UnitedHealth Group's IT subsidiary Ingenix says it is acquiring compliance and medical management consultants Executive Health Resources, with undisclosed financial terms to be finalized by the year's end.
Ingenix, based in Eden Prairie, MN, says the acquisition will improve its ability to help hospitals manage medical necessity compliance with the CMS at a time when patient volumes for government-sponsored plans are expected to grow.
"The expertise and evidence-based clinical insights that Executive Health Resources and its outstanding team provide, combined with Ingenix's unmatched health information and analytics capabilities, will help our clients thrive in the evolving regulatory environment for health care," says Ingenix CEO Andy Slavitt.
Federal and state laws require hospitals to perform compliance reviews for medical services provided to patients covered by Medicare/Medicaid to ensure that the care is medically necessary and delivered in the proper setting. Congress expanded federal auditing oversight in 2006 to all 50 U.S. states to reduce federal payment discrepancies with hospitals.
"The regulatory landscape is complex and ever-changing, and compliance has become a crucial aspect of a hospital's operational integrity," says Robert Corrato, MD, president/CEO of Newtown Square, PA-based Executive Health Resources. "As we continue to support our clients in this rapidly growing market with solutions that simplify the compliance process, Ingenix's impressive data assets and sophisticated technologies will help us to more quickly deliver critical, technology-enabled intelligence for our clients."
Executive Health Resources advises more than 1,100 hospital and health systems nationwide, including for-profit and non-profit systems, academic medical centers, community hospitals, and specialty centers.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.