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NHCAA Comments on Proposed Changes to MLR Under Medicare Parts C & D

The Centers for Medicare and Medicaid Services (CMS) has proposed significant changes to how medical loss ratio is calculated and reported for Medicare Advantage and Part D plans. If made final, the rule would expand the definition of Quality Improvement Activities (QIA) to include fraud reduction activities, including fraud prevention, fraud detection, and fraud recovery. NHCAA submitted a letter of support.

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Medical Identity Theft

The Office of Inspector General recently released some helpful information and resources on medial identity theft. View the OIG website for more details.

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DOJ Announces Opioid Fraud and Abuse Detection Unit, Followed by Large Drug Diversion Case

On August 2, 2017, Attorney General Jeff Sessions announced the formation of an Opioid Fraud and Abuse Detection Unit as a new Department of Justice (DOJ) pilot program to utilize data to help combat the devastating opioid crisis that is ravaging families and communities across America. The new unit will focus on identifying and prosecuting people who contribute to the nation's prescription opioid fraud and abuse epidemic.

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National Health Care Fraud Takedown

The Office of Inspector General (OIG), Department of Justice (DOJ), Federal Bureau of Investigations (FBI), and other law enforcement partners announced a National Health Care Fraud takedown. This operation marks both the largest number of healthcare fraud defendants (412) and medical professionals charged (115). The loss amount to fraud is approximately $1.3 billion. The takedown specifically targeted the opioid epidemic, including 120 individuals charged in cases involving illegal distribut...

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