article thumbnail

NASHP Model Act to Limit Out-of-Network Provider Rates

NASHP

1002(32), but excludes any coverage by Medicare, Medicaid, TRICARE, Veterans Administration, Indian Health Services, and the Federal Employee Health Benefit Plan. If a health benefit plan does not reimburse claims on a fee-for-service basis, the payment method used must take into account the limits specified in subsection (2)(A).

article thumbnail

Exposing Healthcare Fraud with Jonathan Tycko| E. 68

Vie Healthcare

And as you know, obviously a huge percentage of healthcare spending is funded through Medicare, Medicaid, Tricare, the VA system, and these are all programs that are covered by the False Claims Act. It’s a highly regulated industry. So there’s that instinctual resistance to it. That you have to deal with compliance.

Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties

KHN

Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar. Some injured patients are turning to the courts in hopes of holding the firms accountable for what the patients view as lapses in care or policies that favor profits over patients.

Doctors 145
article thumbnail

Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties

KHN

Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar. Some injured patients are turning to the courts in hopes of holding the firms accountable for what the patients view as lapses in care or policies that favor profits over patients.

Doctors 52