September 20, 2022
Texas is at least the 12th state to settle with St. Louis-based Centene Corp. over allegations that it overcharged Medicaid prescription drug programs.
September 07, 2022
The studies are part of a series that examines the use of telehealth in Medicare and the characteristics of beneficiaries who used telehealth during the pandemic.
August 29, 2022
RISE summarizes recent regulatory news.
August 22, 2022
The U.S. Departments of Labor, Health and Human Services (HHS), Treasury has issued final rules to clarify the federal process to protect consumers against surprise billing.
August 11, 2022
In this article we look at the RISE West 2022 sessions planned as part of the Compliance and Regulatory Updates track at the annual RISE West conference, September 1-2, in Los Angeles.
August 10, 2022
RISE summarizes recent regulatory news.
August 08, 2022
Since the U.S. Supreme Court overturned Roe v. Wade in June, ER doctors say they—and their patients—are trapped between state anti-abortion laws and the federal law requiring that care be delivered in emergency situations. Women’s lives hang in the balance
August 02, 2022
Five panelists who will speak about health policy at the upcoming RISE West 2022 conference join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
July 26, 2022
The proposed rule affirms protections on nondiscrimination based on sexual orientation and gender identity, and protection of access to reproductive health care.
July 21, 2022
The Department of Justice (DOJ) has brought criminal charges against 36 defendants in 13 federal districts across the United States for more than $1.2 billion in alleged fraudulent telemedicine, cardiovascular, and cancer genetic testing, and durable medical equipment schemes. Meanwhile, the Office of Inspector General has issued a special fraud alert to warn providers about telemedicine scams.
July 20, 2022
Here’s a look at what we’ve planned for the Medicare Product Design Master Class and the RISE Part D Master Class. Both live, in-person events will take place August 25-26 at the Omni Nashville Hotel.
July 18, 2022
Spurred on by opposition to pandemic-related health mandates, a coalition of religious liberty groups, conservative think tanks, and Republican state attorneys general has filed a cascade of litigation seeking to rein in the powers of public health authorities.
June 30, 2022
The guidance includes information on what’s protected and what’s not when using period trackers and other health information apps on smartphones.
June 28, 2022
Xavier Becerra, secretary of the Department of Health and Human Services (HHS), spoke to reporters Tuesday about the Supreme Court’s unprecedented decision on Friday to overturn a long-standing constitutional right and how the department intends to respond.
June 22, 2022
RISE summarizes this week’s regulatory news.
June 15, 2022
RISE summarizes recent regulatory headlines.
June 13, 2022
RISE caught up with Amy Campbell, R.N., MSM, CCDS-O, clinical documentation integrity director, Wolters Kluwer, Health Language, one of the speakers at the recent Risk Adjustment Forum, to discuss coding challenges and strategies to improve compliance of clinical documentation.
June 02, 2022
Get the latest regulatory updates and learn about the future of member accounting and reconciliation at the virtual conference June 29-30.
May 17, 2022
Despite the challenges, if true interoperability can be achieved it would provide granular data that can be used to improve clinical outcomes, reduce utilization, and provide support for clinical research.
May 10, 2022
The 7th annual event, live streamed June 7-8, will feature strategies to improve ODAG & CDAG outcomes, a review of the latest changes to Centers of Medicare & Medicaid Services (CMS) regulations, and strategies to improve member satisfaction.
April 28, 2022
A new report released by the Office of Inspector General (OIG) determined Medicare Advantage Organizations (MAOs) sometimes delayed or denied MA beneficiaries’ access to services even when the requests met Medicare coverage rules.
April 21, 2022
The Justice Department said on Wednesday that the cases allegedly resulted in approximately $150 million in COVID-19-related false billings to federal programs and theft from federally-funded pandemic assistance.
March 15, 2022
Regulatory bodies are increasingly using data analytics to guide their audit processes to great effect. In this landscape, compliance can no longer be an afterthought. Health plans must take proactive steps to address issues before they arise so they may focus their valuable time and resources on what matters most—caring for patients.
February 02, 2022
The Department of Justice (DOJ) collected more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal 2021 and most of that money came from health care fraud cases.
January 13, 2022
The Supreme Court on Thursday blocked a key Biden administration COVID-19 initiative—putting a stop, for now, to a rule requiring businesses with more than 100 workers to either mandate that employees be vaccinated against COVID or wear masks and undergo weekly testing.
January 07, 2022
The proposed rule would revise Medicare Advantage (MA) and Medicare Part D regulations related to marketing and communications, Star ratings, the criteria used to review applications for new or expanded plans, provider network adequacy requirements, medical loss ratio reporting, special requirements during disasters or public emergencies, and the use of pharmacy price concessions to reduce the out-of-pocket costs for prescription drugs under Part D.
