Medicare & Medicaid Costs and Increased Scrutiny


Almost two years ago in April 2014, the Centers for Medicare and Medicaid Services (CMS) released for the first time in 35 years data outlining provider reimbursements. A Wall Street Journal article noted at the time that the data released, which was from Calendar Year 2012, indicated the “top 1% of 825,000 individual medical providers accounted for 14% of the $77 billion in billing recorded in the data”. While this data is not new to the fraud investigators it certainly sheds a light for the public as to where the investigators might focus their efforts. [More]


Capitation - One Alternative to a “Fee for Service”


One can hardly escape conversations about “change” in healthcare circles today. Changing demographics, changing industries, changing regulations; the list continues. However, one change, the change in provider reimbursement, is pervasive. We hear constant sound bites concerning the “movement away from the 'fee for service' model,” but movement toward what? If we are not reimbursing providers for procedures conducted, how are we measuring healthcare delivery and how is it paid for? [More]