Cigna to Pay $173M to Settle False Claims Act Litigation Filed by Whistleblower

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Health insurance giant Cigna agreed to pay nearly $173 million to resolve allegations it violated the False Claims Act by knowingly submitting false diagnosis codes under the federal Medicare Advantage program to increase its payments. In a lawsuit filed last year, the feds alleged that between 2014 and 2019, Cigna submitted to the Centers for…

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HHS-OIG Details Successes of Efforts to Curb Healthcare Fraud and Abuse in Semiannual Report to Congress

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The U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) recently released its Semiannual Report to Congress touting its many successes but also adding that a lack of funding has resulted in an inability to go after even more healthcare fraud and abuse. “We are turning down 300 to 400 viable…

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States Benefit from Multimillion-Dollar FCA Urine Test Lab Settlement

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Several states are now benefiting from a multimillion-dollar settlement agreement signed late last year by a Nevada clinical lab and two of its owners who were charged with submitting false claims for payment to federal healthcare programs. Nevada Attorney General Aaron D. Ford recently announced that his state would receive $335,000 of the settlement money…

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CMS Program to Give Providers Access to Medicare Patient Data

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In an effort to accelerate the transformation of the nation’s healthcare system to one that is value-based, the Centers for Medicare & Medicaid Services (CMS), recently launched the Data at the Point of Care (DPC) pilot program. The pilot program, announced by CMS Administrator Seema Verma during a Blue Button Developer Conference, will give healthcare…

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CMS Issues Proposed Rules for Rehab and Skilled Nursing Facilities

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On April 17, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would update Medicare payment policies for Medicare Inpatient Rehabilitation Facilities (IRF). Two days later, on April 19, CMS issued another proposed rule, this one updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs). Let’s start…

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CMS Issues Guidance on When a Hospital is a Hospital

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Is your hospital really a hospital? Well, that depends on whether Medicare deems it so. Earlier this month, the Centers for Medicare & Medicaid Services issued clarifying guidance on what constitutes a hospital. Under these new guidelines, holding a state hospital license isn’t necessarily the end-all for receiving Medicare reimbursement. CMS says it will now…

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