Monitor Mondays Podcasts

Announced in June by UnitedHealthcare (UHC), its new policy begs the question: “Are you adding the modifier correctly for UHC services for your qualified healthcare professional?” 

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Last week the U.S. Department of Justice announced a $465 million settlement with Mylan, Inc., makers of the trouble-prone EpiPen, to resolve claims that it violated the False Claims Act. The corresponding suit, brought by Mylan’s competitor, Sanofi-Aventis US LLC, alleged improper misclassification of the EpiPen as a generic drug to avoid paying rebates owed mainly to Medicaid.

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RACmonitor legislative analyst Emily Evans, managing director of healthcare policy for Hedgeye, will return to Monitor Mondays next week to report on the latest news from the Centers for Medicare & Medicaid Services (CMS) that portends a retreat from the expansion of the Advancing Care Coordination through Episode Payment Model – a story first reported on last week by Ronald Hirsch, MD.

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With approval from the Centers for Medicare & Medicaid Services (CMS) in hand, two Recovery Audit Contractors (RACs), Cotiviti and Performant, have a new target in their sights: Condition Code 42.

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During the next edition of Monitor Mondays, whistleblower attorney Mary Inman will return to report on three whistleblowers targeting UnitedHealthcare in Wisconsin. 

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