In May 2022, a California doctor was sentenced to nearly eight years in prison for his involvement in a $12 million Medicare fraud scheme. His crime: performing unnecessary vein ablation procedures on patients, and using incorrect billing codes to receive larger reimbursements. He received $4.5 million in reimbursements from Medicare over a three-year period.
Compared to this example, most instances of “upcoding” and “overcoding” are not as malevolent or expensive. But even an
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Health IT | News, Analysis, Insights - HIT Consultant
Waymark Secures $42M to Expand Community-Based Care for Medicaid Patients
What You Should Know:
- Waymark, a San Francisco, CA-based Medicaid provider enablement company raises $42M in new financing to scale technology-enabled, community-based care for primary care providers and their patients enrolled in Medicaid programs. The round was led by Lux Capital and CVS Health Ventures joins as a new investor.
- Existing investors Andreessen Horowitz (a16z) and New Enterprise Associates (NEA) also participated in the round. The investment consists of $22M in
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HIMSS Appoints New Chief Financial Officer & General Counsel
What You Should Know:
- HIMSS announced it has appointed Elizabeth Slater Jasper as general counsel, and Anne Tuzik as its new chief financial officer.
- Jasper comes to HIMSS after serving for 14 years as the chief legal officer, general counsel and corporate secretary for the National Service Office for Nurse-Family Partnership and Child First, an organization that oversees the national replication of maternal, infant and mental health evidence-based
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Innovation Key to Tackling Medicaid Redetermination Challenge
As a result of the Families First Coronavirus Response Act (FFCRA), Medicaid programs were required to keep citizens continuously enrolled through the COVID-19 public health emergency (PHE). These continuous enrollments ended on March 31, 2023, resulting in what many call the unwinding of Medicaid.
In June, the Kaiser Family Foundation (KFF) estimated that between 8 million and 24 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision. The
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Inovalon & AWS to Develop AI/ML Solutions for Healthcare
What You Should Know:
Amazon Web Services and Inovalon announced a collaboration to develop AI and ML-based solutions for healthcare organizations to improve patient outcomes and cost-savings.
- The collaborated capabilities are being developed for multiple applications across the broader Inovalon ONE® Platform, the Company’s SaaS-based software platform supporting more than 20,000 customer organizations across the healthcare ecosystem. The initial offerings will focus on risk
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No More Surprises: Automation Ensures Compliance, Mitigating Penalties
The No Surprises Act (NSA) is a bipartisan effort to protect patients from unexpected healthcare expenses. This law is good news for patients, with a KFF poll showing that 1 in 3 insured adults between 18 and 64 received an unexpected medical bill in the prior two years. The NSA aims to make the cost of care more transparent and minimize surprise billing, which can cause significant financial burdens through higher out-of-pocket expenses and denied claims. Under the NSA, patients now receive
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Rite Aid Files for Chapter 11 Bankruptcy
What You Should Know:
- Rite Aid filed for Chapter 11 bankruptcy protection on Sunday to address its $4B debt load and legal battles for allegedly filing unlawful opioid prescriptions.
- Last Thursday, Rite Aid filed a notice to the US Securities and Exchange Commission (SEC) stating an inability to file its latest quarterly financial report due to exploring “strategic alternatives.”
Interim Plans During Bankruptcy
To support itself during the bankruptcy process, Rite Aid established
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Embracing a Forward-Thinking Vision to Address the Senior Care Crisis
A demographic shift is looming, and we aren’t as prepared as we think.
Colorado has long been revered for its stunning landscapes and outdoor pursuits, earning a reputation as a state with a youthful and active population – but, we are aging.
By 2050, Colorado’s number of older adults is expected to more than double to 1.7 million, second only to Alaska in the U.S. for the fastest-growing population of people over 65. Nationwide, the 85 and older population is projected to more than double
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KLAS Unveils 2023 Top 20 Emerging Solutions
What You Should Know:
KLAS Research presented the 2023 KLAS Top 20 Emerging Solutions awards at HLTH 2023, highlighting the top 20 emerging healthcare solutions with the greatest potential to disrupt and improve healthcare. Selected by healthcare leaders working with KLAS, the solutions were rated on how well they could advance the “Quadruple Aim of Healthcare” – improve outcomes, reduce the cost of care, improve the patient experience, and improve the clinician
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Mount Sinai, UCSD Awarded $8.5M to Establish Data Integration Hub
What You Should Know:
- Researchers at the Icahn School of Medicine at Mount Sinai and the University of California San Diego have been awarded an $8.5 million grant to create a data integration hub aimed at accelerating novel therapeutics and cures for diseases within initiatives supported by the National Institutes of Health (NIH) Common Fund.
- NIH Common Fund programs are large-scale projects designed to collect cutting-edge biomedical research data from human cells, tissues, and
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