The whistleblower brought this suit under the federal False Claims Act.
The False Claims Act (FCA) allows a private party (known as a “relator” or “whistleblower”) with inside information about fraud against the government to file a lawsuit on the government’s behalf and receive 15 to 30 percent ...
If a patient does not have liability for a particular expense, the insurer is similarly absolved of responsibility.
The June 14 issue of RACmonitor focused in part on Anthem’s policy regarding coverage of ED services. The relevant article suggested that insured patients should not face ...
Observation is a service, not a status.
As we have all seen in recent events on television, choice of words matters.
That’s particularly true in the utilization review world. And one word that matters an awful lot is “observation.” I am sure you have all heard this a million times before, but it ...
RACmonitor Partners
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Providers urged to review potentially eligible claims and consider participation in the expanded SCF process.
The Office of Medicare Hearings and Appeals (OMHA) publicly implemented the long-awaited expansion to its Settlement Conference Facilitation (SCF) process on June 15. SCF is an alternative ...
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Andrew B. Wachler, Esq.Andrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew Wachler, Esq., and Sarah Hillegonds, Esq.Angela Phillips, PTChristopher Halleman, DOChuck BuckDavid M. Glaser, Esq.Denise Nash, MD, CCS, CIMDuane Abbey, PhD, CFPEdward Roche, PhD, JDElizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADVErica E. Remer, MD, FACEP, CCDSErin Diesel Roumayah, Esq.Frank D. Cohen, MPA, MBBGloryanne Bryant, RHIA, RHIT, CCS, CCDSGreg FordJ. Paul Spencer, CPC, COCJanelle Ali-Dinar, PhDJessica Forster, Esq.Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADVKim T. Charland, BA, RHIT, CCSKnicole C. Emanuel Esq.Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainerLaurie M. Johnson, MS, RHIA, FAHIMA
