AI: A Good Tool to Combat Bad Actors in Healthcare
AI can be a highly effective tool for plans aiming to reduce fraud, waste and abuse, but only if it is combined with investigative intelligence.
Walgreens to Pay Humana $360M to Settle Claims It Overcharged for Drugs
Walgreens has agreed to pay Humana $360 million to settle a drug pricing dispute that has spanned nearly five years. The payout is roughly half of what Walgreens was originally ordered to pay when the issue was first resolved last year.
presented by
Esperion Sets Its Sights on New Areas While Maintaining Commitment to Cardiovascular Health
In a recent interview, Esperion president and CEO, Sheldon Koenig talks about the reality of statin intolerance and his company’s expansion into new diseases
Feds slap UPMC, cardiothoracic surgery chair with billing fraud suit
The lawsuit alleges that UPMC and the chair of its cardiothoracic surgery department knowing submitted false claims for concurrent surgeries that violated regulations. But, according to UPMC, there is no regulation that prohibits overlapping surgeries or billing for them.
Justice Department joins False Claims lawsuits against Kaiser Permanente
The government has intervened in complaints alleging Kaiser Permanente entities defrauded Medicare out of "tens of millions of dollars" by knowingly submitting false diagnoses for Medicare Advantage beneficiaries. Kaiser denies the allegations, saying it is in compliance with program requirements.
Report: Federal agencies fighting healthcare fraud recouped $3.1B in 2020
Spearheaded by the Departments of Justice, and Health and Human Services, efforts to investigate and prosecute healthcare fraud resulted in the government recovering billions, including about $2.1 billion for the Medicare Trust Funds.