Earlier this month, the Centers for Medicare & Medicaid Services (“CMS”) introduced plans to implement a new strategy for fraud audits used by Medicare administrative contractors (“MACs”). Under the new program, MACs will target only those providers and suppliers with the highest claim error rates or billing practices that vary significantly from their peers. Current processes permit MACs to largely flag and challenge claims at random, which has led to a crushing backlog of pending appeals. The new program is designed to address such concerns. It is expected that this new audit strategy will result in fewer providers and suppliers
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On Tuesday, August 1, 2017, the Senate Health Committee (the “Committee”) announced hearings, to take place in September, on the issue of stabilizing the individual health insurance market. The announcement of these hearings is in response to continued legislative efforts to repeal Obamacare and President Trump’s threats to stop paying insurance companies cost-sharing subsidies, currently availed under Obamacare, that reduce out-of-pocket expenses for low-income policyholders. Republican Senator Lamar Alexander, Chair of the Committee, is working with Democratic Senator Patty Murray to make the hearings bipartisan. Congress must develop a solution before September 27th, when insurers enter into contracts with the
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