Compliance & Legal

Judge orders Maine to expand Medicaid
Jun 07, 2018 | Susan Morse
Expansion benefits include care quality and a reduction in uncompensated care costs.
Oncologists sue HHS over Part B drug payment cuts
Jun 01, 2018 | Susan Morse
The cuts have forced the closure or acquisition of numerous independent cancer clinics and upped the…
May 30, 2018 | Susan Morse
Regulatory changes for 2019 could save health plans up to $54 million a year, CMS says.
fraud investigator charged in $20 million billing scheme
May 25, 2018 | Beth Jones Sanborn
Investigator allegedly helped provide patient information, billing codes for use in billing submissions and…
NYC H+H goes after UnitedHealthcare for $11.5M in wrongful denials
May 23, 2018 | Susan Morse
CEO Mitchell Katz says it and other hospitals have been benefitting private insurance…
WV doctor faces 390 years in prison, $5 million fine for fraud
May 22, 2018 | Beth Jones Sanborn
Lone physician at family clinic charged with 19 counts of distribution of controlled…
Part D plan sponsors face compliance action on gag orders
May 18, 2018 | Susan Morse
CMS existing policy requires plan sponsors to ensure enrollees pay the lesser of the Part D negotiated price or…
Mercy Health settles for $14M over alleged improper physician payments
May 17, 2018 | Beth Jones Sanborn
The settlement resolves allegations that Mercy Health paid six employed physicians above and…
Memorial Hermann gets fined by DOJ
May 15, 2018 | Beth Jones Sanborn
Memorial Hermann allegedly billed for inpatient services for Medicare beneficiaries that could have been treated…
May 08, 2018 | Susan Morse
Some entities, such as ACOs, have to create work-arounds because they won't…