The instructions alone stretch out for 291 pages. The completed form (CMS-2552-10, if you're playing along at home) prints out into a stack of papers more than an inch thick. And the audit and reimbursement process lasts for years — even if there are no appeals. Welcome to the complex and opaque realm where the federal government pays hospitals for services to patients covered by Medicare. And then hospitals justify the expenditures for which they have been reimbursed. And then third-party auditors review those justifications. It's as exciting as it sounds.
Health care is vital to Charlotte's economy when it comes to jobs and economic impact. The industry employs more than 116,500 people in the region — roughly 11 percent of the area's population. And the health and life-sciences sector had a total economic impact of $27.7 billion last year. "It's really a big engine for this community, relative to growth, job growth and economic growth," says Alan Sauber, chief ethics and compliance officer at Premier Inc. But the health-care industry is facing pressure as it braces for changes tied to how health care is delivered and paid for,Michael Tarwater, chief executive of Carolinas HealthCare System, told roughly 450 in attendance at the Charlotte Chamber's annual health-care summit.
Health care is full of buzzwords. The latest is "engagement." The theory behind it is that all will be well if we can just get people—especially those with chronic diseases—more involved with their illnesses. But what if the opposite is true? Let's do a simple experiment. Imagine you have a chronic disease. Someone approaches you, asking whether you'd like to be more engaged with your diabetes or lupus or Crohn's disease. Whether you actually have one of these conditions or not, you can easily imagine that your answer would be a categorical "no."
Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital or United Way. Some hospitals in New York, Florida and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law's marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care. But the hospitals' efforts have set up a conflict with insurers, who worry that premium assistance programs will skew their enrollee pools by expanding the number of sicker people who need more services.
The Food and Drug Administration is warning consumers about fake drugs, vaccines and supplements being sold online as treatments to cure or prevent Ebola. The regulatory agency issued an alert Thursday reminding consumers that only the FDA has authority to approve a drug or vaccine, and has not yet approved any products as a treatment for the disease. The warning comes amid a massive outbreak of the Ebola virus, which has killed over a thousand people in West Africa. "Since the outbreak of the Ebola virus in West Africa, the FDA has seen and received consumer complaints about a variety of products claiming to either prevent the Ebola virus or treat the infection," said the agency.
Eleven armed FBI agents crept around a stone-and-glass house here just before dawn. An AR-15 rifle and four other guns were registered to the man in the house. "FBI warrant," the agents called out, and a man in a T-shirt and shorts emerged. It was no drug lord. The target was a doctor who moonlighted as a movie producer with an Alec Baldwin comedy to his credit. The Justice Department charged the doctor, Robert A. Glazer, with writing prescriptions and certifications resulting in $33 million of fraudulent Medicare claims. The raid in May capped a year-long investigation by the Medicare Fraud Strike Force, a joint effort by the Justice Department and Department of Health and Human Services. [Subscription Required]