January 07, 2022
The Supreme Court on Friday took up one of the most contentious issues of the COVID-19 pandemic, hearing a series of cases challenging the Biden administration’s authority to require workers to get a COVID vaccine or be tested for the virus regularly.
January 04, 2022
Here are our predictions for the health care industry in 2022 based on interviews with industry experts in 2021, presentations at RISE conferences, and observations from our editorial team.
December 30, 2021
Whether you want to learn more about health policy, COVID, health care costs, or the latest news, we’ve gathered our picks for health care podcasts to add to your listening library in 2022. And a shameless plug – of course RISE Radio is on the list!
December 20, 2021
As we head into 2022, here’s a look back at our most viewed articles of 2021. Trending topics included fraud lawsuits, Star ratings, and federal investigations into overpayments.
December 09, 2021
Accuracy issues raise red flags because the data is used to plan and direct resources in the nation’s continuing response to the COVID-19 pandemic.
December 02, 2021
America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds due to the work of the Department of Health and Human Services (HHS), Office of Inspector General (OIG), according to a new report.
November 30, 2021
A federal judge on Monday ruled that the Centers for Medicare & Medicaid Services (CMS) doesn’t have the authority to enforce a vaccine mandate of staff at Medicare and Medicaid-certified facilities in 10 states.
October 18, 2021
The Centers for Medicare & Medicaid Services (CMS) issued a long-awaited memo outlining best practices for Medicare marketing campaigns conducted by third parties. But does it go far enough? RISE weighs in.
September 22, 2021
The Department of Justice (DOJ) said 42 doctors, nurses, and other licensed medical professionals are among the 138 defendants facing criminal charges for their alleged involvement in health care fraud schemes that resulted in nearly $1.4 billion in alleged losses.
September 13, 2021
It’s not easy to get the necessary resources to ensure your organization is able to prevent and properly respond to ransomware attacks. But as the number of attacks increase in the health care industry, it’s vital that organizations put the right people and resources in place. Here’s how Integra Managed Care has responded to the growing threats and why your organization may want to follow the managed long-term care plan’s lead.
August 24, 2021
In this white paper, we explore the opportunities, as well as the technical and strategic challenges that payers face on the path to achieve complete digital transformation in health data access, interoperability, and data-driven health care.
August 23, 2021
Scripps Health recently revealed it was the victim of a significant cyberattack, which forced the organization to shut down its systems and initiate emergency manual down-time procedures until it could restore all its systems 25 days later. The massive attack cost the San Diego-based health system nearly $113 million. The organization is far from alone. Ransomware attacks on the health care industry are increasing in number and severity.
August 02, 2021
The government has intervened in False Claims Act lawsuits against Kaiser Permanente affiliates for submitting inaccurate diagnosis codes for risk-adjusted payments to the Medicare Advantage (MA) program. Mary A. Inman, a partner in the whistleblower practice group at Constantine Cannon, which is representing one of the whistleblowers, will take a deeper look at the case as part of a RISE West session on lessons learned from whistleblower-litigated False Claims Act cases.
July 29, 2021
Pharmaceutical companies routinely cover the cost of patient copays for expensive drugs under private insurance. A federal judge could make the practice legal for millions on Medicare as well.
July 28, 2021
RISE rounds up the latest news on COVID-19.
July 19, 2021
RISE West 2021 will bring together senior leaders from Medicare Advantage health plans, commercial marketplace sponsors, Part D health plans, providers groups, pharmacy benefit managers, and accountable care organizations to discuss the hot topics facing the industry. We talked to four of the 50 speakers about their sessions to learn what attendees can expect at this year’s hybrid event, which will take place live in Colorado Springs and virtually via livestream August 30-September 2.
July 15, 2021
Angela G. Huskey, PharmD, CPE, senior vice president and chief clinical officer at Millennium Health, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
July 08, 2021
The new workgroups will address issues of most concern to members of RISE’s Medicare Member Acquisition & Experience (MAE) community. Up first, the fallout from Joe Namath’s Medicare television commercials and key performance indicators (KPIs) around marketing and sales.
May 17, 2021
The event, held on June 22-23, is the only non-association yearly gathering for Special Needs Plan (SNP) professionals who are mid- to senior-level management to stay current in a highly regulated and evolving environment.
May 03, 2021
A report from the Government Accountability Office paints a picture of an already strained behavioral health system struggling after the pandemic struck to meet the treatment needs of millions of Americans with conditions like alcohol use disorder and post-traumatic stress disorder.
April 29, 2021
Without certification, health insurers will no longer be able to run advertisements on Google’s platform after June 2.
