Medicare’s Program Integrity Transformation

Medicare has been considered a “High Risk program” by the Government Accountability Office since 1990 due to its size, complexity and susceptibility to improper payments. In 2018, improper payments accounted for 5% of the total $616.8 million of Medicare’s net costs.

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What You Need to Know: Proposed Reforms to the Federal Anti-Kickback Statute and the Stark Law

Last week, the Department of Health and Human Services (HHS) published two proposed rules: “Modernizing and Clarifying the Physician Self-Referral Regulations” and “Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements.” This piece provides a recap of the main points and motivations in each rule.

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The Departments Issue Final Rule on HRAs

According to the Centers for Medicare and Medicaid Services (CMS), health reimbursement arrangements (HRAs) are a type of account-based health plan that employers can use to reimburse employees for their medical care expenses. Because HRAs are tax-preferred, workers who buy an individual market plan with an HRA receive the same tax advantages as workers with traditional employer-sponsored coverage, as stated by the Department of Health and Human Services

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Gaining Consumer Trust in a Digital World

Out with the fax machine, in with the smartphone. In early February, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released two proposed rules regarding interoperability. Much of the rules’ buzz centers on the standardization of APIs to make sharing patient data more useful and transferable. With Apple’s Health Records already having met these standards, one can imagine the number of apps and businesses eager to take advantage of the gap in interoperability and optimize personal health information (PHI).  

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Waiver Program to Offer States Increased Flexibility

On October 22, 2018, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Treasury jointly announced new guidance overhauling the 1332 Waiver process, which will take effect in 2020. With modification of the 1332 waiver process, the new policy will address states’ request for greater flexibility. It will also permit states to use waivers to increase choice and competition within their insurance markets, use subsidies to help consumers afford health coverage, and introduce new flexibilities.  

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