The Centers for Medicare & Medicaid Services (CMS) introduced its Accountable Health Communities (AHC) model, an innovation to address the gap they say exists between clinical care and community services.
The U.S. Department of Justice (DOJ) has joined a whistleblower’s False Claims Act lawsuit that alleges UnitedHealthcare fraudulently overbilled the government under its Medicare Advantage (MA) health plans.
A Dallas-based anesthesiologist pled guilty to charges of conspiracy to pay healthcare bribes and kickbacks to physicians and other health professionals for referring patients to a specialty hospital that he part-owned.
The U.S. Department of Justice (DOJ) Fraud Section has updated its Evaluation of Corporate Compliance Program guidelines. While the guidelines are not specific to healthcare, they can serve as an effective standard against which compliance staff could evaluate the efficacy of current compliance programs.
The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) will this month implement its final rule for exclusion of individuals and entities from participation in federal healthcare programs. These changes will be included under section 1128 of the Social Security Act and will broaden the power of the OIG to make such exclusions.
During his confirmation hearing in January, Secretary of Health and Human Services (HHS) Tom Price said that the Centers for Medicare & Medicaid Services (CMS) should spend less time focusing on medical necessity verification and more time rooting out true fraud and abuse.
The Government Accountability Office (GAO) in February released a report outlining the need for the Department of Health and Human Services (HHS) to improve its planning and evaluate its efforts to increase information exchange via electronic health records (EHRs) in the post-acute care setting.
The California Department of Health Care Services has fined Kaiser Permanente $2.5 million for failing to divulge data on patient care required by the state’s Medicaid program, according to a report from Kaiser Health News (KHN).
A review of Medicare Advantage online provider directories revealed that 45% of listed provider locations are inaccurate, according to a recent report from the Centers for Medicare & Medicaid Services (CMS).