Alexandra Gehrke faces sentencing for a $600 million Medicare healthcare fraud scheme targeting elderly patients, highlighting regulatory and compliance challenges in healthcare billing and Medicare oversight.

HHS OCR settles with Concentra over HIPAA violations for untimely access to medical records, marking the 54th Right of Access enforcement and emphasizing regulatory compliance in healthcare.

Discover how 2026 CMS compliance deadlines and cybersecurity expectations are reshaping payer IT with FHIR interoperability, prior authorization modernization, and outcomes-driven digital strategies.

Explore Optum's internal challenges and controversies surrounding Medicare Advantage billing practices and local medical service restructuring within the U.S. healthcare market.

Explore how the new federal executive order on AI impacts state health insurance regulations, compliance challenges, and patient protections amid evolving U.S. policy.

The First Circuit rules that clinical labs can rely on doctors' orders to demonstrate medical necessity under Medicare, impacting FCA fraud claims and regulatory compliance.

Peaks Medical and Urgent Care in Colorado has been chosen for the federal rural healthcare provider transition project, aiming to strengthen small rural hospitals and health clinics with expert technical assistance.

ePsych Billing unveils a specialized billing platform designed to reduce administrative burdens and improve insurance claim processing for mental health professionals nationwide.

A recent OIG audit identifies $4.7 million in Medicare overpayments to optometrists for nursing home services due to insufficient CMS review processes and billing controls. The report urges enhanced oversight and provider training to prevent future improper payments.

Medicare telehealth waivers enabling expanded coverage during COVID-19 expire in 2025. Providers must prepare for significant Medicare and regulatory changes affecting telehealth reimbursement and compliance.