Fierce Exclusive: Therapy benchmarks serve as a red flag for SNF false claims

For the last 15 years, evidence has been mounting that skilled nursing facility therapy claims are subject to widespread overpayments. RehabCare's $125 million settlement in January, coupled with newly released data about SNF utilization, may have opened the door to additional claims involving ultra-high therapy billing. From the government's perspective, the use of therapy benchmarks appears to be a red flag. 

Former gynecologist accused of taking pharma kickbacks says she was unfairly targeted

A former Massachusetts gynecologist accused of taking kickbacks from Warner Chilcott says she was targeted by federal officials because she is an Indian woman, according to


Provider group lashes out at statistical sampling in FCA cases

The American Health Care Association has strong feelings about the use of statistical sampling in False Claims Act cases, as evidenced by an amicus brief filed this week in the government's case against a hospice provider.


Lawsuits accuse OptumHealth of hiding Medicaid billing errors

The company that oversaw New Mexico's Medicaid program and ignited claims that 15 behavioral health providers were defrauding the state program has suddenly found itself facing three lawsuits alleging it hid billing errors from the state, according to the Santa Fe New Mexican.


Sleep apnea mask manufacturer pays $34M to settle kickback allegations

A Pennsylvania manufacturer that specializes in sleep apnea masks has agreed to pay $34.8 million to settle allegations it offered free services to durable medical equipment suppliers to incentivize increased equipment sales, according to the Department of Justice.


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Guest post by S cott Kashman, chief administrative officer of Cape Coral Hospital, part of the Lee Memorial Health System in southwest Florida. Have you ever invited people over to our home? Of...


Both health insurers and employers have a stake in driving down healthcare costs for their member populations. Increasingly, businesses are turning to payers to design wellness programs to aid in the effort. But it's not as simple as handing out activity trackers or launching a member wellness portal. Every company is different and there are many ways to measure success.  FierceHealthPayer  spoke to three health insurance executives to find out how they're designing wellness programs--and how they're demonstrating their value to customers.