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Program Integrity

In recent years, the Centers for Medicare & Medicaid Services has drastically increased the number of program integrity auditors that review hospital claims to identify improper payments.
Public

AHA Urges CMS to Reconsider Medicare Program Integrity Rule

Member

HHS Finalizes Changes to Medicare Appeals Process

The HHS Jan.
Public

AHA before the Senate's Special Committee on Aging: "Improving Audits..."

Public

AHA Statement Re: Needed Reforms to the Medicare Appeals and Audits Systems

Member

Final Rule on Reporting and Returning Medicare Overpayments

Public

AHA to HRSA Re: 340B Civil Monetary Penalty Rule Delay

Member

Supreme Court Issues Decision in False Claims Act Case

Supreme Court issues decision in False Claims Act case.
Member

HHS Proposes Changes to Medicare Appeals Process

The Department of Health and Human Services late June 28, issued a proposed rule that would make changes to the procedures for Administrative Law Judge (ALJ) appeals of payment and coverage determi
Member

CMS Issues Final Notice of Benefit and Payment Parameters for 2019

On April 9, CMS issued a final rule and related guidance that will implement the standards governing health insurance issuers and the Health Insurance Marketplaces for 2019. In the rule, CMS provides details on the benefit and payment parameters for qualified health plan issuers selling in the marketplaces.