Waste Accounts for 25% of Health Care Spending. Addressing Fraud and Abuse Can Help.

It already hurts to hear that the United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product and more than $10,000 per individual.

A report published last week in The Journal of the American Medical Association makes those numbers even more painful as it reveals the estimated cost of waste in the United States ranges from $760 billion to $935 billion, accounting for approximately 25% of total health care spending. This amount exceeds national military spending, as well as total primary and secondary education spending.

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Let the Data Speak for Itself: The Relationship Between Work and Health

Both before and after the Centers for Medicare and Medicaid Services’ (CMS) policy reversal on work requirements, stakeholders have debated whether employment leads to improved health outcomes. CMS and states that have implemented or are trying to implement work requirements argue they do, while others disagree. The recent research of the Kaiser Family Foundation (KFF), a nonpartisan organization, illuminates what the data says on the relationship between work and health. This piece provides a recap of KFF’s findings.

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CMS Continues Mission on Integrity with Affiliations Final Rule

Last week, the owner and CEO of Video Doctor Network pled guilty to a $424 million Medicare kickback scheme. He admitted to receiving kickbacks and bribes from recruiters, pharmacies and brace suppliers in turn for arranging doctors to order medically unnecessary orthotic braces for Medicare beneficiaries. As reported by Healthcare Dive, this is one of the largest schemes to defraud Medicare ever investigated by the Federal Bureau of Investigation (FBI) and the Health and Human Services (HHS) Office of the Inspector General and prosecuted by the Department of Justice.

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HMA Conference Recap

The Health Management Associates (HMA) conference brought together hundreds of industry executives from health plans, governments and community-based organizations serving Medicaid, Medicare and vulnerable populations. Set in Chicago, Illinois, the conference shed a light on the challenges and opportunities for health care entities in the publicly sponsored health care arena.

In case you were not able to attend, here is a recap of the key topics discussed:

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CBO Report: A New Framework on Single-Payer Health Care

Earlier this month, the Congressional Budget Office (CBO) released a report outlining options and technicalities lawmakers need to consider to establish a single-payer health care system in the United States. Although a lot to assess, the “single-payer” term generally refers to a system in which health care is paid for by a single public authority, as stated by Kaiser Health News (KHN). While once a pipe dream, this topic is officially mainstream and cultivating questions quickly.  

Here’s what you need to know: 

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How America is Leveraging Social Determinants of Health

Although Social Determinants of Health (SDoH) has become a buzzword in recent policy conversations, it is still a powerful tool to analyze the social, economic, and environmental factors that influence consumer activity and overall health. If used properly, SDoH have the potential to improve health outcomes and reduce health care utilization and spending.

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