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.

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.

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.

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.