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From Evolution to Innovation, from Health Care to Health: How Health Plans With Collaborators Are Re-Defining the Industry

Jane Sarashon

As a constant observer and advisor across the health/care ecosystem, for me the concept of a “health plan” in the U.S. Furthermore, health plan members now see themselves as medical bill payers, seeking value and consumer-level services for their health insurance premium investment. is getting fuzzier by the day.

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Fifth Circuit Upholds ACA Risk Adjustment Program

Healthcare Law Blog

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger insurers. See Vista Health Plan, Inc. United States Dep’t of Health & Hum. 2018 Final Rule, 83 Fed.

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Texas OIG Inspectors Discover Errors in Reported Nursing Home Staff Hours

Med-Net Compliance

On November 3, 2022, the OIG released the results of a recent inspection of a nursing home by the Texas Health and Human Services (HHS) Office of Inspector General Audit and Inspections Division (OIG Inspections).

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What you should know about Part B drug payments to comply with IRA 2022

Innovaare Compliance

The Inflation Reduction Act of 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they are administered in the provider’s office (Part B) or used in the ambulatory setting (Part D). Part B drugs have had the fastest spending growth for drugs for Medicare. percent annually.

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Cardiology: The New Darling of Private Equity Investment

Healthcare Law Today

As of 2019 almost 95% of such persons had Medicare coverage and about half of those also had some sort of supplemental health insurance coverage. The United States is aging, and becoming more obese, and the need for cardiologists will increase as a result. Moreover, 40% of Americans are considered medically obese.

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How Serious are OIG Exclusions? Key Insights into the Fraud Risk Spectrum

Provider Trust

Luckily for all us, there’s a spectrum–and it was created with visibility and safety in mind. Department of Justice (DOJ), the U.S. And when patient care and reimbursements are on the line, even one bad actor can put an entire organization’s reputation in jeopardy. How the OIG Finds & Prosecutes Healthcare Fraud.

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CMS Advances Rulemaking for Section 111 Civil Money Penalties and Future Medicals

Medval Compliance Blog

by Frank Fairchok, Vice President of Medicare Reporting Services. Last week, the Centers for Medicare & Medicaid Services (CMS) advanced the rulemaking process in two long-awaited areas. 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047). 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047).