by Advize Admin | Nov 11, 2022 | Healthcare
Doris Spatz takes a once-a-day pill, Kisqali, to keep her metastatic breast cancer in check. As a patient in the Defense Department health system, she can fill routine prescriptions at a military pharmacy without a copay but also has the option of using a regular...
by Advize Admin | Aug 26, 2022 | Commentary, OIG Files
A phrase that does not often come up is “medical loss ratio,” or MLR. As an OIG Agent, I spent very little time looking at the OIG Workplan (I’ve blogged and spoken about how OIG Agents follow the current frauds, and how the plan is very much used to direct the work...
by Advize Admin | Aug 19, 2022 | Compliance, Healthcare
Kyle Kopec, Braden Health’s chief compliance officer, holds up a sample of diagnostic images left behind at a Tennessee hospital. As the company takes over abandoned hospitals, a major task is figuring out what to do with old medical records stacked in...
by Advize Admin | Aug 12, 2022 | Business, Healthcare
For decades, the drug industry has yelled bloody murder each time Congress considered a regulatory measure that threatened its profits. But the hyperbole reached a new pitch in recent weeks as the Senate moved to adopt modest drug pricing negotiation measures in the...
by Advize Admin | Aug 12, 2022 | Healthcare
The giant health care, climate, and tax bill expected to pass the House on Friday and be sent to the president for his signature won’t be as sweeping as the Democrats who wrote it had hoped, but it would help millions of Americans better afford their prescription...
by Advize Admin | Aug 5, 2022 | OIG Files
While CMS reported that is collected half of the overpayments previously identified by OIG, the OIG in another recent review (full report) found that number to substantially less. The OIG is the watchdog for HHS. All OIGs serve in this role for the respective...
by Advize Admin | Jul 29, 2022 | Healthcare
Data wonks with mighty computers are overjoyed. Ordinary consumers, not so much. That’s the reaction about three weeks into a data dump of enormous proportions. Health insurers are posting their negotiated rates for just about every type of medical service they cover...
by Advize Admin | Jul 22, 2022 | Business
President Joe Biden has ordered the Federal Trade Commission to combat consolidation in the health care industry, saying that it is driving up prices for consumers and limiting their access to care. The new Democratic majority on the FTC has signaled that it not only...
by Advize Admin | Jul 15, 2022 | Commentary, Healthcare
The National Association of Insurance Commissioners (“NAIC”) is a resource we enjoy for providing regulatory support functions, presenting insurance standards and best practices to help support compliant and informed decisions. On July 11th, NAIC...
by Advize Admin | Jun 10, 2022 | Healthcare, Technology
Tina Passione needed health insurance in a hurry in December. The newly retired 63-year-old was relocating to suburban Atlanta with her husband to be closer to grandchildren. Their house in Pittsburgh flew off the market, and they had six weeks to move out 40 years of...
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