Payer organizations are responsible for making payments toward their members’ healthcare services. They have to ensure that payments are accurate, resolve any under- or overpayments, and detect patterns of fraud, waste, and abuse (FWA)….
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If your hospital, nursing home or doctor’s office received financial relief from the government during the pandemic, be prepared for some scrutiny that might be headed your way. Tens of billions of dollars were showered…
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Welcome to our Healthcare IT Today Weekly Roundup. Each week, we’ll be providing a look back at the articles we posted and why they’re important to the healthcare IT community. We hope this gives…
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There’s widespread consensus that payments to Medicare Advantage Organizations (MAOs) are a mess. These programs, which care for more than 30 million of the nearly 64 million Medicare enrollees, operate on the cutting edge…
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Amid swirling accusations that Medicare Advantage Organizations (MAOs) are overbilling the U.S. government and calls for better oversight, the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. They expect to recoup 4.7 billion dollars through this program.
This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. The article is based on an interview with Kel Pults, chief clinical officer and vice president of MediQuant. A future article will explain how Medicare Advantage plans are trying to improving data collection and reporting,…
