Medicaid patient access to care has been a challenge for years. Many providers have historically opted to not participate in Medicaid because of the low reimbursement rates and the increased administrative requirements t...

Adhering to compliance standards protects all consumers of healthcare services and ultimately enables the delivery of the highest levels of healthcare across the country. An annual Compliance Week provides a great opport...

In June, 2022, the OIG issued its 2021 Iowa Medicaid Fraud Unit (MFCU) Inspection Report. The OIG inspection revealed a MFCU unit with exceptionally strong case outcomes over the 2019-2021 period compared to other simila...

Insurers constantly  look for ways both to attract new enrollees and to retain existing membership. The competition is stiff in many areas of the country, and there were instances historically where plans gave away ...

Healthcare professional licensing and certification is controlled by states and local jurisdictions.  All healthcare professionals must apply for licensure by the state (s) in which they intend to practice medicine....

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or Program) under the joint direction of the Attorney General and the Secr...

During the PHE, access to care was limited and social isolation was real. To increase access, the Centers for Medicare & Medicaid Services (“CMS”) through blanket waivers and state  Medicaid programs tempora...

The Texas Office of the Inspector General for the state’s Health and Human Services agency recently published a reminder about the significance of exclusion screening. Texas, like many states, maintains a state exclusi...

Over the past 5 years, there has been a decreased in false claims recoveries by the DOJ. That trend was resoundingly reversed in fiscal year 2021. In a press announcement on February 1, 2022, the DOJ released the foll...