Compliance & Legal

Pennsylvania-based Geisinger has developed five major bodies of oversight, each headed by a senior executive, and a centralized compliance office.

$12 million healthcare fraud case in Houston

The Centers for Medicare & Medicare Services is calling on doctors, hospitals and health professionals to participate in a new aspect of the federal government's Million Hearts program, a national initiative to prevent 1 million heart attacks and strokes between 2012 and 2017.

Feds claim Vicki S. House, executive director of Nurses' Registry and Home Health, paid three local physicians who referred patients to Nurses' Registry.

The multimillion dollar fine is more than the hospital's annual revenue and is believed to be the largest ever applied to a community hospital.

Hospitals allegedly conspired to carve out marketing territories in the state to limit competition between the facilities and keep consumers from learning about competing providers.

The healthcare industry is now getting the scrutiny that financial institutions and other publicly traded companies have experienced, said Phil Bezanson, a partner at Bracewell & Giuliani in Houston.

The dedicated litigation team will focus on the smaller entities such as individual physicians and executives in civil penalties and exclusion cases.

Insurers can focus on optimizing individual plans with cost-comparison and provider-choice tools and value-based benefit designs, expert says.

The King v. Burwell ruling means more than six million residents in the 34 states with federal exchanges can keep their tax subsidies for healthcare insurance under the Affordable Care Act.