News

To make real progress in healthcare fraud prevention, both government and private payers must integrate fraud risk controls at the front end of their claims payment workflow processes. The most effective fraud detection programs use a layered approach to analyzing claims that includes analytics that focus on identity integrity, claims legitimacy and relationships.

In diverse communities like Philadelphia, healthcare providers treat an array of patients. In an effort to provide the best care for each individual, and to help them participate in the process, Jefferson University Hospitals' Family Medicine Associates has been working to provide multicultural care by "systemizing" its practice.

Highmark's efforts to acquire struggling hospital operator West Penn Allegheny Health System has brought into sharp focus the acrimonious relationship between the insurer and the region's dominant hospital operator, University of Pittsburgh Medical Center.

Most accountable care organizations, spurred by the Medicare Shared Savings Program, are taking four different approaches to creating new payment models, according to a new report sponsored by the Commonwealth Fund.

The Centers for Medicare & Medicaid Services has corrected $684.8 million in improper payments since FY 2010, according to an update released earlier this month on its Medicare Fee-for-Service Recovery Audit Program.

The Minnesota-based insurer sees a greater need for healthcare in rural America, as well as an increase in people on government-funded insurance programs and a decrease in physicians, and points to telehealth and telemedicine as possible solutions.

Massachusetts-based medical device company, Boston Scientific, plans on investing $150 million in China over the next five years in order to expand its presence in one of the fastest-growing medical device markets.

This article looks at how four healthcare providers are trimming the fat since PrivewaterhouseCoopers reported the nation's healthcare system loses $1.2 trillion a year.

In early July, the Drug Enforcement Administration finally answered a nine-year-old petition from medical marijuana advocates asking the government to reclassify marijuana from a Schedule 1 controlled substance.

Patients may need to take a walk instead of a pill, according to some healthcare providers. Programs that promote parks for health are gaining popularity.