still missing payment mechanism; How to work effectively with law enforcement to fight fraud;

News From Around the Web

>'s back-end mechanism to reconcile payments between the government and insurers remains inactive, forcing insurers to manually bill the government for subsidies and cost-sharing plans, Fox Business reported. Article

> New legislation that would provide a 12-month patch for relief from the sustainable growth rate (SGR) formula also would deliver good news to Medicaid expansion opt-out states--a one-year delay to Medicaid disproportionate share hospital (DSH) payment cuts, The Washington Post reported. Article

> The gap between what Canadian insurers take in and what they pay out has increased threefold over the past twenty years, according to a study published in the Canadian Medical Association Journal. Announcement

Healthcare Fraud Prevention News

> Payments for diabetic supplies can be worth investigating because fraud, waste and abuse related to these items have gouged Medicare and Medicaid, according to an Office of Inspector General spotlight report. Article

> FierceHealthPayer: Anti-Fraud interviewed two field experts who shared their best advice on how payers can improve relationships with law enforcement to serve the mutual interests of both. Article

And Finally... Don't mess with the birthday girl's playlist. Article

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