Retrieving Billions in Overpayments by CMS

Retrieving Billions in Overpayments by CMS

Amid swirling accusations that Medicare Advantage Organizations (MAOs) are overbilling the U.S. government and calls for better oversight, the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. They expect to recoup 4.7 billion dollars through this program.
This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. The article is based on an interview with Kel Pults, chief clinical officer and vice president of MediQuant. A future article will explain how Medicare Advantage plans are trying to improving data collection and reporting,…

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Q&A: How the PHE's end could affect telehealth, patient care

Q&A: How the PHE’s end could affect telehealth, patient care

The public health emergency declared in early 2020 was put in place to provide waivers from the Centers for Medicare and Medicaid Services to ease the burden on hospitals and other providers during the pandemic. It has been extended 12 times since its implementation and is finally slated to end on May 11. Heather Meade, principal at Washington Council Ernst & Young, spoke with MobiHealthNews about how the end of the PHE could affect telemedicine companies’ funding streams and patients’ access to care.  
MobiHealthNews: What are the benefits and detriments to the PHE ending, especially for telehealth?
Meade: I mean, we need permanent policy…

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Digital as the Differentiator for Biopharma and Medtech

Digital as the Differentiator for Biopharma and Medtech

With the Inflation Reduction Act now on the books, the U.S. Centers for Medicare & Medicaid Services (CMS) will begin negotiating drug prices with the pharmaceutical industry. That, combined with other headwinds such as increased competition from me-too drugs, and ever-present pricing pressure from payers, means that pharma players now more than ever need a new and powerful tool to differentiate their products. We believe the next decade of transformation is digital.
Learning from the auto industry Almost every industry has had to confront a fundamental existential question: What is our product? Consider the automotive industry, which once was largely about hardware…

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