Compliance & Legal

Doctors indicted in 15-year $580M kickback scheme

Jun 19 | Beth Jones Sanborn

More doctors indicted in 15-year-long $580 million kickback scheme at Pacific Hospital of Long Beach

Surgeons allegedly were paid millions in exchange for referring spinal surgeries to the…

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CEO, physicians indicted in $200M Medicare fraud

Jun 15 | Beth Jones Sanborn

Healthcare CEO, physicians indicted in $200 million Medicare fraud involving opioid doses, harmful injections

Alleged scheme preyed on Medicare beneficiaries, some of whom were addicted to…

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AHIP files court brief to prevent dismantling of ACA

Jun 15 | Susan Morse

America's Health Insurance Plans files court brief to prevent dismantling of ACA

AHIP focuses on the impact that a preliminary injunction or declaratory relief would have on patients, health…

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Court rules against insurers in risk corridors payments

Jun 14 | Susan Morse

Appeals court rules against insurers' case for billions in risk corridors payments

Between 2014 and 2016, total payments fell short by more than $12 billion.

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Close to have of physicians report sexual harassment

Jun 13 | Jeff Lagasse

Close to half of physicians have been sexually harassed on the job, report shows

About 47 percent of physicians who indicated they had been harassed said they were harassed by another…

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Signature Healthcare hit with $30M settlement over alleged billing scheme

Jun 12 | Beth Jones Sanborn

Signature Healthcare hit with $30 million settlement over allegations they miscategorized care

The Kentucky-based skilled nursing provider also allegedly forged pre-admission certifications…

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Jun 07 | Susan Morse

Judge orders Maine to enact Medicaid expansion after group sues for implementation

Expansion benefits include care quality and a reduction in uncompensated care costs.

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Oncologists sue HHS over Part B drug payment cuts

Jun 01 | Susan Morse

Oncologists sue Health and Human Services Secretary Azar over Part B drug payment cuts

The cuts have forced the closure or acquisition of numerous independent cancer clinics and upped the…

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May 30 | Susan Morse

CMS allows payers to send evidence of coverage information electronically for the first time

Regulatory changes for 2019 could save health plans up to $54 million a year, CMS says.

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fraud investigator charged in $20 million billing scheme

May 25 | Beth Jones Sanborn

Former Anthem fraud investigator, physician charged in $20 million billing scheme

Investigator allegedly helped provide patient information, billing codes for use in billing submissions and…

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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.

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?

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.

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Top 10 healthcare issues to watch in 2016

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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.

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. ...

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.

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Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle Hospital systems across the country are looking to streamline their billing and collection processes to become more efficient and better compete in their markets. The challenge many face is how to turn the data ...

Credible, Defensible Estimates In healthcare, every interaction with the patient matters. Especially in today’s environment of continuous improvement, efforts have been concentrated on coordination among providers, the patient care experience and quality outcomes – all laudable goals.

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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