PayerGovernment Lets Health Plans That Ripped Off Medicare Keep the Money
Payers have long feared CMS would demand repayment of billions of dollars in overcharges.
PharmaAmgen Pressed for 'Voluntary Compliance' in Senate Pharma Tax Avoidance Probe
Lawmakers are examining strategies drugmakers use to shield billions of dollars in profits from U.S. corporate taxes.
TelehealthMultistate AG Coaltion Urges Apple to Ensure Privacy of Third-Party Health Apps
In a letter to Apple CEO Tim Cook, the AGs say patient privacy has become a priority since the SCOTUS...
PayerOIG: Medi-Cal Made $15.7M in Unallowable Capitation Payments
The California Department of Health Care Services agrees with the audit findings.
PayerBlue Shield of California Campaigns Against Medi-Cal 'Failed' Contracting Process
The payer has complained that the skewed process has allowed the state to award contracts to 'national, for-profit companies beholden...
PayerHHS-OIG says Humana's MA Plan Overcharged $34.4M
HumanaChoice says it 'strongly disagreed' with the audit, which found that 76% of claims 'were not supported in the medical...
PayerHHS-OIG Says Highmark Senior Health Upcoded $6.2M
The payer disputes an audit finding that 70% of the diagnosis codes submitted for 'high risk groups' in 2016 and...
TechnologyAudio-Only Telehealth Visits During Pandemic Draw GAO Scrutiny
The federal oversight agency recommends CMS adopt new coding procedures to compare care quality to in-person visits.
Post-AcuteAARP Files Class Action Lawsuit Against Nursing Home Provider for Neglecting Residents
The Alden Group, a healthcare provider for older adults, is being accused of intentionally understaffing their facilities.
PayerOIG: States' Improper Medicaid Capitation Payments Up 60% in 2020
Auditors say the increase coincided with an overall increase in Medicaid enrollment during the first year of the pandemic.
Revenue CycleClawback: Feds say NYC Improperly Billed Medicaid for $84.3M
OIG auditors were unable to determine if an additional $112 million in non-emergency medical transportation claims complied with state and...
PayerAudit Shows CMS Slow to Collect $498M in Medicare Overpayments
HHS OIG says CMS has not properly documented more than half of overpayment collections it claims to have made.