In a report released this week by the HHS Office of Inspector General, the leading federal agency focused on combating healthcare fraud emphasized the OIG's audits, evaluations, and investigations consistently identify a high risk of fraud, waste, and abuse in the Medicare Advantage risk adjustment program, which provides higher...National News
On Monday, U.S. Department of Health and Human Services (HHS) Inspector General Christi A. Grimm provided testimony to the U.S. House Committee on Energy and Commerce Subcommittee on Oversight and Investigations that included the federal government has demonstrated significant problems with risk adjustment in Medicare Advantage, raising...Arizona News
After a request from Congress, the Office of Inspector General analyzed prior authorization and appeals data from 115 risk-based managed care organizations (MCOs) including Centene's Arizona Complete Health & Care1st Health Plans. According to the report, in Arizona Centene denied one out of every eight prior authorization (PA)...National News
Despite the Centers for Medicare and Medicaid Services’ (CMS) efforts to reduce the amount of psychotropic drugs in nursing homes, rates remained “constant” between 2011 and 2019.
A new report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) found 80% of Medicare's long-stay nursing home...Government
The U.S. Department of Heath and Human Services Office of Inspector General conducted a review of 320 hospitals nationwide. The review is designed to provide a national perspective from front-line hospital administrators on how responding to the COVID-19 pandemic has affected their capacity to care for patients, staff and communities....CMS Rules
A U.S. Department of Health and Human Services watchdog reported that Seema Verma, Centers for Medicare and Medicaid Services chief, mishandled millions of dollars in federal contracts that ultimately benefited friends and former Trump officials.
The Office of Inspector General Report concluded Verma violated federal contracting...
A report from the Department of Health and Human Services (HHS) inspector general's office analyzed Medicare Advantage (MA) encounter data from 2016, stemming from concerns that MA organizations use chart reviews to inaccurately inflate risk adjusted payments. The result was billions in additional payments.
The Office of Inspector...
The Department of Health and Human Services (HHS) unveiled a proposal spearheaded by the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG) on Oct. 9 to make changes to anti-kickback legislation and Stark Law in an effort to modernize.
In a news release announcing the proposals, HHS...National News
The U.S. Department of Justice (DOJ) cracked down on 35 individuals found to be tampering with genetic testing reimbursements in a fraudulent Medicare billing scheme totaling $2.1 billion. The defendants were linked to various telemedicine and telemarketing companies as well as cancer genetic testing labs for their participation in the...Arizona News
The Centers for Medicare and Medicaid Services (CMS) still has $1.6 billion to collect in Medicaid overpayments, news revealed through Office of Inspector General (OIG) audits. A new December OIG report explains that CMS's timely recovery of overpayments helps to confirm that federal funds are being used effectively and...National News
A November Office of Inspector General (OIG) report found that 46 percent of Medicare patients in Long-term-care hospitals (LTCH) experienced some type of harm during care. The OIG examined other post-acute settings such as skilled nursing facilities (SNFs) and rehabilitation centers, but LTCHs had the highest overall...
