Latest Headlines

Latest Headlines

CMS clarifies 60-day rule, lookback period for overpayments

The Centers for Medicare & Medicaid Services has finalized rules that specify when the 60-day clock begins ticking for providers to return overpayments, and shaves four years off of the overpayment lookback period, according to  FierceHealthFinance.  

Imagining how a 2-for-1 deal could combat healthcare fraud

Cees Klumpler, chief risk officer for the Global Fund to Fight AIDS, Tuberculosis and Malaria, is responsible for $4 billion in annual funding that is distributed to 130 different countries. Following years of fraud and abuse that plagued the organization, Klumper has developed a unique 2-for-1 approach to recovering fraudulent payments. It's a methodology that the healthcare industry could benefit from. 

UnitedHealth sues feds over Medicare Advantage overpayment rule

UnitedHealthcare and 40 other affiliated companies have sued the federal government in an attempt to change what they argue are unfair regulations governing Medicare Advantage overpayments.  

Minnesota audit finds state spent as much as $271M on ineligible beneficiaries

Minnesota overpaid as much as $271 million over a five-month period on ineligible beneficiaries within the state's health insurance exchange program, according to a recently released audit.  

Former CEO claims he was fired for calling out improper payments

A prominent physician and former CEO of an Oregon health system says he was fired by the governing board last year for suggesting the provider self-report $10 million in improper Medicare claims, according to  The Oregonian,

Virginia spent as much as $38M covering ineligible Medicaid recipients

The state of Virginia spent between $21 and $38 million covering ineligible Medicare recipients in 2014, according to a state watchdog agency.

State audit: Nebraska failed to act on overpayment referrals

More than 12,000 overpayment referrals are sitting untouched in the Nebraska Department of Health and Human Services' "overpayments mailbox," according to a state audit released last week.

Obama budget director wants more aggressive approach to improper medical payments

The Obama administration is zeroing in on fraud, waste and abuse, as evidenced by a letter from a White House official calling for "a more aggressive strategy" to combat improper payments within government healthcare programs.  

Whistleblower suit implicates dozens of health plans in Medicare Advantage overpayments

More lawsuits targeting Medicare Advantage are rolling in, and the latest calls into question the practices of one company that performed in-home health assessments on elderly patients for 30 health plans in more than 15 states across the country, according to a report from the Center for Public Integrity.

Improper payments among the four key issues facing Medicaid

Preventing improper payments, which comprised $17.5 billion of Medicaid spending in 2014, represents a specific concern for the long-term health of the government-run health program, according to a report released last week by the Government Accountability Office.