Category: News

June 28, 2023

Associated Press

WASHINGTON — The Justice Department has charged dozens of people in several healthcare fraud and prescription drug schemes, including one totaling $1.9 billion and a doctor accused of ordering fake ankle braces for a patient whose leg had been amputated, officials said Wednesday.

The scheme involving the submission of nearly $2 billion in bogus claims is one of the largest healthcare fraud cases ever brought by the Justice Department, the agency said. It’s one of several announced as part of a crackdown in states around the country.

Yakima Valley Memorial Hospital in Washington settles breach that affected 419 people

June 15, 2023

Today, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced a settlement with Yakima Valley Memorial Hospital, a not-for-profit community hospital located in Yakima, Washington resolving an investigation under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  OCR investigated allegations that several security guards from Yakima Valley Memorial Hospital impermissibly accessed the medical records of 419 individuals.  HIPAA is a federal law that protects the privacy and security of protected health information.  The HIPAA Privacy, Security, and Breach Notification Rules apply to most health care organizations and set the requirements that HIPAA-regulated entities must follow to protect the privacy and security of health information.

June 14, 2023

VICTORIA TURNER 

National health expenditures will surpass $7 trillion and consume nearly one-fifth of the U.S. economy in 2031, according to projections the Centers for Medicare and Medicaid Services’ Office of the Actuary published Wednesday.

Healthcare spending will rise by an average of 5.4% a year from 2022 through 2031, when it will reach $7.17 trillion, or 19.6% of gross domestic product. “Health spending over the course of the next 10 years is expected to grow more rapidly, on average, than the overall economy,” CMS actuaries wrote in the journal Health Affairs.

June 08, 2023

NONA TEPPER 

Medicaid beneficiaries have the right to sue state agencies they allege break federal law, the Supreme Court ruled Thursday.

The 7-2 decision reaffirms previous precedent that U.S. District Court for the Northern District of Indiana challenged in 2020 when it dismissed a case against a county-owned nursing home accused of violating federal patient protection laws. The high court decision upholds a 2021 ruling by the U.S. Court of Appeals for the 7th Circuit. The case now returns to the district court.

May 24, 2023

CAROLINE HUDSON 

Hospitals and health systems hope for a resolution to the federal government’s debt ceiling standoff, warning that a failure to reach an agreement could have a catastrophic impact on provider payments.

Republicans and Democrats continue to haggle over a deal to raise the $31.4 trillion national debt limit and keep the U.S. from defaulting on its agreements, potentially in early June.

May 02, 2023

NONA TEPPER

Envision Healthcare has notched a win in its ongoing out-of-network reimbursement dispute against UnitedHealth Group, the physician staffing company announced Tuesday.

March 20, 2023

CAROLINE HUDSON 

Insurance companies are ramping up efforts to recover overpayments made to hospitals and health systems—adding to providers’ operational and financial challenges in an already-tough economic environment.

In a practice known as clawbacks, insurers can recoup money after determining they’ve paid too much on past claims due to incorrect coding or fee-for-service reclassifications. Some enlist third-party companies to find overpayments, even if they occurred years ago. Insurance companies typically offset the amount owed by deducting it from the current plan account, meaning they pay less for other services.

March 13, 2023

GABRIEL PERNA 

Venture capital firms and founders of digital health companies are picking up the pieces after an eventful few days tied to the failure of Silicon Valley Bank. 

“We had all of our money at Silicon Valley Bank. They were our full banking partners,” said Ellen DaSilva, CEO and founder of Summer Health, a text-based pediatric care provider. “When I started the company, I would say all of the people in my life also banked with SVB.” 

March 10, 2023

BROCK E.W. TURNER 

The Federal Deposit Insurance Corporation’s decision to take over Silicon Valley Bank on Friday is likely to leave many digital health companies scrambling to pay employees and suppliers. 

SVB, the nation’s16th largest bank and headquartered in Santa Clara, California, was a big bank for tech companies, startups and venture capital firms. The bank said on its website that it had $78.8 billion in healthcare deposits and investments as of December.