The California Department of Managed Health Care has levied fines of $350,000 against Blue Shield of California and $250,000 against Anthem Blue Cross over inaccurate provider directories that overstated their physician networks during the rollout of Affordable Care Act coverage…
Legal & Regulatory Issues
An independent audit has been issued related to previously revealed findings of payroll fraud, theft, illegal distribution of drugs and criminal conspiracy at Jackson Parish Hospital in Jonesboro, La., according to a News Star report.
A state appeals court in San Francisco ruled Oct. 27 against Sacramento-based Sutter Health, denying its appeal to arbitrate allegations the health system uses its market dominance in North California to overcharge patients, employers and insurers, according to the Sacramento…
Payment for self-administered medications provided to Medicare beneficiaries who are receiving outpatient part B services, including observation services, are statutorily prohibited from payment by Medicare part B. Hospitals are required to bill patients for self-administered medications at the hospital chargemaster…
As the big five health insurers aim to become the big three, mental health advocates are requesting regulators closely scrutinize the mega-mergers, according to The Washington Post.
Advertisement
Among hospitals, new Medicare and other payer policies have focused attention on measures of "quality" and "value." Among some, the new focus on quality and value is viewed as the steam engine for transformation and innovation in relationships with physicians…
CMS issued a final rule Thursday to clear up issues inherent in shared savings payments that could implicate physicians in fraud and abuse laws.
From 457 hospitals across the nation agreeing to pay the federal government $250 million for alleged overuse of implantable cardiac devices to an ex-COO suing a Texas hospital over mass layoffs, here are the latest healthcare industry lawsuits and settlements…
The Department of Justice has inked a deal for more than $250 million with 457 hospitals across the nation — including hospitals from systems such as Franklin, Tenn.-based Community Health Systems, Nashville, Tenn.-based Hospital Corporation of America and Dallas-based Tenet…
Paul Abraham served as COO of Forest Park Medical Center's facility in San Antonio, Texas, until he was terminated in mid-October when the hospital closed. Claiming violations of the Worker Adjustment and Retraining Notification Act, Mr. Abraham has filed a…