Both government and private payers continue to aggressively monitor providers to prevent and recover overpayments. This is evidenced by the fact that the number of audits conducted in recent years has increased dramatically. A negative audit finding can result in the need to repay five- or seven-figure amounts. Types of Audits Private Payer Audits Private…
(Reuters)—The American Hospital Association warned U.S. antitrust regulators that Anthem Inc.’s proposed acquisition of Cigna Corp. will hurt other health insurers’ ability to compete with Blue Cross Blue Shield plans, leading to higher premiums for consumers. Anthem, the country’s second-largest health insurer, runs Blue Cross Blue Shield plans in 14 states. The hospital group, in…
(Reuters)—The president of Hollywood Presbyterian Medical Center said on Wednesday that his hospital paid hackers a ransom of $17,000 in bitcoins to regain control of their computer systems after a cyber attack. Allen Stefanek said in a statement that paying the ransom was the “quickest and most efficient way” of regaining access to the affected…
(Reuters)—Pfizer Inc. said its Wyeth unit has agreed to pay $784.6 million to settle cases related to the calculation of Medicaid rebates for a gastric drug between 2001 and 2006. The claims alleged that Wyeth’s calculation of rebates for its proton pump inhibitor Protonix (pantoprazole) violated the Federal Civil False Claims Act and other laws…
On Nov. 2, 2015, President Barack Obama signed the Bipartisan Budget Act of 2015 (the Act) into law. This critical piece of legislation raises the federal debt ceiling and provides the framework for the federal budget through 2017. Of particular importance, the Act significantly changes the way Medicare will reimburse hospitals for outpatient services furnished…
NEW YORK (Reuters)—The federal appeals court in New York struck down a U.S. regulation that made it harder for hospitals to provide better medical care at lower cost by claiming they were “rural” for some purposes and “urban” for others. Thursday’s decision by the Second U.S. Circuit Court of Appeals is a victory for hospitals…
LOS ANGELES (Reuters)—A Southern California doctor was sentenced to 30 years to life in prison on Friday for over-prescribing drugs that caused the fatal overdose of three patients in a murder case capped by the first conviction of its kind in the U.S. The case against Dr. Hsiu Ying “Lisa” Tseng, 46, comes amid what…
(Reuters)—The U.S. government has suspended new enrollment in Cigna Corp’s Medicare Advantage health plans for seniors and standalone Medicare prescription drug plans, citing noncompliance in its appeals and grievances procedures. The government said Cigna had deficiencies in its appeals and grievances processes in both Medicare Advantage and the Medicare prescription drug program, according to a…
In busy rheumatology practices, mountains of paperwork for insurance companies and federal healthcare programs make it hard to keep track of what’s legal. Missing documentation is the most common way to spark an investigation. Here are a few considerations to help you avoid legal pitfalls…
WASHINGTON (Reuters)—The U.S. Supreme Court, which delivered major rulings in 2012 and 2015 preserving President Barack Obama’s signature healthcare law, on Tuesday declined to take up a new, long-shot challenge to Obamacare brought by an Iowa artist. The court turned away an appeal by Matt Sissel, who had asserted that the 2010 Affordable Care Act…