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The continued advancement of artificial intelligence holds great promise for healthcare, but the industry still struggles with ..read more
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Recovering overpayments from providers is often contentious, requiring payers to perform advanced statistical analysis and ..read more
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Several alleged schemes that billed for unnecessary and expensive genetic testing as well as “pill mills” dispensing ..read more
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When a health plan is deciding whether to pay a claim, there’s no shortage of information to consider and reviews that must ..read more
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What qualities do today's healthcare leaders need to succeed in driving innovation and solving the challenges of value-based ..read more
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From hfm magazine: Moving from theory to practice in value-based payment has proven more difficult than was originally ..read more
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The Centers for Medicare & Medicaid Services (CMS) recently released the health plan-specific 2018 benefit year risk ..read more
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A “brazen” alleged drug fraud scheme and indictments related to home healthcare, compounded medications, and portable x- ..read more
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Amid frequent regulatory and structural shifts, healthcare delivery and payment models in the United States are likely to be ..read more
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Payment accuracy programs are critical to delivering value to health plan members. Some plans excel at recovery management ..read more

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