Why the Office of Personnel Management Needs Access to Government Employee Health Plan Claims Data
Without knowledge of the exact amount providers billed and middlemen charged in fees, OPM can’t fix payment discrepancies.
OIG: 3 Largest MA Insurers Deny Prior Auth Requests at High Rates for Long-Term Acute Care, Inpatient Rehab
An OIG report found that the three largest Medicare Advantage insurers denied prior authorization requests for long-term acute care and inpatient rehabilitation at higher rates than other MA plans in 2024.
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Inside an Automated Healthcare Practice: Redesigning Care Around People, Not Paperwork
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Medicare Part D Spending on 10 Diabetes Drugs Hit $35.8B in 2023
Medicare Part D spending on 10 diabetes drugs increased 364% between 2019 and 2023.
How the Right AI Can Improve Health Risk Assessments
Healthcare needs a better way to collect information from all sources, organize it, summarize it and present it to providers in a way that lets them deliver the necessary treatment, confident that the material is sound and verifiable.
4 States Received Enhanced Medicaid Funding During Covid Despite Wrongly Terminating Coverage
New York, Florida, Texas and Minnesota terminated Medicaid coverage for some enrollees for “unallowable or potentially unallowable reasons” during the Covid-19 public health emergency, according to a recent Office of Inspector General report.
Health IT Firms Could Be Fined Up to $1M for Info Blocking Starting 9/1
Beginning September 1, HHS’ Office of the Inspector General will begin enforcing the anti-information blocking regulations laid out in the 21st Century Cures Act. EHR vendors are the entities that are most at risk of being fined — they could face penalties up to $1 million.
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Top 7 Modern AI-Powered EAP Providers for Global Workforces in 2026
Discover the top AI-powered EAP providers for 2026. Compare platforms like Kyan Health and Spring Health on triage speed, global reach, and clinical quality to transform workforce wellbeing.
OIG: Medicare Part B Spending on Lab Tests Rose 17% in 2021
The 17% increase is the largest jump since OIG began tracking lab spending in 2014. This increase was due to higher volume for three test types: Covid-19 tests, genetic tests and chemistry tests.
OIG: Over 50,000 Medicare Part D beneficiaries experienced an opioid overdose in 2021
Over 1 million Medicare beneficiaries had a diagnosis for opioid use disorder in 2021. But despite this high number, only 18% received medication to treat their disorder.
OIG: MA companies used chart reviews, health risk assessments to boost CMS payments
Overall, MA companies generated an estimated $9.2 billion in risk-adjusted payments for diagnoses listed only on chart reviews and health risk assessments, with the top 20 companies receiving more than half of the payments. OIG is urging CMS to provide more oversight.
OIG: Pandemic forced hospitals into ‘survival mode’
A new report from the HHS' Office of Inspector General lays bare the varied challenges hospitals faced in the past year — and continue to face. These range from challenges in healthcare delivery to staffing shortages to shaky finances.
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New Webinar: The Payer AI Readiness Gap: Why Better Data Will Define the Next Era of Health Plan Performance
We'll explore why the next era of payer performance will depend on building a trusted data foundation that connects people, providers, and relationships across the enterprise.
What providers need to know about OIG’s plans to audit telehealth services
The Office of the Inspector General will audit Medicare Part B telehealth services to detect potential vulnerabilities and ensure compliance with regulatory requirements. To prepare, providers must first take stock of their programs and conduct audits of their own, experts say.
Report: CMS Administrator spent millions on outside consultants
A Congressional investigation found that outside consultants billed CMS nearly $6 million in less than two years. The expenditures, which included setting up interviews with CMS Administrator Seema Verma, were found by a previous Inspector General audit to violate federal contracting requirements.
Report uncovers patient safety issues with VA’s EHR go-live
Two reports published by the Office of the Inspector General shed light on why the VA pushed back its rollout of a new health record system. The OIG said the March 2020 deployment date was “likely unrealistic.”
OIG report: CMS improperly reimbursed doctors $3.7M in telehealth payments
In a sample of 100 claims from 2014 and 2015, 69 met telehealth service requirements and the other 31 did not, resulting in an estimated $3.7 million in extra costs.
OIG report lists HHS’ top 10 challenges
Curbing the opioid epidemic, improving care for vulnerable populations and keeping HHS data safe from cybersecurity threats are all issues outlined in the 48-page report.