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The Pennsylvania Patient Safety Authority is an independent state agency located in Harrisburg, Pennsylvania, United States. Its mission is to improve the quality of healthcare in Pennsylvania by collecting and analyzing patient safety information, developing solutions to patient safety issues, and sharing this information through education and ...
Health Insurance Portability and Accountability Act of 1996; Other short titles: Kassebaum–Kennedy Act, Kennedy–Kassebaum Act: Long title: An Act To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use ...
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.
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 ...
Nearly 200 people have been charged in a sweeping nationwide crackdown on health care fraud schemes with false claims topping $2.7 billion, the Justice Department said on Thursday. Attorney ...
The Justice Department has charged dozens of people in several health care fraud and prescription drug schemes, including one totaling $1.9 billion and a doctor accused of ordering fake ankle ...
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 ...
Electronic visit verification ( EVV) is a method used to verify home healthcare visits to ensure patients are not neglected and to cut down on fraudulently documented home visits. Beginning January 1, 2020, home care agencies that provide personal care services must have an EVV solution in place or risk having their Medicaid claims denied ...