Auditors say the increase coincided with an overall increase in Medicaid enrollment during the first year of the pandemic. The value of improper Medicaid capitation payments made by states to managed ...

Ohio charges the estates of deceased Medicaid recipients sometimes more than the cost of services they received, a practice not recommended by a national advisory group, a Dayton Daily News ...

BOSTON, Mass. (SHNS)–MassHealth errantly paid more than $84 million related to care for residents who were living in other states, Auditor Diana DiZoglio’s office concluded in a new report that the ...

MassHealth errantly paid more than $84 million related to care for residents who were living in other states, Auditor Diana DiZoglio’s office concluded in a new report that the executive branch ...

The Centers for Medicare & Medicaid Services (CMS) was very busy last week! On Jan. 30, CMS issued its long-awaited Risk Adjustment Data Validation (RADV) Final Rule. Two days later, it published its ...

In a unanimous decision filed Monday, November 20, 2023, the Minnesota Court of Appeals affirmed a district court opinion that limits medical assistance claims against estates to only the amount of ...

Established healthcare organizations, whether it be health systems, accountable care organizations, or independent provider groups often grapple with the dilemma of fully embracing risk. Fears of ...

Despite efforts to shift provider payment away from fee-for-service and toward more risk-based alternatives, fee-for-service remains dominant -- and is growing, according to a study published in ...

Jointly authored by administration leaders, a recent New England Journal of Medicine Perspective reflects on the past and lays out a future vision for accountable care organizations (ACOs) that ...