MSA Fines – Recent Ruling Adds More Risk

In a recent ruling between Humana vs. Western Heritage Insurance, the courts upheld the rights of Medicare Advantage Organizations (MAOs) to sue for double damages for any costs they incurred that should have been paid by the primary carrier. In a nutshell, MAOs will now have the same protections and rights as the Centers for

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HIPAA Fines – More Prominent and Pricey

In looking at this article on HIPAA fines, it is clear that penalties from the Department of Health and Human Services for HIPAA violations are increasing. While the number of audits performed is still small, there is an upward trend in the frequency and fine amounts that will continue. Currently, the average settlement is 2 million dollars. Even

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Largest Single Healthcare Fraud Case in U.S. History

The U.S. Justice Department just recently indicted three Florida residents in the “largest single criminal healthcare fraud case ever brought against individuals.” While the case has not gone to trial yet, the numbers are staggering. It is alleged that over $1 billion in Medicare and Medicaid billings were fraudulently charged by just a few co-conspirators –

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War of Mergers

I have previously written about the increased pace of medical provider/hospital mergers since the Affordable Care Act was passed. By consolidating choices and moving more services into hospital settings, where pricing is much higher for the same treatment, facilities are able to negotiate better PPO rates, increase revenue, and improve profitability. This exact same trend

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Common Sense & HIPAA

This article discusses a HIPAA violation so obscene it is difficult to believe. A nurse took a picture of a patient’s private area while he was unconscious, and then sent the pictures to her coworkers via text message. Obviously this is a colossal mistake, and a violation of privacy, decency and common sense. These types

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An Observation – Deadly Healthcare Mistakes & Orlando’s Tragedy

I often find myself coming back to this issue because it is so troubling – the third leading cause of death in America is, in fact, our nation’s healthcare. Patients are dying from the medical treatment itself versus the actual health issue they sought care for in the first place. Whether it be inappropriate medications,

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