June 30, 2022
The American Hospital Association has asked the Department of Justice (DOJ) and Centers for Medicare & Medicaid Services (CMS) to look into commercial payers that routinely deny access to care and services.
Category: Blog
DOJ Reaches $22.7 Million Settlement with Providence Over Medically Unnecessary Neurosurgery Procedures
Thomas Sullivan Last Updated May 30, 2022
The Department of Justice had a $22.7 million settle with Providence Health & Services Washington (Providence) to resolve allegations that Providence inappropriately billed claims to federal programs (Medicare, Medicaid, Tricare, etc.) for services that were not medically necessary.
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Peoples Health Network (Contract H1961) Submitted to CMS
Of the 242 unique enrollee-years that were audited, 98 had validated medical records that supported the HCC (Hierarchical Condition Categories) diagnoses submitted. The other 144 unique enrollee-years diagnoses were not supported by the medical records, because Peoples Health was not able to locate the medical records.
HHS to stop reimbursing providers for vaccine administration
Starting April 5, HHS will no longer adjudicate claims submitted for vaccine administration due to a lack of funds.
Digital Maturity Helps in the Fight Against Pandemics
In the face of such an unprecedented storm in the form of a pandemic, the need for information sharing, collaboration and rapid system development took on new urgency. There are truly remarkable examples globally of healthcare providers’ agility and innovation.
In charting a future course for healthcare, let’s think bigger
AI, augmented reality, biomedical sensors and beyond – by mapping out a clear vision now, we can widen our ambitions and improve modernization strategies to better harness the vast potential offered by technology advances.
US Department of Labor announces enforcement, effort for focused inspections in hospitals, nursing care facilities treating COVID-19 patients
For two years, millions of the nation’s healthcare workers have been battling the coronavirus. Many have endangered themselves as they care for those who contract COVID-19 while working in high-risk settings that expose themselves and their families.
Personalized healthcare driven by an explosion of patient needs
Rich Corbridge, CIO at Boots UK and Ireland, discusses how the pandemic transformed clinician and patient attitudes toward technology and how digital tools can help improve personalized healthcare.
HHS Reduced Medicare Appeals Backlog by 88% During FY 2022 Q1
With the recent 88 percent reduction of the Medicare appeals backlog, HHS is on track to meet its court-ordered goal of clearing the backlog by the end of FY 2022.
Salisbury Medical Practice Pays the United States Over $286,000 to Resolve Claims that it Billed for Medical Services Not Provided
Peninsula Internal Medicine, L.L.C., a medical practice located in Salisbury, Maryland, and the Estate of Candy Burns have paid the United States $286,631.33 to settle allegations that Peninsula Internal Medicine (“PIM”) and its former owner, Candy Burns, submitted false claims to the United States for medical services that were not provided.