All Articles In 'Compliance'
Health Care Fraud: Using Health Services Research to Detect Fraud and Abuse
Fraud in the health care system is a significant and growing threat. The FBI estimates that between 3% and 10% of all health care expenditures are lost to fraud each year – up to $280 billion [...]
Medicare Drug Benefit: Formulary Oversight in Medicare Part D
Medicare Part D, the Medicare drug benefit, served roughly 31 million seniors last year. Medicare Part D is more similar to Medicare Advantage than to traditional Medicare in that enrollees can choose among several private health [...]
State Tort Liability for Generic Prescription Drugs: SCOTUS Pharma and Biotech Case Previews
Generic drugs have operated under a different set of rules than brand-name drugs since 1984, when Congress passed the Drug Price Competition and Patent Term Restoration Act of 1984, or Hatch-Waxman Act. Brand-name drug manufacturers must [...]
Medicaid Program Integrity: Federal Investigations, Audits, and Evaluations to Combat Medicaid Waste, Fraud, and Abuse
In its latest Medicaid Integrity Program Report, the HHS Office of Inspector General (OIG) outlines Medicaid program integrity activities for FY 2011, including Medicaid-related audits and evaluations and Medicaid-related legal and investigative outcomes. Funding was employed [...]
Prescription Drug Pricing: Estimating Generic Drug Cost Savings
Prescription drug spending rose by $135 billion between 2001 and 2010 to comprise approximately 12 percent of the nation’s overall healthcare outlay. While drug expenditure was one of the fastest growing components of U.S. healthcare spending [...]
Medicaid: Recommendations for Strengthening Medicaid Program Integrity
Federal and state Medicaid spending currently exceeds $460 billion and, with this, accountability is necessary on all levels. To ensure Medicaid program integrity: Consistent incentives must be offered for better health outcomes. Services must be used [...]
Medicare and Medicaid Compliance: OIG Advice for Operating an Effective Compliance Program
Comprehensive compliance programs are essential for all hospitals, health systems, physician practices, Medicare Advantage plans, Medicaid health plans, Medicare prescription drug plans, drug manufacturers, medical device makers, long-term care providers, and others doing business with Medicare, Medicaid, or [...]
Compliance Challenges of Health Reform: Questions Compliance Professionals Should Ask as They Prepare for Health Care Reform
With an array of payment reforms, quality and safety requirements, massive expansion of Medicaid, and creation of the new State Health Benefit Exchange marketplace, the Affordable Care Act (ACA) presents extraordinary new challenges for compliance, especially [...]
Direct-to-Consumer Advertising of Prescription Drugs: Legal, Policy, Market, and Public Health Issues for Potential Bans on DTC Advertising of New Brand Drugs
Direct-to-Consumer (DTC) advertising of prescription drugs, especially new brand-named drugs, remains controversial. Some in Congress remain eager to prohibit advertising of brand-name prescription drugs to consumers in the first two years following a drug’s approval by [...]
Medicaid Fraud and Abuse: Investigations, Prosecutions, Spending, and Staffing by State Medicaid Fraud Control Units in 2010
Nearly every State has a Medicaid Fraud Control Unit (MFCU) to investigate and prosecute cases of Medicaid fraud and patient abuse and neglect. MFCUs are a key part of an array of federal and state agencies combating [...]
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