Providers utilize business intelligence to monitor referral patterns and collaborate with clinicians who order their services. Such analytics tools have also been deployed in the specialty to improve productivity, track patient satisfaction and bolster quality.
The Medicare Advantage insurer said the payout is equal to what a CMS audit stated was the total amount the company was overpaid for patient care services. Despite receiving the cash, the agency has yet to officially withdraw its enforcement action, as the two parties are still negotiating.
A report from Trilliant Health looking at payer data found that, as prescriptions for the popular weight loss drugs spike, so rises the number of approved benefits.
State Attorney General James Uthmeier is forcing the company to hand over thousands of documents related to its pharmacy contracts and reimbursement policies to see if the retail giant is abusing its position in the market as both a pharmacy benefit manager and a retail chain of drug stores.
Medaxiom CEO Jerry Blackwell, MD, MBA, FACC, discusses investor's interest in buying cardiology practices, noting that PE ownership remains relatively low.
Looking at the three largest Medicaid managed care plans related to maternal health, the Office of Inspector General found instances of ineligible providers being included in directories, as well as other errors such as incorrect contact information.
In a lawsuit, plaintiffs allege the company changed course from a long-standing policy of denying medical claims, hiding from investors its impact on profits. The insurer denies any wrongdoing and vowed to defend itself in court.
If President Trump initiates a 25% tariff against pharmaceuticals imported from Ireland, it might impact the price for X-ray iodine contrast agents in the U.S. depending what rules are put in place.
Bloomberg writes about a company, Quick Health, run by a former comedy writer, who through a loophole in the law is accused of "hiring" members for fake jobs to enroll them in junk insurance policies.
Five Tenet Healthcare hospitals are suing the Leapfrog Group, accusing the organization of pressuring hospitals to share internal data in exchange for higher scores in its annual safety rankings. The watchdog outright denies the claim.
For the second time in less than two years, the struggling retail pharmacy chain has filed for Chapter 11 bankruptcy protection, seeking buyers as it prepares for store closures.
The three insurance giants are accused of conspiring with brokers to enroll profitable patients in Medicare Advantage plans, in exchange for "hundreds of millions" in kickbacks.