Medicare Compliance & Reimbursement
LOOKING INWARD ON MEDICAID PRICING, REBATES
Sparked by federal scrutiny, drugmakers examine compliance practices. Medicaid rebates and drug pricing issues are heating up, and drug manufacturers are examining their practices to set things right. The latest example: Bristol, TN-based King Pharmaceuticals says it's adjusting its financial statements to reflect about $46.5 million in Medicaid overpayments between 1998 and 2002. That adjustment arose from an internal review by the audit committee of King's board of directors - a review that was sparked by a Securities and Exchange Commission investigation. The company says the adjustment relates to amounts it underpaid Medicaid under the Medicaid rebate program and other government drug pricing regimes. King has contacted the HHS Office of Inspector General, the Department of Justice and the Centers for Medicare & Medicaid Services on the matter and expects to resolve it later this year. King isn't the first drugmaker to start looking into its compliance practices. Just last week, Bristol-Myers launched an internal compliance review of its sales and marketing tactics. King says it is putting in place more aggressive compliance measures - including new information technology applications - to improve the accuracy of its rebate payments. Lesson Learned: Pharmaceutical manufacturers are well advised to take a close look at their compliance programs now - before the feds force them to the task.
Medicare Compliance & Reimbursement
- Long-Term Care:
BETTER PAY FOR HIGH-QUALITY CARE?
SNFs must prepare for a proposed link between payment and QI data. If a skilled [...] - HIPAA:
HIPAA, UNPREPARED PROVIDERS COULD CAUSE CLAIMS NIGHTMARES
Some provider groups are predicting a claims "train wreck." Three months before the Health Insurance [...] - Long-TermCare:
WHAT THE 2004 ADJUSTMENTS MEAN FOR NURSING HOMES
Industry braces for much-needed cash infusion. Skilled nursing facilities are in for a significant payment [...] - Medicare Reform:
DISCOUNT CARD AGREEMENT PUTS MOMENTUM BACK IN MEDICARE REFORM NEGOTIATIONS... BUT FOR HOW LONG?
House and Senate Medicare conferees have reached a "tentative agreement" on rules for prescription-drug discount [...] - HealthPlans:
WHY HEALTH PLANS HATE THE IDEA OF MEDICARE 'REGIONS'
The White House, House, and Senate all want to ensure health-plan choices for Medicare beneficiaries [...] - DME:
WHEN IS IT OK TO GIVE A FREE UPGRADE?
It's more often than you might think. Some suppliers might be scared off from furnishing [...] - Rehab:
WHAT'S MISSING FROM THE 2004 IRF PAYMENT UPDATE
Controversial 75 percent rule still unsettled. Inpatient rehabilitation facilities will get a 3.2-percent raise in [...] - Hospitals:
CMS PROPOSES 3.8-PERCENT OPPS UPDATE
Hospital payments under the outpatient prospective payment system would get a 3.8-percent increase under the [...] - Pharmaceuticals:
LOOKING INWARD ON MEDICAID PRICING, REBATES
Sparked by federal scrutiny, drugmakers examine compliance practices. Medicaid rebates and drug pricing issues are [...] - Rehab:
HOW RELATED PARTY ISSUES CAN LAND PROVIDERS IN PRISON
When a compensation package is too good to be true. A Missouri rehab operator capped [...] - Physicians:
PHYSICIAN FACES 'SHOCK' PROBATION
Upcoding leads to weekends behind bars Health care fraud enforcers are using the latest trends [...] - HomeCare:
LAWMAKERS COULD TARGET HOME CARE FOR CUTS
It just may have become more difficult to get negative home care provisions out of [...] - Medicare+Choice:
2 FLORIDA M+COS BUSTED FOR MARKETING VIOLATIONS
As the competition to enroll Florida seniors in Medicare+Choice plans heats up, more health plans [...] - PROGRAM MEMO ROUNDUP
Starting Jan. 1, 2004, patients will have a better sense of what's going on if [...]
