Management & Administration

Why Is Medicare Advantage Overpayment and Fraud So Hard to Stop?
Management & Administration Why Is Medicare Advantage Overpayment and Fraud So Hard to Stop?

The Medicare Advantage program, designed to provide seniors with an alternative to traditional Medicare, has faced persistent issues of overpayments and fraud for over a decade. Despite the numerous efforts by the Centers for Medicare & Medicaid Services (CMS) to address and rectify these

Health Insurers' Executive Security: Balancing Costs and Necessity
Management & Administration Health Insurers' Executive Security: Balancing Costs and Necessity

When considering the financial landscape of health insurance companies, one often contemplates policyholder benefits, premiums, and claims rather than the intricate details of executive security spending. This lesser-known aspect of corporate operations unveils a surprisingly broad spectrum of

How Will Nontraditional Models Transform Primary Care by 2030?
Management & Administration How Will Nontraditional Models Transform Primary Care by 2030?

Primary care in the United States is on the brink of a significant transformation, driven by an evolving mix of traditional and nontraditional providers. By 2030, nontraditional providers are expected to capture around 30% of the primary care market, fundamentally altering how primary care is

Can the GMC Effectively Regulate PAs and AAs Under New Reforms?
Management & Administration Can the GMC Effectively Regulate PAs and AAs Under New Reforms?

The UK's healthcare regulatory framework is undergoing significant changes, with the General Medical Council (GMC) set to include Physician Associates (PAs) and Anaesthesia Associates (AAs) within its scope of regulation starting December 2024. This expansion represents a noteworthy shift in

How Is Ghana Improving Access to Free Dialysis Treatment Nationwide?
Management & Administration How Is Ghana Improving Access to Free Dialysis Treatment Nationwide?

Beginning today, kidney patients across Ghana will have access to free dialysis treatment at twenty accredited health facilities. This significant initiative is a result of efforts by the National Health Insurance Authority (NHIA). With Ghana experiencing a rising prevalence of kidney-related

How Does the Fifth Circuit's NSA Ruling Impact QPA Calculations?
Management & Administration How Does the Fifth Circuit's NSA Ruling Impact QPA Calculations?

The recent decision by the Fifth Circuit Court of Appeals regarding the No Surprises Act (NSA) carries profound implications for how the Qualifying Payment Amount (QPA) is calculated. This intricate ruling touches not only the processes healthcare providers and insurers employ but also

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