Program Integrity

Apr 12, 2018
On April 9, CMS issued a final rule and related guidance that will implement the standards governing health insurance issuers and the Health Insurance Marketplaces for 2019. In the rule, CMS provides details on the benefit and payment parameters for qualified health plan issuers selling in the…
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Program Integrity

Oct 17, 2017
In recent years, the Centers for Medicare & Medicaid Services has drastically increased the number of program integrity auditors that review hospital claims to identify improper payments. These audit contractors include recovery audit contractors (RACs) and Medicare administrative contractors (…
Jan 17, 2017
The HHS Jan. 13 issued a final rule that makes changes to the procedures for Administrative Law Judge appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare appeals.
Jan 12, 2017
The Department of Health and Human Services’ Office of Inspector General today issued a final rule expanding its ability to exclude individuals or entities from federal health care programs, as authorized by the Affordable Care Act and other laws.
Nov 14, 2016
Beginning Dec. 1, the CMS will reopen settlement for certain inpatient status claims.
Jun 29, 2016
The Department of Health and Human Services late June 28, issued a proposed rule that would make changes to the procedures for Administrative Law Judge (ALJ) appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare…
Jun 16, 2016
Supreme Court issues decision in False Claims Act case.