Compliance & Legal
The mandate for hospitals to share their negotiated rates with MA and other payers, remains.
Merck reaped billions while Kaiser and its members paid higher prices for two popular drugs to lower cholesterol, the lawsuit says.
Only 16 drugs approved through the pathway have ever been withdrawn, and in some cases the confirmatory trials were never done.
The suit alleged that Mednax racked up more than $50 million in improper payments as a result of unnecessary neonatal testing.
Investigations related to this type of conduct will likely increase under the Biden Administration, says antitrust expert.
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The IRS requires hospitals to spend on community benefit but doesn't specify what type, for what purpose or how much.
The total yearly penalty ranges from $109,500 to more than $2 million per hospital.
Failing to follow through on price transparency requirements could alienate a large swath of a given health system's customer base.
The team believes it has found the best way forward, in part through use of artificial intelligence in the EHR.