and profitable cholesterol-lowering drug Lipitor. Patent protection for drugs lasts 20 years. Typically, drugs that lose their patent...
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Proposing Sunshine for Pharma
CMS has finally issued its proposed rule to require manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid, or CHIP to report payments or transfers of $10 or...
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Painful Pills
Americans now use 70 percent of the world’s legal supply of narcotics. As a result, the number of deaths from narcotic overdoses has tripled in the last decade. Now, drug companies are developing pain...
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The Cost of Medicaid Expansion Under the ACA
On January 10, the 26 states challenging the Affordable Care Act (ACA) filed their brief on the issue of Medicaid expansion. The states argue that the mandatory expansion of Medicaid to include all...
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Insurers profit under the ACA
Although those calling for the repeal of the Affordable Care Act (ACA) argue that it is a job-killing, business crushing burden, there is one industry segment that has definitely profited under the ACA...
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Balancing States of “Conscience”
The Departments of Health and Human Services, Labor, and the Treasury recently released the final rule implementing the Affordable Care Act’s requirement that non-exempt group health plans and health...
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Mandatory Compliance Programs: Coming Soon to a Provider Near You
For over 14 years, the Office of Inspector General (OIG) has been encouraging Medicare and Medicaid providers to adopt voluntary compliance programs. Since 1998, the OIG has issued compliance guidance...
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Healthcare Disparities
The battle over the Affordable Care Act (ACA) has divided the country. Whether it is the individual mandate or the expansion of Medicaid, the issues focus on insurance. Individuals do not want to be...
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