- PDS Health opens practices in California, Virginia
- OHSU opens $650M cancer pavilion
- Lakeland Regional Health plans 2 freestanding EDs
- Supreme Court backs challenge to Colorado conversion therapy ban
- Virginia behavioral health hospital names president
- After Man’s Death Following Insurance Denials, West Virginia Tackles Prior Authorization
- FTC: Evidence too strong to toss USAP antitrust case
- Average tuition for 12 best dental schools in the US
- Lifepoint Health to acquire 8 ScionHealth hospitals
- The Hospitals Winning on LOS Have Better Technology – and They Know How to Use It.
- New York medical society demands physician privileges be protected in Maimonides merger
- 4 hospital, health system layoffs in March
- Texas to lead ibogaine research after pharma proposals fall short
- Advocate plans largest drone delivery network and 2 more supply chain updates
- AI scribes linked to time savings at 5 health systems
- New Hampshire ASC 1st in US to earn new accreditation
- Amgen drug under FDA review in wake of 8 deaths
- Hennepin Healthcare warns of closure without legislative funding
- Hennepin Healthcare warns of closure without legislative funding
- Visa renewal delays sideline physicians at US hospitals
- BayCare residency program size doubles on Match Day gains
- Ohio GI practice acquired
- Health systems rethink innovation
- 8 revenue cycle headlines to know from March
- Prisma Health plans ASC in Tennessee
- Bill takes aim at ASC, HOPD payment gap
- Ensemble, Cohere building first RCM-native LLM
- Honey Almond Cream Cheese, Sold at Einstein Bros. Bagels, Recalled Due To Undeclared Nuts
- Trump Supports Surgeon General Pick Despite Senate Concerns
- Tennessee orthopedic practice closes abruptly
- 4 health systems back in the black in 2025
- ‘Our stockholders are the members of our community’: Inside Carilion Clinic’s mission-driven margin strategy
- Lilly answers Novo's GLP-1 pill with highly anticipated FDA nod for Foundayo
- Supreme Court Blocks Colorado Limits on Therapy for LGBTQ Minors
- Antidepressant Might Help Long COVID Fatigue, Study Says
- Home-Delivered Groceries Boost Heart Health In Food Deserts, Study Says
- Nicotine E-Cigarettes Help Smokers Quit, Review Concludes
- Kinesio Taping’s Benefits in Doubt, Major Evidence Review Finds
- High Sodium Intake May Trigger New Heart Failure
- Study Shows BMI Often Gets Your Weight Category Wrong
- Clinicians are burnt out. Peer support can help
- Novo's Wegovy nets cardio nod from UK cost gatekeeper, adding 1M+ eligible patients
- Trump’s One Big Beautiful Bill Act Darkens Outlook for Government-Backed Clinics
- Readers Sound Off on Wage Garnishment, Work Requirements, and More
- CVS Health opens pharmacy-only locations as it rightsizes store footprint
- How Rural Health Systems Are Advancing Cardiac Imaging
- How Rural Health Systems Are Advancing Cardiac Imaging
- Beyond Reimbursement: Why Market Access is MedTech’s Strategic North Star
- Beyond Reimbursement: Why Market Access is MedTech’s Strategic North Star
- Evotec hires exec with AI experience to lead rebooted commercial team
- The Human Side of AI Medical Devices: Why Safety Depends on Design, Not Just Algorithms
- The Human Side of AI Medical Devices: Why Safety Depends on Design, Not Just Algorithms
- Whoop raises $575M series G, Abbott comes on board amid hiring spree
- True ROI of health tech, according to finance leaders
- ‘There isn't as much meat left to cut’: Biopharma layoffs maintain slowdown in Q1
- Where 6 specialty DSOs stand in 2026
- 16 new ASCs in March
- Intermountain joins national trauma, grief network
- Practice closures, new dental schools, DLRs & more: 6 dental updates in New York
- Workforce, patient care, private equity & more: 5 statistics scaring dentists
- American Society of Addiction Medicine updates youth treatment standards
- The shifting oral surgery landscape
- Moody’s upgrades UK King’s Daughters’ credit rating
- Private equity in dentistry has gotten smarter
- 7 DSO leadership changes to know
- University Hospitals swings from loss to 2.6% margin in 2025
- Mark Cuban backs bill to break up vertically integrated insurers
- Lawmakers introduce child suicide prevention bill
- Bipartisan bill introduced to stabilize physicians' year-to-year pay changes
- Dental lab group receives private equity investment
- Dental Care Alliance appoints chief revenue officer
- UnitedHealthcare launches Avery, a generative AI companion for members
- 14 behavioral health executive moves to know
- Missouri agencies warn of rising nitazene threat
- Only 44% of SUD treatment facilities accept older patients on Medicare: HHS report
- 7 state behavioral health policy updates
- Republicans eye further healthcare cuts: Report
- Uninsured patients drive nearly 40% of healthcare collections: Cedar survey
- FDA flags serious liver injury cases, 8 deaths with ‘reasonable’ link to Amgen's Tavneos
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- HHS urges hospitals to align patient menus with updated dietary guidance
- Hartford HealthCare, K Health launch PatientGPT, new AI tool to help patients find health information
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Medicaid covers approximately 22% of Michiganders:
https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2023/08/22/mihealthylife
MDHHS moving forward with MIHealthy Life to provide improved access to care for Medicaid health plan enrollees
By Lynn Sutfin - August 22, 2023
Department rebidding contracts that serve 2.2 million Michiganders
LANSING, Mich. – The Michigan Department of Health and Human Services (MDHHS) today provided new information related to the rebidding of contracts for health plans that provide services to 2.2 million Michiganders receiving coverage through Medicaid and Michigan’s Healthy Michigan Plan.
