Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability


DOJ Nabs 601 Defendants in Biggest Healthcare Fraud Takedown Yet

July 3, 2018 - HHS Secretary Alex Azar and Attorney General Jeff Sessions have announced the largest healthcare fraud takedown yet after HHS, the Department of Justice (DOJ), and other law enforcement agencies charged 601 healthcare professionals for $2 billion in fraudulent activities. Nearly 165 providers and co-conspirators have been charged with billing Medicare, Medicaid, TRICARE, and other...

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Senators: Stop $89B in Medicare, Medicaid Improper Payments

by Thomas Beaton

The US Senate Budget Committee has penned a letter to HHS Secretary Alex Azar urging the department to address approximately $89 billion in improper payments within Medicare and Medicaid. The Senators referenced a recent GAO report suggeste...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS Offers Opioid Coverage, Health IT Guidance for Medicaid Plans

by Thomas Beaton

CMS has issued new opioid coverage strategies and health IT guidance to help states improve opioid safety within Medicaid plans. The guidelines include advice for state programs about treating infants with neonatal abstinence syndrome (NAS)...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

HHS Made Nearly $90B in Improper Payments to Medicaid, Medicare

by Thomas Beaton

HHS made approximately $90 billion in improper payments to Medicaid and Medicare programs during 2017 and may require updated payment evaluation procedures to address improper payments, a new Government Accountability Office (GAO) report fo...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Commercial, Public Payer Healthcare Fraud Cases Total $21.6M

by Thomas Beaton

The latest string of commercial and public payer healthcare fraud cases totaled $21.6 million from providers launching various schemes such as patient kickback agreements and false claims submissions. Public payer programs are frequently ta...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

AHIP Calls for Changes in Proposed Association Health Plan Policy

by Thomas Beaton

AHIP has issued a statement to CMS that calls for changes in the agency’s proposed rule on association health plan (AHP) and short-term plan policy to avoid unintentional disparities in health insurance access for individuals with pre...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

HHS Appoints James Parker to Address Health Insurance Costs

by Thomas Beaton

HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan availability. Parker previously served a...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

HHS Must Address Adverse Selection in Medicaid, Medicare Renal Care

by Thomas Beaton

AHIP is urging HHS secretary Alex Azar to address adverse selection related to Medicaid or Medicare end stage renal disease (ESRD) in order to ensure that vulnerable beneficiaries continue to receive appropriate healthcare services. AHIP as...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

OIG: Medicaid Fraud Control Units Recovered $1.8B in 2017

by Thomas Beaton

Medicaid fraud control units (MFCUs) recovered $1.8 billion in 2017 through effective collaboration with state governments, according a new report released by the Office of the Inspector General (OIG). MFCUs recovered $6.52 for every dollar...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Proposed Rule Deregulates Medicaid Managed Care, Fee-for-Service

by Thomas Beaton

CMS has proposed a new rule that deregulates certain aspects of Medicaid managed care and Medicaid fee-for-service (FFS) programs in order to reduce regulatory burdens at the state level. The rule would exempt managed care programs from cer...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS: Idaho Association Health Plan Expansion Violates ACA

by Thomas Beaton

CMS Administrator Seema Verma informed Idaho governor C.L. “Butch” Otter (R-ID) and state insurance officials that efforts to launch an expansion of association health plan (AHPs) sales violates the market protections safeguarde...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Latest Medicare Fraud Schemes Targeted $139.4M via Kickbacks

by Thomas Beaton

Three Medicare fraud schemes in recent weeks have targeted a total $139.4 million, which led the Department of Justice (DoJ) to seek multiple convictions and a combined 33 years in prison sentences. Each of the schemes involved the use of p...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS Proposes 9-Month Extension of Short-Term Health Plans

by Thomas Beaton

CMS is proposing that consumers should be allowed to stay on short-term health plans, including association health plans, for twelve months at a time, despite the fact that these plans are generally non-compliant with the Affordable Care Ac...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

2019 HHS Budget Aims for ACA Repeal, Public Payer Savings

by Thomas Beaton

The newly proposed HHS Budget for fiscal year (FY) 2019 says a repeal and replace of the Affordable Care Act (ACA) would save the government trillions, while restructuring Medicare and Medicaid could produce federal savings. The budget inco...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

VA, HHS Announce Healthcare Fraud Prevention Partnership

by Thomas Beaton

The Department of Veterans Affairs (VA), HHS, and CMS agreed to participate in a healthcare fraud prevention partnership that leverages data sharing to identify fraud and abuse within healthcare programs they collectively oversee. The organ...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Provider Health Insurance Fraud Schemes, Settlements Top $310M

by Thomas Beaton

Law enforcement agencies and federal healthcare administrators including HHS, the Office of the Inspector General (OIG), the FBI, and US Attorney's Offices across the country investigated provider healthcare schemes that defrauded Medic...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

HHS Pilot Encourages Streamlined Health Plan HIPAA Compliance

by Thomas Beaton

HHS is launching a pilot program that streamlines reviews of health plan HIPAA compliance, the organization announced in an email to the CMS listserv. The HHS HIPAA Administrative Simplification Optimization Project pilot is an effort to ac...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Humana Adds Former ONC Chief Karen DeSalvo as Board Member

by Thomas Beaton

Former National Coordinator for Health IT and Assistant HHS Secretary Karen DeSalvo, will join Humana’s board of directors, the payer announced in a press release. Humana believes that the addition of DeSalvo to the board will improve...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Top 5 Most Common Healthcare Provider Fraud Activities

by Thomas Beaton

Healthcare provider fraud is extraordinarily common and can be conducted at a shockingly large scale.  The largest healthcare provider fraud takedown in US history was announced just recently, resulting charges against 400 defendants i...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Providers Caught in Medicare Fraud Schemes Topping $200M

by Thomas Beaton

Law enforcement officials continue to crack down on Medicare fraud schemes that siphon millions of dollars from the programs, as individuals submit fraudulent claims or overcharge for unnecessary healthcare utilization. Federal law enforcem...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}


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