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Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging

Kaiser Health News

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. ” The health plan required patients to have an X-ray first to prove a CT scan was needed.

Medicare 107
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Compliance Risks Associated with Outlier Payments 


This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). However, there are certain circumstances when Medicare, for example, will reimburse additional amounts beyond the prospective payment rate.