I recently offered training to a health system about how to respond to whistleblower complaints. Regular readers will know many of the tips I discussed.
Healthcare compliance just got a lot more complicated. We’re not dealing with traditional whistleblowers anymore – the ones who needed inside access to spot problems.
The U.S. Department of Justice (DOJ) announced a settlement of up to $100 million with Independent Health, a Medicare Advantage (MA) plan serving upstate New
Earlier this month, a toxicology lab doing business as Precision Diagnostics agreed to pay $27 million to resolve allegations raised by three whistleblowers under the
A recent whistleblower case decision has revealed how federal prosecutors going after providers for fraud have been frustrated by the murkiness of federal regulations. United
The DOJ Sept. 13 filing of a complaint in intervention in a case against Buffalo-based Independent Health (IH) and its coding consultant subsidiary, DxID is
This is the largest Medicare Advantage fraud settlement involving a hospital group. Late last month, Sutter Health, a healthcare giant operating more than 20 hospitals
The government’s most drastic power is its ability to dismiss the case entirely. Recently, a three-judge panel of the U.S. Court of Appeals for the
The suits allege that defendant Kaiser Permanente inappropriately inflated reimbursement applications for Medicare Advantage beneficiaries. In a titanic legal battle over healthcare reimbursement, a prominent
Email is a wonderful thing. As a kid, or even as an adult, I rarely wrote letters because the act of addressing an envelope was
Late last week, Integra Med Analytics, a corporate whistleblower that has filed several lawsuits alleging healthcare fraud, was dealt its latest blow when the Fifth
The saga of increased scrutiny of Medicare Advantage plans continues to unfold. UnitedHealthcare’s SuspensionCMS announced a suspension of one year for the UnitedHealthcare H5322 contract
Medicare regulations are complex and even seasoned professionals struggle to apply them consistently. Due to overwhelming demand, Dr. Hirsch returns for Part 2 of Ask Dr. Hirsch: Clarifying Medicare’s Most Misunderstood Rules to answer even more of Medicare’s most misunderstood questions, covering inpatient status, observation, SNF access, Medicare Advantage denials, and more. Join Dr. Hirsch as he provides clear, referenced answers to real-world questions submitted by your peers, helping you navigate Medicare compliance with confidence and clarity.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Artificial intelligence is rapidly transforming healthcare revenue cycle operations, from coding and auditing to compliance and denials. Join industry leaders Pam Warren (MaineHealth) and Raemarie Jimenez (AAPC) for a live fireside chat exploring how AI is changing workflows, workforce roles, payer-provider dynamics, and compliance risk—and what organizations should be doing now to prepare.
Prepare for FY 2027 IPPS changes with a comprehensive 3-part masterclass covering ICD-10-CM/PCS updates, MS-DRG shifts, NTAPs, compliance risks, and reimbursement strategies.
Stay ahead of FY 2027 reimbursement changes with expert analysis of MS-DRG shifts, NTAP updates, Medicare Code Edits, and emerging technologies impacting inpatient payment accuracy.
Stay ahead of FY 2027 ICD-10-PCS changes with expert analysis of new procedure codes, revised guidelines, and high-impact updates affecting reimbursement, compliance, and inpatient coding accuracy.
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