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OIG’s report to Congress profiles plenty of activity, including the ongoing battle against the opioid abuse epidemic. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is in the business of rooting out “fraud, waste, and abuse” in the nation’s healthcare system, to echo the…
May 16, 2019

The Myth About Pass/Fail Rates for Providers

By Frank D. Cohen, MPA, MBB
Projecting results of an audit to a larger population of providers can be a serious step. Many of the organizations with which I engage feel this pressing need to use the results of individual provider audits to infer an overall pass/fail rate, either to everything that provider does or to…
Last week the Centers for Medicare & Medicaid Services (CMS) released a blog post from agency Administrator Seema Verma titled “Recovery Audits: Improvements to Protect Taxpayer Dollars and put Patients over Paperwork.” In the post, Ms. Verma talked about the Recovery Audit Contractor (RAC) changes CMS made back in 2015,…
May 2, 2019

The Pharm Report: Oligopoly and Drug Pricing

By Timothy Powell, CPA CHCP
Prices of certain drugs continue to spiral out of control as alternatives are sought. ol·i·gop·o·ly (äləˈɡäpəlē), noun: a state of limited competition, in which a market is shared by a small number of producers or sellers. I have been looking at data from the Centers for Medicare & Medicaid Services…
April 25, 2019

The Favorable Economics of Robotic Surgery

By Edward Roche, PhD, JD
Surgery has a long history. Even as long ago as in ancient Egypt, we have found remains showing evidence of trephination, the boring of a hole in the skull for brain surgery. More than a century of experimentation in repairing the intestines without causing sepsis eventually was solved with a…
April 18, 2019

New Guide Revealed for Tele-behavioral Health

By Kathy Seward, MD, CHCQM-PHYADV
New guide offers the possibility of improving a hospital’s bottom line. Last week, The National Quality Forum and the American Hospital Association Center for Health Care Innovation released their how-to guide for hospitals and health systems seeking to implement, strengthen, and sustain tele-behavioral health. Entitled Redesigning Care, the guide outlines an…
Two dozen individuals were charged in a landmark investigation historic in breadth. “A million dollars isn’t cool,” remarked pop star Justin Timberlake in the Oscar-winning 2010 film The Social Network, portraying entrepreneur Sean Parker as he advises a young Mark Zuckerberg and his associates in a nightclub amid the fledgling…
The head of the federal healthcare oversight body was a popular guest on Monitor Mondays. Daniel Levinson, Inspector General of the U.S. Department of Health and Human Services (HHS), is stepping down from his post at the end of May, following nearly 15 years in his position as healthcare’s top…