Within the past few weeks, we have seen at least two of the large payors seek to institute policies that would require providers to submit their...
FWA Articles
Watch: Emergency Room Turns Simple Injury Into a Big Bill
Leigh Fava wound up in the emergency room after injuring her thumb at her New Orleans home. She said she received a tetanus shot and a badly...
Nursing Home Owners Drained Cash During Pandemic While Residents Deteriorated
After the nursing home where Leann Sample worked was bought by private investors, it started falling apart. Literally. Part of a ceiling collapsed...
Did Your Health Plan Rip Off Medicare?
Today, KHN has released details of 90 previously secret government audits that reveal millions of dollars in overpayments to Medicare Advantage...
MA and Risk-Scoring, We Can Do Better (and Advize does)
When you first open this article, the most glaring of things is the time frame from which the audit was derived. 2011-2013 data is at this point...
Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges
Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some...
Supreme Court to Hear Nursing Home Case That Could Affect Millions
When Susie Talevski sued the agency that managed her elderly father’s care before he died, she hoped to get justice for her family. She did not...
Centene Agrees to Pay Massachusetts $14 Million Over Medicaid Prescription Claims
Massachusetts has become the latest state to settle with health insurance giant Centene Corp. over allegations that it overbilled the state’s...
Centene to Pay $166 Million to Texas in Medicaid Drug Pricing Settlement
Health insurance giant Centene Corp. has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program...
OIG Files: Open (Enrollment) Season on Fraud
Open enrollment will be upon us in the coming month. With it will come a slew of fraud complaints as it relates to managed care...
Come Fly With Me: Heard It Through the Grapevine
This week our very own Eric Rubenstein, Sr. Director of FWA and I, flew out to Dallas to present to the Texas Office of the Attorney General...
Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging
Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the...
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