Allegations were made of kickbacks in the form of co-pay waivers. Late last month, US WorldMeds, a pharmaceutical manufacturer, agreed to pay the U.S. Department
CHS and Medhost have categorically denied all of the allegations in the complaint. As the use of electronic health records (EHRs) has expanded at a
Filing focuses on generic drug costs levied by pharmacies absorbed by the pharmacy giant. In 2013, J. Douglas Strauser, a pharmacist, filed a whistleblower lawsuit
Decision expected soon in the Providence lawsuit. As regular Monitor Monday listeners know, we have been closely tracking the progress of data analysis firm Integra
Individual policyholders in Georgia launch a class-action lawsuit against Anthem for deceptive sales. Early last week, Frances Kirby and John David Marks, two individual policyholders
Individual policyholders in Georgia launch a class-action lawsuit against Anthem for deceptive sales. Early last week, Frances Kirby and John David Marks, two individual policyholders
Not enough information in the public use databases to know that a claim is fraudulent. “In God we trust; all others bring data.” That is
Filing marks shift in nature of healthcare litigation of this nature. The whistleblower cases I report on for RACmonitor typically are brought by the quintessential
Federal takedown is considered the largest healthcare fraud in history. The Department of Justice (DOJ) has charged hundreds of medical professionals in what was dubbed
The whistleblower brought this suit under the federal False Claims Act. The False Claims Act (FCA) allows a private party (known as a “relator” or
The whistleblower brought this suit under the federal False Claims Act. In February 2014, whistleblower Sarah Benhke, the former senior Medicare Part D actuary at
This is the third time that the nurse has brought a successful whistleblower lawsuit against a hospital system where she has worked. Banner Health, a
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
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