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Washington's Chronic Care Management Project targets the most medically expensive, high-risk Medicaid clients in its long-term care system. It has lowered mortality and improved the health of clients with chronic conditions such as diabetes, heart disease, and musculoskeletal diseases.
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There is no question that decreasing inappropriate use of the emergency department for Medicaid patients can save significant costs, but getting results is a daunting challenge.
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Medicaid programs may never have had as much reason to redouble their utilization review efforts, in order to be sure funds are not being spent inappropriately, as they do right now.
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In fiscal year 2008, Alabama's Program Integrity Division's Pharmacy Audit unit reviewed 143 medical providers and 629 pharmacies to assure proper claim payment and recovery of identified overpayments.
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On the one hand, expenditures for Medicaid Buy-In participants, who pay monthly premiums, more than doubled from $887 million to $1.9 billion between 2002 and 2005, as did program enrollment. On the other hand, this group was found to be less expensive than other adult disabled Medicaid enrollees, with lower average Medicaid expenditures.
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Congestive heart failure (CHF) is the most common DRG for Medicare patients in U.S. hospitals and is therefore the target of considerable regulatory attention due to its financial impact on the federal budget.
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Results from a Phase 3 study of dabigatran, intensive lipid-lowering in CVD, H1N1 vaccine dosing and efficacy, and FDA Actions
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