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What If Costco Designed the Prescription Drugs Sales Model?

Jane Sarashon

Consumers Overpay for Generic Drugs , a new paper from the Leonard Schaeffer Center for Health Policy & Economics asserts, with recommendations to address the intermediaries who benefit from the way Americans currently pay for medicines. The good news about prescription drugs, in the context of medical spending in the U.S.,

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Navigating the Intersection of Payment Integrity and Provider Relations in Healthcare

Innovaare Compliance

Balancing AI-Driven Payment Integrity with Provider Relations A large health insurance company implemented an AI-powered payment integrity system to identify and prevent potential fraud, waste, and abuse in healthcare claims. They also streamlined their dispute resolution process to ensure quick and fair resolutions.

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Retrieving Billions in Overpayments by CMS

Healthcare IT Today

Challenges of Investigating Overpayments Undeserved payments are needles lurking in the haystack of 135 million Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). How can such overpayments be uncovered? public in overpayments. But the needles pile up fast.

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18 Former NBA Players Indicted For Alleged $4 Million Health Care Fraud Scheme

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] Indest III, J.D.,

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Introduction to Telebehavioral Health

AIHC

Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. Not all forms of technology are recognized as services which can be reimbursed by health insurance.

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Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Health Provider News

Hall Render

Cedars Leads Latest Round Of Funding In Yolo County, 16,000 Medi-Cal patients lose doctors in Dignity Health dispute with Partnership HealthPlan Kaiser med school names CEO Kaiser Permanente launches food-is-medicine hub Kaiser, Vizient target healthcare greenhouse gas emissions L.A. Can lawmakers do anything about it?