The United States alleged that the home health agency operator Bayada purchased two of Watermark’s properties in Arizona to induce referrals of Medicare beneficiaries. A former Bayada executive earned about $3.8M for blowing the whistle.
Based in Tucson, Watermark manages 79 senior retirement homes but the scheme was designed around...
As cyberattacks on healthcare providers and industry services continue into 2023, the U.S. Department of Health and Human Services (HHS) announced that it reached a $1.25 million settlement with Banner Health following a federal probe into a 2016 data breach that disclosed the protected health information of 2.81 million...
According to new data from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), there was a slight decrease in the number of cyber attacks on health data, but the decrease was only enough to rank the year second worst of all time in the number of reported breaches.
The breaches peaked in October with...News
Medicare Advantage enrollees who use insulin may not know the insulin cost cap limits all monthly out-of-pocket costs for insulin to $35 -- and that could influence how they select their Medicare Advantage plans during the open enrollment period.
For the current open enrollment period, the insulin cost cap was not factored into the...
As seniors, the Centers for Medicare and Medicaid Services (CMS) and Medicare Advantage (MA) plans gear up for a landmark Medicare Advantage Open Enrollment Period beginning October 15, Medicare Advantage on the whole is in hot water.
Last week, the New York Times published an earthshaking story documenting the extent to which...
The U.S. Department of Justice has lost a case that would have blocked UnitedHealth Group (UHG) from acquiring Change Healthcare, a healthcare technology and data platform, for $13 billion.
Judge Carl Nichols of the U.S. District Court for the District of Columbia issued the opinion on Monday, which ordered Change Healthcare to sell...CMS Rules
The No Surprises Act, a law that aims to protect Americans covered by private health plans from receiving surprise medical bills relating to emergency services or non-emergency services from out-of-network providers at in-network facilities, has been met with trouble since its implementation at the beginning of the year.
In February,...National News
Medicare Advantage and the hundreds of investors pumping venture capital into new MA startups rely on one thing: MA growth. For the past several years, MA has been on a quick trend upward, but as it currently only captures under 50% of the market, some are left wondering if the seemingly endless demand isn't just a giant investment...
The a rolling 7-day average in the United States is now 1,319 deaths per day. On December 6, there were 113,992 new cases of COVID-19 reported nationwide. Over 60,000 Americans are currently hospitalized with complications from COVID-19.
Only 60% of the country is fully vaccinated with 71% of the population having received at least...
Across the county, accusations of fraud related to Medicare, Medicaid, and Medicaid Advantage have increased and Arizona has not escaped involvement. While, nationally, complaints against Kaiser Permanente and UnitedHealthcare have been filed or escalated, in Arizona, 27 individuals and business entities have been indicted on criminal...
A former DaVita employee claims in a new lawsuit that DaVita and its outpatient provider competitors allegedly colluded to skew the executive labor market and suppress wages. The lawsuit follows last week's criminal indictment of DaVita and its former CEO Kent Thiry, who was charged with two counts of conspiring with competing employers...National News
Last week the Department of Justice announced criminal charges against 14 defendants in seven federal districts across the country for allegedly participating in various healthcare fraud schemes that exploited the COVID-19 pandemic, which resulted in over $143 million in false billings before being blocked.
As well a the DOJ, the...National News
This week, Congress moved forward on a COVID-19 relief bill that would strengthen the Affordable Care Act (ACA). Studies show that Americans are generally confused by health insurance, especially when they don't have plans of their own and undoing Trump era rules that sought to undermine the ACA is turning out to be quite a...Arizona News
Cigna is charged with falsifying the health conditions of its Medicare Advantage plan members, essentially scamming CMS out of larger payments to cover the cost of care for beneficiaries diagnosed through the insurer's medical assessment program.
Last year the Office of Inspector General undertook a study because it suspected...National News
Last week, 18 states, including Arizona, two individuals and the Trump administration’s Department of Justice filed opening briefs for California v. Texas, a case currently before the Supreme Court that debates the constitutionality of the Affordable Care Act. Nearly 23 million Americans have insurance through the ACA marketplace and...Arizona News
Chandler-based drug manufacturer Insys Therapeutics, infamous for the questionable marketing practices of its highly-addictive opioid fentanyl spray Subsys, announced plans to sell off assets to Wyoming-based BTcP Pharma and London-based Hikma Pharmaceuticals in a series of U.S. Securities and Exchange Commission filings.
After...National News
The practice of funding co-pays so members don’t feel the impact of price increases was alleged against Jazz Pharmaceuticals, Lundbeck LLC and Alexion Pharmaceuticals. The so-called “patient assistance programs” were set up to funnel money to patient for co-pays.
Quote from U.S.
Attorney Andrew Lelling’s...National News
The settlement announced October 1 resolves DaVita from False Claims Act liability for providing inaccurate information that caused Medicare Advantage plans to receive inflated Medicare payments.
DaVita voluntarily disclosed to the feds practices instituted by HealthCare Partners, a large California-based independent physician...
