The Medicare Advantage insurer said the payout is equal to what a CMS audit stated was the total amount the company was overpaid for patient care services. Despite receiving the cash, the agency has yet to officially withdraw its enforcement action, as the two parties are still negotiating. 

Hospitals are not the only healthcare entities competing over a limited pool of qualified compliance officers. Payers, vendors and others are in the race too. But hospitals and health systems may have the most to lose if they let down their guard on adherence to regulatory rules.

With Election Day only four months away, healthcare is again emerging as a major source of idealistic campaign promises. Many of these are driven by widespread public angst. What sorts of changes can U.S. healthcare stakeholders realistically expect once the results are in? 

The owners of a local pharmacy in Mississippi have been ordered to pay back the money they stole from Medicare and Medicaid by billing for expensive prescriptions they never dispensed to patients. 

An analysis from cybersecurity consultancy group Omega Systems reveals that most healthcare practices place too much trust in their third-party vendors to secure patient data, neglecting their own IT systems in the process.

An emergency department nurse at Heritage Valley Sewickley Hospital is accused of stealing drugs and neglecting patients, causing at least two fatalities. A lawsuit filed by two whistleblowers further alleges that hospital leadership covered for the drug-dependent nurse. 

The Trump administration said the reduction can be attributed to a cleanup of fraud, waste and abuse, but the real reason extends back to enhanced subsidies put in place during the COVID-19 pandemic.

Led by Massachusetts and California, the plaintiffs say CMS ignored the will of Congress by strictly defining a “medically frail” exemption that would allow a person access to safety net medical coverage.

Memo to health execs: If your hospital hasn’t had a C. auris scare yet, odds are quite high that it soon will. 

Many or most who left their jobs in the early 2020s—whether for other nursing jobs or entirely new work—were thinking about doing so prior to the pandemic. 

As the Medicare drug price negotiation program enters its fourth year next year, regulators are looking to put a set of guidelines in place that make it clear how medications are selected for inclusion and what the deliberation process will look like for biopharma companies.

"These high costs could pose barriers to care for such plans’ beneficiaries,” researchers wrote July 1 in the American Journal of Roentgenology. 

The groups hope to standardize heart failure terminology and ensure everyone is on the same page when discussing this complex condition.