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Congressional Hearings Question Minnesota Medicaid Managed Care

On April 25, 2012, the Joint Congressional Committee on Oversight held hearings on the question, “Is government adequately protecting taxpayers from Medicaid fraud?”. The committee heard testimony...

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Most Current Individual Insurance Plans Are Not Exchange-Worthy

More than half of the individual health insurance policies in effect in 2010 fell below the minimum threshold that individual policies will have to meet starting in 2014, according to a study published...

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End of Week Roundup

This week, the FDA advised against expanding the use of drug Xarelto for acute coronary syndrome. A study found that, in 2010, over half of all individual health insurance policies failed to meet...

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What’s All This About the Death Spiral for Health Insurance Coverage?

Anyone and everyone with an interest in the healthcare system is anxiously awaiting the Supreme Court’s decision on the validity of the Patient Protection and Affordable Care Act. Will the individual...

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Health Reform Law Implementation Continues After Supreme Court Decision

In the wake of the U.S. Supreme Court’s decision upholding, for the most part, the Patient Protection and Affordable Care Act (P.L. 111-148), the Obama Administration is continuing its impelemtation of...

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Chief Justice Robert’s PPACA Opinion: Conservative and True To Form

Despite allegations of the opposite, the PPACA-related opinion of Chief Justice Roberts is a very conservative opinion, even though the effect of it is to join with the liberal justice who voted to...

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Do Medicaid Managed Care Plans Succeed Financially?

Can a company actually make a profit managing—and paying for— the care of Medicaid beneficiaries? CMS and the Commonwealth Fund recently published a study on the financial health of Medicaid managed...

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What Will Enrollees in the New Health Exchanges Look Like?

In about one year from now approximately 12 million individuals will begin looking for health insurance coverage by using a health insurance exchange authorized by the Affordable Care Act (ACA) (P.L....

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Lessons From Kentucky’s First Year of Medicaid Managed Care

For months, Kansas Governor Sam Brownback has planned to implement KanCare, a mandatory, statewide Medicaid managed care program, on January 1, 2013. CMS has not yet approved the waiver request, and on...

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How Did Consumers Benefit from the Medical Loss Ratio and Rebate Requirements?

A recent study published by the Commonwealth Fund examined the effects of the medical loss ratio (MLR) requirement on premiums and costs. Specifically, the authors, Michael McCue and Mark Hall,...

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Should Fraud Prevention Expenditures Be Counted as Incurred Costs in the...

On June 20, 2013, the HHS Office of Inspector General (OIG) issued a report entitled “Prescribers With Questionable Patterns in Medicare Part D.” The report concluded that over 700 general-care...

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Milliman Updates Analysis of Medicaid HMO Profitability

For the fifth consecutive year, Milliman Research  has issued an analysis of the financial performance of Medicaid managed care organizations (MCOs). Authors Jeremy Palmer  and Christopher Pettit have...

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Overpayment Solutions Require Multipayer Data, Payer/Provider Collaboration

For health care providers and payers, investigating and resolving overpayment issues is costly. Solving health care claims overpayments takes leveraging technology across multiple payers and the...

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