CHICAGO (Reuters)—Seniors have received some unpleasant news in their mailboxes in recent weeks: premiums for many Medicare prescription drug insurance plans will rise at double-digit rates next year. Premiums for the ten most popular Medicare Part D prescription drug plans (PDPs) will rise an average of 8 percent next year—the fastest clip in five years,…
Complex Patients More Likely to Switch from Medicare Advantage
NEW YORK (Reuters Health)—Medicare Advantage plans might not be meeting the needs of patients requiring the costliest and most complex levels of care, a new study suggests. Between 2010 and 2011, such patients were more likely to switch from Medicare Advantage plans to traditional Medicare, rather than vice versa, researchers found. The results suggest people…
Adventist Health System to Pay $118 Million to Settle Fraud Claims
(Reuters)—Florida-based healthcare system Adventist Health System has agreed to pay $118.7 million to settle a whistleblower lawsuit that accused it of paying kickbacks to doctors in exchange for referrals, attorneys for the plaintiffs announced on Monday. The agreement comes in a lawsuit filed by three former employees of Adventist’s Park Ridge Health hospital in Hendersonville,…
Pros, Cons of Provider-Based Conversions
When the local hospital approaches you about selling your practice and converting it to a provider-based outpatient department, you may want to hear them out. There are many benefits to becoming a department of the hospital, but what would it mean for you and the practice you worked tirelessly to build? What Does It Mean…
U.S. Doctors Group Says Planned Health Mergers Are Anti-Competitive
NEW YORK (Reuters)—Two proposed mergers of U.S. health insurers worth tens of billions of dollars would hurt competition in commercial health plans in as many as 17 states, the American Medical Association, the U.S. group that represents physicians, said on Tuesday. Aetna Inc. announced plans to buy smaller rival Humana Inc. in early July and…
U.S. Business Groups Call for Probe of Medical Funding Industry
(Reuters)—Two business lobbying groups this week called on the Consumer Financial Protection Board to investigate the medical funding industry after a Reuters investigation revealed that private investors are funding operations for women who have sued makers of surgical implants. The American Tort Reform Association and DRI-The Voice of the Defense Bar told Reuters on Tuesday…
Internal Due Diligence Reviews Critical for Physician Practices
The only way to be confident your practice is performing well is to conduct periodic internal reviews of your practice operations. This allows you to familiarize yourself with the intimate details of your practice operations and identify what you are doing well and what needs improvement. Doing so will not only help your practice become…
China to Expand Medical Insurance for Major Illnesses
BEIJING (Reuters)—China will expand medical insurance to cover all critical illnesses for all urban and rural residents by the end of the year, the cabinet said on Sunday, the latest step in a plan to fix a healthcare system that has sparked public discontent. The State Council said 50% of the medical costs will be…
Authorities Arrest 243 People in $712 Million Medicare Fraud
(Reuters)—The U.S. Department of Justice said on Thursday that 243 people have been arrested across the country, charged with submitting fake billing for Medicare, a government healthcare program, that totaled $712 million. Attorney General Loretta Lynch described the arrests as the largest criminal healthcare fraud takedown in the history of the Justice Department. Those arrested…
Internal Due Diligence Review Important for Physician Practices
Whether you’re considering selling your practice, growing your practice or maintaining the status quo, it’s important to periodically do a checkup on your internal operations and compliance with the law. It’s always preferable to discover problems within your practice and correct them (if possible) before those issues are discovered by third parties, such as the…
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