Compliance & Legal

Jan 28 | Susan Morse

Payer payment integrity audits are a financial burden to providers

Study finds 8% of providers are spending upwards of $1 million dealing with post-payment audits each year.

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Jan 24 | Susan Morse

California in violaton for requiring insurers to offer abortion coverage

Violation comes with threat of withholding federal funding for non-compliance.

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Jan 23 | Jeff Lagasse

Cardinal Health recalls millions of surgical gowns due to sterility concerns

The gowns were not registered with the U.S. Food and Drug Administration and were not qualified by Cardinal…

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Jan 21 | Jeff Lagasse

Fewer than half of US clinical trials have complied with the law on reporting results despite new regulations

Trials with non-industry sponsors are far more likely to breach the rules than…

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Jan 10 | Susan Morse

Of $3 billion DOJ recovered in fraud, $2.6 billion attributable to healthcare

Over $2.1 billion arose from lawsuits filed by whistleblowers under the qui tam provisions of the False Claims…

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Jan 08 | Jeff Lagasse

Department of Justice claims Community Health Network fraudulently billed Medicare

CHN allegedly received referrals from physicians in violation of the Stark Law and submitted Medicare…

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Jan 08 | Jeff Lagasse

Price transparency rule could lead to narrower networks, experts say

For capitalism to continue in healthcare, negotiations need to continue behind closed doors, one expert said.

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Jan 07 | Jeff Lagasse

Owner of Los Angeles rehab center pleads guilty to $175 million healthcare fraud

The owner pleaded guilty to seven counts of grand theft, five counts of insurance fraud and one count each of…

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Jan 03 | Jeff Lagasse

New Maine law says private health insurers must provide hearing aid benefits

Previously, Maine required hearing aid coverage for children under the age of 18, and capped the insurer's…

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Jan 03 |

Federal watchdog cracks down on inflated Medicare payments

Insurers were allegedly found to be exaggerating the health ailments of patients, receiving billions.

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Featured Resources

Beyond Dollars and Cents: A Closer Look At Value Beyond the expected improvement in specific metrics, many organizations that outsource RCM with a trusted and certified partner are seeing several ancillary benefits of such agreements.

Debunk the Myth: Outsourcing Doesn't Mean Losing Control With shifts in payer mixes and reimbursement structure, the margin of reimbursement has been shrinking steadily over the last five years. How do revenue cycle leaders navigate payment reform while maintaining stable business office operations?

Care Collaboration Success for Improved Outcomes The nature of our healthcare ecosystem has been one of siloed care. Rarely do payers, providers and local resources come together with the patient's well-being prioritized as a unifying mission. Read how these organizations are getting it right.

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Analyze this: Health systems, health plans get to the core of big data Pamela Peele knows that people who subscribe to cooking magazines have a much higher risk of going to the emergency room. But how she knows that is a whole other story.

Healthcare mergers and acquisitions in 2016: Running list While 2015 was a record-breaking year in healthcare mergers and acquisitions, 2016 saw more change as organizations across the industry adjust and adapt to the evolving financial landscape.

Once-failing hospitals say accountability, transparency key to surviving fallout from failing patient safety grades When Leapfrog released their Spring 2016 patient safety grades recently, 15 hospitals got slapped with a very public 'F' grade casting a spotlight on them that no institution wants. ...

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Clinical Quality Measures 101 Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to report ...

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