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NASHP Model Act to Limit Out-of-Network Provider Rates

NASHP

1002(32), but excludes any coverage by Medicare, Medicaid, TRICARE, Veterans Administration, Indian Health Services, and the Federal Employee Health Benefit Plan. If a health benefit plan does not reimburse claims on a fee-for-service basis, the payment method used must take into account the limits specified in subsection (2)(A).

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Exposing Healthcare Fraud with Jonathan Tycko| E. 68

Vie Healthcare

And as you know, obviously a huge percentage of healthcare spending is funded through Medicare, Medicaid, Tricare, the VA system, and these are all programs that are covered by the False Claims Act. It’s a highly regulated industry. So the actual amount of fraud is probably some multiple of that.

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Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties

KHN

They argued the procedures were done needlessly, in keeping with a corporate strategy to maximize profits by overtreating kids from lower-income families enrolled in Medicaid. Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar.

Doctors 145
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Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties

KHN

They argued the procedures were done needlessly, in keeping with a corporate strategy to maximize profits by overtreating kids from lower-income families enrolled in Medicaid. Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar.

Doctors 52