January 08, 2021
President Donald Trump made substantial changes to the nation’s health care system using executive branch authority. But reversing policies that Democrats oppose would take time and personnel resources, competing with other priorities of the new administration.
December 21, 2020
The live-streaming event will be held on February 9-10, 2021 and will feature 16 sessions and more than 20 industry leaders who will discuss critical topics and developments related to mandatory reporting, legislative updates, conditional payments, and Medicare set-asides.
December 11, 2020
RISE’s new seminar on March 23-24 is designed for Medicare beneficiary representatives, plaintiff attorneys, paralegals, legal assistants, payee representatives, and other advocates of Medicare beneficiaries associated with workers compensation, liability, and no-fault insurance claims. The ultimate purpose of the seminar is to provide attendees with an understanding of how to protect Medicare beneficiaries compliantly. We talked to industry expert Rafael Gonzalez, Esq., about the planned sessions and why you don’t want to miss this groundbreaking seminar.
December 11, 2020
RISE examines the regulatory headlines of the week.
November 23, 2020
The Centers for Medicare & Medicaid Services (CMS) on Friday finalized changes to the Physician Self-Referral Law, more commonly referred to as the Stark Law, which prohibits physicians from making referrals to providers or entities if they have a financial relationship with them. Here is a summary of the changes.
November 19, 2020
In a new interview with Kaiser Health News, the nation's top infectious disease expert breaks down how to survive the coming months and describes how hard it is when people still insist the coronavirus outbreak is “fake news.”
October 14, 2020
Learn more about one of the exciting benefits of joining the RISE Association.
October 08, 2020
COVID-19 continues to dominate headlines in the wake of President Trump’s diagnosis and hospitalization. Here’s a roundup of the latest news.
October 07, 2020
William Dede, MPP, health policy associate, Special Needs Plan Alliance, will lead a session on CY21 integration requirements for FIDE-, HIDE-, and D-SNPs during RISE’s upcoming live-streamed virtual event on Oct. 27-28.
October 02, 2020
RISE looks at the latest headlines that impact Medicare and Medicaid.
September 29, 2020
Mark your calendars! We are excited to return to Nashville, Tenn. in March for RISE National 2021. Get a first look at the new tracks we’ve already planned for you.
September 15, 2020
Learn best practices to improve outcomes for hard to reach and at-risk populations during a live-streamed virtual event on Oct. 27-28.
August 21, 2020
For the first time, RISE’s 4th annual CompliancePalooza will be a virtual event! The October event will feature two days of high-quality content, timely updates, lively discussion, and networking.
August 18, 2020
A New York federal judge on Monday stopped the Trump administration from enforcing a new rule that rolls back nondiscrimination protections for transgender patients.
March 24, 2020
Christi A. Grimm, the principal deputy inspector general, warns about “bad actors” preying on people’s fears over COVID-19 and perpetuating fraud schemes.
September 26, 2019
One of the most anticipated sessions at RISE’s upcoming CompliancePalooza is an in-depth look at recent CMS audits featuring a panel of four health plan compliance experts who will talk about their experiences. RISE interviewed two of the panelists ahead of the conference to find out what they would suggest that health plans do to improve audit preparation.
September 19, 2019
Rhonda Glover spent 34 years working for the Federal Bureau of Investigation before retiring last year from a career she loved. She had no choice–the age cut off for agents in federal law enforcement is 57. But she had far too much energy and ambition to leave the working world behind. RISE talked to Glover ahead of CompliancePalooza about what she has learned about leadership and her own career reset as founder and CEO of a training, development, and career coaching firm.
September 06, 2019
There is no need to panic if your health plan receives a notification from the Centers for Medicare & Medicaid Services (CMS) that your organization has been selected for a workplace audit— that is, if you're prepared, according to Heather Metz, manager of government compliance for Gateway Health Plan, one of the country’s leading managed care organizations that currently serves Medicare and Medicaid enrollees across five states. RISE got a chance to interview Metz about her strategies for successful workplace audits, one of two topics that she will discuss at CompliancePalooza, Oct. 21-22, in Washington, D.C.
September 03, 2019
This year’s conference will focus on the effective monitoring of departments and data, and the latest regulatory updates to mitigate compliance risks and ensure a successful Centers for Medicare & Medicaid Services (CMS) audit. Here’s a look at what compliance professionals can expect when RISE gathers on Oct. 21-22 at a brand-new venue—the elegant and historic Omni Shoreham Hotel in Washington D.C.
October 04, 2018
Health plan leaders and compliance experts from across the country will address hot button issues from 2018 audits and potential changes for the 2019 audit season at CompliancePalooza on Oct. 29-30 in Baltimore.