Vermont To Begin All-Payer ACO Project To Cover Medicare, Medicaid And Commercial Plans
The federal government is giving the state nearly $10 million to help start the experiment, which is designed to more directly reward the quality of care. Also, the nation's largest private nursing home company has agreed to pay $145 million to resolve fraud lawsuits, and Kaiser Health News offers some tips about Medicare enrollment.
Modern Healthcare:
Vermont's All-Payer ACO Will Begin In January
In January, Vermont will become the first state in the nation to move to a voluntary all-payer accountable care organization model, the CMS announced Wednesday. The Vermont program is modeled after a similar one from Maryland, but the Maryland program covers only hospitals. The Vermont ACO will cover Medicare, Medicaid and commercial payers, requiring those who participate to pay similar rates for all services.The CMS is giving Vermont $9.5 million in start-up funding to support the transition. The demonstration, funded through a 1115 waiver, will last five years. (Muchmore, 10/26)
Reuters:
Life Care To Pay Record $145 Mln Over Medicare Fraud Claims
Life Care Centers of America Inc and its owner Forrest Preston agreed to pay $145 million to resolve federal lawsuits accusing one of the largest privately held U.S. nursing home chains of Medicare fraud, the U.S. Department of Justice said on Monday. The accord with the Cleveland, Tennessee-based company is the Justice Department's largest with a skilled nursing facility chain, according to Benjamin Mizer, who heads the department's civil division. As part of the settlement resolving claims under the federal False Claims Act, Life Care also entered a five-year corporate integrity agreement requiring independent annual reviews of its Medicare billings, the department said. (Stempel, 10/24)
Health News Florida:
Life Care Will Pay $145M To Settle Medicare Lawsuit
The U.S. Department of Justice has settled a lawsuit with the nation’s largest private nursing home company. Life Care Centers of America will pay $145 million to settle allegations. It will pay a $45 million down payment, and the rest over three years. Life Care Centers of America has more than 60 nursing homes in Florida, from Jacksonville to Orlando to Fort Myers. The Justice Department alleges the company put patients into the highest levels of therapy so it could bill Medicare at the highest rates. (Aboraya, 10/26)
Kaiser Health News:
How To Enroll In Medicare And Avoid Costly Mistakes
Your 65th birthday is coming up. Soon, you think, the government will send you a packet explaining how to enroll in Medicare — its vast health program for 46 million seniors. Don’t hold your breath. ... Making a mistake can be costly. If you miss enrollment deadlines or make incorrect assumptions about coverage, you may find yourself without insurance protection for several months or incur substantial penalties. (Graham, 10/27)
