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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. B) A health care provider that violates any provision of this act or the rules and regulations adopted pursuant hereto shall: i. 1) Definitions. 5) Enforcement. (B)

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Zelis Unveils New In-Network Pricing Solution for Streamlined Claim Processing

HIT Consultant

Extensive Program Support: Handles commercial, Medicaid, Medicare, Tricare, and more. We understand that navigating complex stakeholder relationships and evolving healthcare regulations requires more from a cost management partner than strictly managing cost,” said Jay Deady, President of Price Optimization for Zelis.

Tricare 52
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To Stay On Right Side Of Referral Relationships, Here’s What Home-Based Care Providers Should Know

Home Health Care

However, providers need to be sure they’re not running afoul of the federal laws, or the state law equivalents, that regulate the financial relationships between agencies and their referral sources. Providers that violate these laws can be excluded from participating in federal health care programs, such as Medicare and Medicaid.

Tricare 93
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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 the actual amount of fraud is probably some multiple of that.

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

KHN

They argued the procedures were done needlessly, in keeping with a corporate strategy to maximize profits by overtreating kids from lower-income families enrolled in Medicaid. Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar.

Doctors 145
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Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties

KHN

They argued the procedures were done needlessly, in keeping with a corporate strategy to maximize profits by overtreating kids from lower-income families enrolled in Medicaid. Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar.

Doctors 52