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 –
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
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,
Recently, we were researching the likely impact of an MPN (Medical Provider Network) implementation for a client in California. The data can vary dramatically depending upon the client and region of the state. The California Workers’ Compensation Institute (CWCI) issued a Research Report in early June regarding the impact of physician networks in California Workers’ Comp.
One of the main selling points of the Affordable Care Act (ACA) was the contention that it would reduce the number of people going to the emergency room (ER) for non-emergency services. When a patient does not have health insurance, these costs are often subsidized by taxpayers. And even when there is insurance coverage, an
Last week, I shared my thoughts in Risk & Insurance on the hot debate ignited by the recent ProPublica/NPR series, “The Demolition of Workers’ Compensation.” While I focused on “big-picture” questions that we must ask ourselves as we examine the points raised, I did want to follow up with some additional commentary. The authors took
The following article has some great data on how case management has had an impact on long-term costs and increased health. It is different than our programs because we are very injury specific, and their’s is more preventative of chronic issues, but the goal of targeting high-risk people and intervening proactively for better results is