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Tennessee claimed $1B in improper uncompensated care, audit finds

Tennessee’s Medicaid program did not comply with federal requirements for claiming uncompensated care at public hospitals as certified public expenditures, exceeding the allowed claim amount by $1.1 billion, according to a recent audit. The Health and Human Services Department’s Office of Inspector General report found that for state fiscal years between 2009 and 2014, Tennessee claimed a total of $2 billion in certified public expenditures. Of this amount, only $909.4 million was allowable and supported. TennCare claimed $482.1 million in excess certified public expenditures that it did not return after…

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CMMI and its revised strategy – Healthcare Economist

Created by Section 3021 of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Innovation (CMMI; aka The CMS Innovation Center) has been tasked with creating new reimbursement strategies to improve quality and decrease costs. Over the past decade, CMMI has tested over 50 new payment models, and in just the last 3 years (2018-2020) CMMI models have reached almost 28 million patients and over half a million health care providers and plans. Despite these ambitious goals, CMMI reports that “only six out of more than 50 models…

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Oak Street Health buys virtual specialty-care firm RubiconMD for $130M

Oak Street Health on Thursday said it acquired RubiconMD, a startup that provides telehealth specialty consults to primary-care doctors. The primary-care provider purchased RubiconMD for $130 million in cash, with the potential for an additional up to $60 million in cash or a cash-and-stock combination based on performance milestones. Oak Street, which went public last year, offers a capitated model of managing care for high-needs Medicare patients. The company plans to integrate RubiconMD’s services so that its clinics can provide virtual specialty consults, which will allow its primary-care doctors to…

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Beaumont suspends 370 workers over COVID vaccine mandate

Just over 1 percent of Beaumont Health System’s workforce, or 370 of its roughly 33,000 workers, were suspended this week for not receiving the COVID-19 vaccine, the system told Crain’s Thursday. The Southfield-based health system announced all employees, contractors and vendors had to receive the vaccine for continued employment in late July with a later established Oct. 18 deadline. The 370 workers have until Nov. 16 to receive the vaccine or their employment will be terminated, Mark Geary, head of communications for Beaumont, told Crain’s in an email. An additional…

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Massachusetts hospital workers lose bid on vaccine mandate

A federal judge denied a request by several employees at the largest hospital system in Massachusetts for an injunction to block the company from placing them on unpaid leave for violating the system’s COVID-19 vaccine mandate. But the judge on Wednesday did not rule on the issue of whether the workers at Mass General Brigham were the victims of discrimination for being denied medical or religious vaccination exemptions. “This is a tentative decision based on an incomplete factual record and legal analysis,” U.S. District Court Judge Dennis Saylor said. Another…

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CMS official questions future of Medicare Advantage payments

A top official with the Centers for Medicare and Medicaid Services questioned the future of Medicare Advantage payments Thursday, pointing to studies from government watchdogs and experts. The Office of Inspector General for the Health and Human Services Department suggested Medicare Advantage plans may be making their beneficiaries look sicker than they really are to maximize payments from the federal government. “We too are very concerned with the overall trend lines for code growth in the MA program versus the overall fee-for-service program,” said Jonathan Blum, principal deputy administrator of…

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