July 7, 2022
CEO of Raleigh Healthcare Company Pleads Guilty to Multi-Million Dollar Healthcare Fraud
July 6, 2022
In an interview with Health Care Compliance Association (HCCA), the new Inspector General of HHS-OIG, Christi A. Grimm indicated that their focus continues to be around compliance and fraud, waste, and abuse.
July 1, 2022
The FBI Internet Crime Complaint Center (IC3) issued a warning to employers that stolen Personally Identifiable Information (PII) and Deepfakes are being used by bad actors to apply for remote work and work-from-home positions. The types of positions being targeted by these bad actors include: information technology and computer programming, database, and software related job functions. If hired, these bad actors could have “access to customer PII, financial data, corporate IT databases and/or proprietary information.”
June 30, 2022
Molina Healthcare, Inc. (Molina) and its previously owned subsidiary, Pathways of Massachusetts (Pathways), have agreed to pay $4.625 million to resolve allegations that it violated the False Claims Act by submitting reimbursement claims while violating several regulations related to the licensure and supervision of staff.
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.
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.
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.
Starting April 5, HHS will no longer adjudicate claims submitted for vaccine administration due to a lack of funds.
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.
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.