by Advize Admin | Jul 28, 2023 | Healthcare, Healthcare Law
The only government program that I can think of that did not authorize price negotiations for prescription medications was the Medicare Part D program. In its inception in 2006, price negotiations were not part of the law, and drug manufacturers were essentially at...
by Advize Admin | Dec 2, 2022 | Compliance, FWA, Medical Record Auditing, OIG Files
When you first open this article, the most glaring of things is the time frame from which the audit was derived. 2011-2013 data is at this point so aged, the calculation of $1,000 per patient enrolled in a Medicare Advantage (MA) as the overcharged amount is simply...
by Advize Admin | Dec 2, 2022 | Coding, FWA, Medical Record Auditing
Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some plans overbilling the government more than $1,000 per patient a year on average. Summaries of the 90 audits, which...
by Advize Admin | Sep 16, 2022 | Commentary
This week’s topic is patient advocacy. As the season of enrollment is upon us, we think about what makes this difficult-to-understand process easier for everyone. Google could potentially be making it easier for enrolling in Medicare and/or Medicaid. ...
by Advize Admin | Aug 26, 2022 | Commentary, OIG Files
A phrase that does not often come up is “medical loss ratio,” or MLR. As an OIG Agent, I spent very little time looking at the OIG Workplan (I’ve blogged and spoken about how OIG Agents follow the current frauds, and how the plan is very much used to direct the work...
by Advize Admin | Aug 12, 2022 | Healthcare
The giant health care, climate, and tax bill expected to pass the House on Friday and be sent to the president for his signature won’t be as sweeping as the Democrats who wrote it had hoped, but it would help millions of Americans better afford their prescription...
by Advize Admin | Feb 25, 2022 | Healthcare
A congressional effort to fix the nation’s deteriorating mail service may come at the expense of an even bigger and more complicated problem: Medicare solvency. The Postal Service Reform Act of 2022 would help shore up post office finances by ending the...
by Advize Admin | Jul 30, 2021 | Healthcare
Three years ago, pharma giant Pfizer paid $24 million to settle federal allegations that it was paying kickbacks and inflating sales by reimbursing Medicare patients for out-of-pocket medication costs. By making prohibitively expensive medicine essentially...
by Advize Admin | Jul 23, 2021 | Healthcare
SACRAMENTO, Calif. — Getting clean drinking water cost Ignacio Padilla his health insurance. The World War II veteran needed to repay the loan for the water pump installed on his 1-acre property in rural Tulare County, the only source of water to his mobile home. He...
by Advize Admin | Jul 16, 2021 | Healthcare
The budget package Democrats are assembling in Congress would likely provide the biggest jolt to the American health care system since the passage of the Affordable Care Act in 2010, according to sources familiar with work on the plan. Democrats in the Senate...
Recent Comments