Compliance & Legal
Regulatory changes for 2019 could save health plans up to $54 million a year, CMS says.
Investigator allegedly helped provide patient information, billing codes for use in billing submissions and helped conceal the scheme from other investigators, DOJ says.
CEO Mitchell Katz says it and other hospitals have been benefitting private insurance companies by not pursuing denied claims effectively enough.
Lone physician at family clinic charged with 19 counts of distribution of controlled substances, including opioids, as well as defrauding Medicare and Medicaid.
CMS existing policy requires plan sponsors to ensure enrollees pay the lesser of the Part D negotiated price or copay.
The settlement resolves allegations that Mercy Health paid six employed physicians above and beyond fair market value for their services.
Memorial Hermann allegedly billed for inpatient services for Medicare beneficiaries that could have been treated on outpatient basis, the DOJ said.
Some entities, such as ACOs, have to create work-arounds because they won't include substance use information due to existing regulations, a witness told the House subcommittee.
Shephard Lee Spruill, CEO of Carolina Support Services, joins the growing contingent of hospital executives charged as criminals.
Judge dismisses a contract dispute over billing practices that is now expected to head to arbitration.