Compliance & Legal

Court rules against insurers in risk corridors payments
Jun 14, 2018 | Susan Morse
Between 2014 and 2016, total payments fell short by more than $12 billion.
Close to have of physicians report sexual harassment
Jun 13, 2018 | Jeff Lagasse
About 47 percent of physicians who indicated they had been harassed said they were harassed by another…
Signature Healthcare hit with $30M settlement over alleged billing scheme
Jun 12, 2018 | Beth Jones Sanborn
The Kentucky-based skilled nursing provider also allegedly forged pre-admission certifications…
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…