MDHHS is announcing network requirements and minimum qualifications for bidders in its upcoming request for proposals for the Comprehensive Health Care Program contract for Michigan’s Medicaid health plans.
“We want to provide Michiganders served by Medicaid health plans with a more equitable, coordinated and person-centered system of care,” said Elizabeth Hertel, MDHHS director. “Through this rebid process, MDHHS seeks to provide improved affordable health care coverage for Michiganders served by Medicaid health plans.”
The contract is being rebid during fiscal year 2024, which begins Oct. 1, with new contracts beginning in fiscal year 2025. The rebid is part of MIHealthyLife, an initiative to strengthen Medicaid services informed by input from nearly 10,000 enrollees and family members, health care providers, health plans and other community partners.
Consistent with federal standards and input from MIHealthyLife stakeholders, the rebid will include updates to Michigan’s Medicaid Health Plan network adequacy and timely access standards, which can be found at Michigan.gov/MDHHS/MIHealthyLife.
When determining whether these standards are met, MDHHS will only consider providers with whom bidders have executed contracts at the time of bid submission. MDHHS is releasing its updates to Comprehensive Health Care Program network adequacy and timely access standards in advance of the rebid to provide time for potential bidders to review their provider networks and execute provider contracts necessary to meet the new standards.
MDHHS’s new Medicaid Health plan network adequacy and timely access standards can be found at Michigan.gov/MDHHS/MIHealthyLife, along with mandatory minimum requirements Medicaid Health Plans must meet in order to qualify for review under the rebid.
In addition, the request for proposals will incorporate several Comprehensive Health Care Program changes intended to advance the MIHealthyLife pillars. These include:
- A commitment to health equity demonstrated by plans achieving the NCQA’s Health Equity Accreditation, beginning the process no later than Oct. 1, 2024.
- A strong emphasis on addressing social determinants of health demonstrated by investment and engagement with community-based organizations.
- Efforts to increase childhood vaccination rates, including increasing provider participation in the Vaccines for Children Program.
- Adoption over time of a more person-centered approach to mental health care coverage.
The Medicaid Health Plan request for proposals will be posted to the SIGMA system in Fall 2023, with responses due in January 2024. New contracts resulting from this rebid are scheduled to begin on Oct. 1, 2024. MDHHS reserves the right to change mandatory minimum requirements, dates or any other information deemed necessary.
Go to Michigan.gov/MDHHS/MIHealthyLife for more information. Questions about MIHealthyLife can be sent to mdhhs-mihealthylife@michigan.gov. Procurement-related questions can be sent to Samuelb@michigan.gov.
Will the rebidding prevent $ 500 million Medicaid frauds like this?
Metro Detroit doctor to pay $6.5M over fraud health care fraud claims
Charles E. Ramirez - August 29, 2023A Metro Detroit doctor and his three Macomb County pain management clinics have agreed to pay $6.5 million over claims he scammed the federal government, officials said.
Rajendra Bothra and his businesses, the Pain Center USA PLLC and Interventional Pain Center PLLC, agreed to the settlement to resolve allegations that they billed Medicare and Medicaid for unnecessary treatments, drug tests and braces, federal officials announced Monday.
"When healthcare providers manipulate the Medicaid and Medicare systems, it wastes resources meant to help those in need," Devin Kowalski, Acting Special Agent in Charge of the FBI’s Detroit Field Office, said in a statement. "This settlement brings to bear some economic justice by requiring those who orchestrated the fraud scheme to pay for their actions."
The alleged fraud took place between Jan. 1, 2015, and Dec. 31, 2018, said Dawn Ison, U.S. Attorney for the Eastern District of Michigan.
Bothra and federal authorities are not strangers to each other.
In 2018, federal officials indicted Bothra and five other doctors who worked for him at his clinics on charges they cheated Medicare and Medicaid out of almost $500 million by illegally prescribing more than 13 million doses of prescription pain medication.
They also alleged the doctors forced patients to undergo painful, unnecessary or ineligible medical procedures in exchange for illegally receiving pain medication, including OxyContin, Vicodin, hydrocodone and Percocet.
Investigators said the operation was run at the Pain Center USA clinics in Warren and Eastpointe as well as the Interventional Pain Center clinic in Warren.
Bothra, once a renowned surgeon, humanitarian and politician who was given India’s highest civilian honor, maintained his innocence but spent three years in federal prison as the COVID-19 pandemic delayed his trial.
In June 2022, a jury acquitted him and three of his former employees of the charges. Two other doctors who were charged took plea deals.
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