31 Oct 2018

CMS SEEKS COMMENT ON PROPOSED RULE TO USE IPI PAY MODEL BY DEC 31

The Centers for Medicare & Medicaid Services intends to test whether phasing down the Medicare payment amount for selected Part B drugs to more closely align with international prices will meet President Trump’s blueprint to lower drug costs and reduce out-of-pocket costs for patients. CMS is soliciting public comments by

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18 Oct 2018

24 MEDICARE ADVANTAGE PLANS AND 27 MEDICARE PART D DRUG PLANS AVAILABLE DURING 2019 OPEN ENROLLMENT PERIOD

With Medicare Advantage playing an increasingly larger role in Medicare, the average person on Medicare will be able to choose among 24 plans during the annual Medicare open enrollment period that began Oct. 15, according to a new analysis from KFF (the Kaiser Family Foundation). The new analysis, Medicare Advantage

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18 Oct 2018

HHS FINES ANTHEM $16 MILLION FOR LARGEST BREACH IN U.S. HISTORY

            Anthem has been hit with a $16 million fine from the federal government as part of a settlement from its massive January 2015 breach, according to HealthData Management. That incident was a result of a cyberattack that enabled hackers to access the electronic protected health information of nearly 79

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16 Oct 2018

DRUGMAKERS FUNNEL MILLIONS TO LAWMAKERS; A FEW DOZEN GET $100,000-PLUS

  By Emmarie Huetteman and Sydney Lupkin Before the midterm elections heated up, dozens of drugmakers had already poured about $12 million into the war chests of hundreds of members of Congress. Since the beginning of last year, 34 lawmakers have each received more than $100,000 from pharmaceutical companies. Two

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16 Oct 2018

CMS PROPOSAL TO REQUIRE MANUFACTURERS TO DISCLOSE DRUG PRICES IN TV ADS COMMENTS DUE BY DEC. 17

  The Centers for Medicare & Medicaid Services proposed Oct. 15 to require that prescription drug manufacturers post the Wholesale Acquisition Cost (WAC) for drugs covered in Medicare or Medicaid in direct-to-consumer television advertisements. “This historic proposal is an important way to create new incentives for drug companies to start

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16 Oct 2018

TELEMEDICINE GIANT HEALTHRIGHT, 4 COMPOUNDING PHARMACIES CHARGED WITH $1 BILLION FRAUD

  HealthRight CEO Scott Roix of the telemedicine company HealthRight pleaded guilty to felony conspiracy charges brought by the Department of Justice. Roix and the company also pleaded guilty to conspiring to commit wire fraud associated with a telemarketing scheme to sell dietary supplements, skin creams and testosterone to patients. Roix and the

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09 Oct 2018

CMS ANNOUNCES PARTICIPANTS IN NEW VALUE-BASED BUNDLED PAYMENT MODEL

  On Oct. 9, the Centers for Medicare & Medicaid Services (CMS) announced that 1,299 entities have signed agreements with the agency to participate in the Administration’s Bundled Payments for Care Improvement – Advanced (BPCI Advanced) Model.  The participating entities will receive bundled payments for certain episodes of care as

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28 Sep 2018

SEEMA VERMA SPEECH: CMS TO BEGIN AUDITS ON MEDICAID INSURERS

Seema Verma, Centers for Medicare & Medicaid Services Administrator, issued a warning to Medicaid plan sponsors on Thursday, warning the agency would begin unscheduled targeted financial audits. The warning came at the 2018 Medicaid Managed Care Summit during a speech Verma delivered in which she vowed to bring more transparency to

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27 Sep 2018

SPEECH: CMS ADMINISTRATOR SEEMA VERMA’S REMARKS AT THE 2018 MEDICAID MANAGED CARE SUMMIT SEPT. 27

It is great to be back in front of a room full of professionals dedicated to improving the lives of Medicaid beneficiaries. For me, it’s a little like coming home. I see the faces of the people out working on the front lines, of transforming the American health care system,

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29 Aug 2018

MEDICAL GROUPS, PATIENT ADVOCATES OPPOSE MEDICARE PLANS TO CONSOLIDATE E/M CODES

More than 150 medical groups sent a letter opposing a government plan to consolidate evaluation and management (E/M) codes, saying it could underpay doctors who treat the sickest patients. In a letter sent to Seema Verma, administrator of the Centers for Medicare & Medicaid Services, the groups — including the American Medical Association

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