ACR representatives outlined its 2025 legislative priorities, including fixing the MPFS, reforming prior authorization & protecting telehealth reimbursement.
U.S. Accuses CVS of Defrauding Medicare over Prescriptions
NEW YORK, Dec 17 (Reuters)—CVS Health Corp. and its Omnicare unit were sued on Tuesday by the U.S. government, which accused them of fraudulently billing Medicare and Medicaid for hundreds of thousands of drugs without valid prescriptions. The U.S. Department of Justice joined two whistleblower lawsuits accusing Omnicare of failing to obtain new prescriptions from…
Ethics Forum: Are We Ethically Bound to Support Access to Rheumatologic Care for All?
A 43-year-old woman is establishing care in your new urban clinic after her previous rheumatologist stopped accepting her Medicaid insurance more than a year ago. Since that time, she has been trying to find a new rheumatologist who will accept Medicaid. She lives 90 miles away in a small town without a rheumatologist. Seven years…
Drug Assistance Programs Offer Little Charity to Uninsured
(Reuters Health)—Many patients who receive assistance from charities set up to defray prescription drugs costs may already have insurance that covers most the cost for their medications, a U.S. study suggests. Researchers examined data on the six largest independent charities offering patient assistance programs through 274 different disease-specific programs. These programs had total revenue ranging…
Medicaid Work Rules Likely to Penalize Chronically Ill
(Reuters Health)—States that require adults on Medicaid to work a set number of hours to get benefits may find many people lose coverage because behavioral health conditions and other chronic health problems make it hard for them to work, a U.S. study suggests. Medicaid, a joint federal and state health program for the poor, allows…
Understanding & Preparing for Payer Audits
Audit activity among Medicare and most third-party payers has increased in response to pressure to reduce healthcare costs. The return of billions of dollars to Medicare, Medicaid and third-party programs through these medical audit reviews has also increased. For example, the Government Accountability Office (GAO) 2014 Annual Report estimated that the Centers for Medicare &…
Rheumatology Champions Call for Lower Prescription Drug Costs, and More in Meeting with Congressional Legislators
ACR advocates recently returned to Capitol Hill to meet with members of Congress as part of the Advocates for Arthritis fly-in conference on Sept. 26. This annual event brings together rheumatology professionals to advocate on behalf of the rheumatology community. Core issues on which the advocates focused this year include lowering the out-of-pocket cost of…
U.S. Senate Health Bill Would Decimate Long-Term Care Coverage
CHICAGO (Reuters)—When Americans think about retirement planning, long-term care usually is a major blind spot – few of us want to contemplate the possibility of infirmity and dependency in old age. But we would do well to think about it now, as the Senate Republicans take a holiday weekend pause in their push to dismantle…
Stripping Americans of Health Insurance Could Be Deadly
(Reuters Health)—Health insurance saves lives—that’s the conclusion of a report released on Monday, just in time to weigh into the debate among Senate Republicans considering a bill that could strip millions of Americans of coverage. “Overwhelming scientific evidence shows that lack of insurance is sometimes deadly,” co-author Dr. David Himmelstein, a professor at the City…
U.S. Republican Leaders in Fierce Push for Senate Healthcare Vote
WASHINGTON (Reuters)—Republican leaders were in a fierce push on Tuesday to shore up support for a healthcare bill in the U.S. Senate after the nonpartisan Congressional Budget Office said 22 million Americans would lose insurance over the next decade under the measure. Vice President Mike Pence is expected to travel to Capitol Hill on Tuesday…
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