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Insurance fraud is any act committed to defraud an insurance process. It occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due. According to the United States Federal Bureau of Investigation, the most common schemes include premium diversion ...
Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
Barr v. American Assn. of Political Consultants, Inc., No. 19-631, 591 U.S. ___ (2020) The Telephone Consumer Protection Act of 1991 ( TCPA) was passed by the United States Congress in 1991 and signed into law by President George H. W. Bush as Public Law 102-243. It amended the Communications Act of 1934. The TCPA is codified as 47 U.S.C. § 227.
Optum and SAS Align to Help Prevent Health Care Fraud, Waste and Abuse Enhanced anti-fraud, waste and abuse solution builds upon Optum solutions that saved $500 million for health plan clients in ...
Under House Bill 2344, hospitals and health systems would be required to provide advance state-level notification and accompanying documentation of mergers and acquisitions of at least $10 million ...
Jimmy Carter signs Medicare-Medicaid Anti-Fraud and Abuse Amendments into law. The Office of Inspector General for the U.S. Department of Health and Human Services, as mandated by Public Law 95-452 (as amended), is established to protect the integrity of Department of Health and Human Services (HHS) programs, to include Medicare and Medicaid programs, as well as the health and welfare of the ...
No. 21-1052, 599 U.S. ___ (2023) The False Claims Act of 1863 ( FCA) [ 1] is an American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. It is the federal government's primary litigation tool in combating fraud against the government. [ 2]
August 7, 2024 at 5:00 AM. Kentucky’s largest addiction recovery group is being investigated by the FBI for alleged health care fraud, federal officials say. Since 2008, Addiction Recovery Care ...