Direct Contracting and The Medicare ‘Money Machine’
…potential restraint on risk-score gaming is that as risk scores go up plans begin approaching the 85 percent Minimum Loss Ratio requirement under the Affordable Care Act. Plans have found…
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Waste, Fraud, and Abuse
…bills the “medical loss ratio” — and they devote considerable resources to finding ways to avoid covering medical expenses. Obligatory disclaimer given recent events: No, I’m not offering a justification…