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"The public health emergency did not create the telemedicine industry. The wide-ranging report – which focuses only on commercial healthinsurance laws, and not Medicaid rules – notes that, although telehealth coverage has widely expanded, not all of these laws are equally effective at ensuring access to virtual care.
Fast-forward through the 1990s and the advent of PBMs — pharmacy benefit management companies — the intermediaries managing drug benefits for healthinsurance plans. Today, the three largest PBMs, processing about 4 in 5 retail prescription claims, are embedded in large healthinsurance companies.
These include the HealthInsurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), the False Claims Act, and other legislation that governs patient care, billing practices, and safety standards.
Additionally, a whitepaper published in 2021 shows that FFS “with no link to quality or value, still accounted for nearly 40% of all insurer payments, and the majority of payments in Medicaid and commercial insurance.”.
For more insights from the Compliance Institute, download our whitepaper on how compliance professionals can help healthcare institutions mitigate risk.). In March of 2022, a New Jersey rheumatologist was convicted by a federal jury for defrauding Medicare and other healthinsurance programs.
BlackRock partners in the ESI with the Financial Health Network, CommonWealth, the Center for Advanced Hindsight Common Cents Lab, along with UPS, Mastercard, Etsy (whose sellers were the subject of an ESI whitepaper on the pandemic and gig workers’ financial health), Brightside, Acorns, and Arizona State University.
Those good intentions notwithstanding, the current health data landscape is dramatically different from when the organizational author of the plan, the Office of the National Coordinator for Health IT, formed two decades ago.
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CMMI has broad statutory authority not only to test, design, and implement health care payment and delivery models for Medicare, Medicaid, and the Children’s HealthInsurance Program (CHIP) but in certain instances, can implement such models without Congressional action.
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