According to the US Department of Justice (DOJ) Civil Division, many of the Fraud Section’s cases are suits filed under the False Claims Act (FCA), 31 U.S.C. §§ 3729 – 3733. The FCA is a federal statute originally enacted in 1863 in response to defense contractor...
Stateline reports health insurance companies are facing “scrutiny for allegedly using artificial intelligence bots and algorithms to swiftly deny patients routine or lifesaving care” without a human reviewing the claims. Lawmakers in in more than a dozen states are...
The Local Coverage Determinations (LCDs) that will directly impact the application and documentation of cellular tissue products (CTPs, aka Skin Subs) have been postponed until January 1, 2026! This postponement came at the last minute, as the LCD was scheduled to go...
Here’s another fantastic post from attorney Knicole Emanuel about the serious overreach problems inside the alphabet soup of Medicare audits. This is an issue that will get even more problematic due to the delay of the “skin substitute” LCD(s). Some auditors are...
A 2/26 article in Chief Healthcare Executive entitled “Hospitals, providers spent $25B on battles over claims, report finds” (it’s free) reports, “Hospitals and other providers are spending a lot more money in battles over insurers over paying claims,...
