Sunday Links

Your Fortress of Solitude

 

Private Medicare Advantage Could Hit 70%

So says Forbes

It won’t

Not without explicit coercion of beneficiaries from the government.

The emphasis on peripheral benefits will erode the core function of the program—covering  healthcare costs.

If I’m wrong and the programs expands in its current form—it will provide a compliance free superhighway into the heart of the Federal Budget.

It will bankrupt us all.

 

 

Two more firms entering the Medicare Advantage consulting space.

This is my competition. They’re coming out of the woodwork.

Attracted by the scent of a river of cash flowing through the system

Larger organizations see them as the safer choice.

They’re all about redirecting data and clinician workflow and nothing about the relationship between the patient and clinician and creating compensation systems that give the clinician skin in the game.

They satisfy the boss that “something is being done” but in general rarely deliver true value.

That’s because they’ve never actually practiced under the system with their own skin in the game, with their practice on the line and to put food on the table.

Theirs is one level of expertise.

Mine is another.

 

Is the DOJ depending on outmoded FCA theory to pursue fraud claims?

I don’t usually link to articles behind firewalls, but if your in the compliance business or potentially at risk for a whistleblower claim, then this is a must read.

It shows how systems and insurers are currently defending FCA accusations in court.

Whether or not the thesis of this article is correct, what’s undisputed is that Medicare Advantage has grown too complex for the successful prosecution of all but the egregious cases of fraud.

The FCA is outmoded indeed.

For far too many organizations “plausible deniability” is the compliance strategy they take.

Over code for $100, get caught and pay back $50, pocket the rest.

Keep yourself squeaky clean.

The bill will eventually come due.

 

TOMISM

Always bet on self-interest. It’s the only horse in the race that’s trying.

It applies to PCPs, too.