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Weekly News, Analysis, and Commentary

Reimbursement Features & News

DOJ Sues UnitedHealth for Medicare Fraud

Source: Pixabay and Geralt

UnitedHealth faces another whistleblower-backed lawsuit from the Department of Justice. Filed on May 2, 2017, the whistleblowers are offering up details from UnitedHealth employees and former employees who claim they warned the company numerous times about Medicare payment problems.


The LD in DC

Getting the low down on healthcare happenings in Washington, D.C. helps prepare us for challenges—and…

“Obamacare is gone. Just gone”

President Trump / HSS Secretary, Tom Price, M.D. / Source: Wikimedia Commons

Health insurers have just weeks to file their 2018 rate and service plans with the states. Trump and his HHS Secretary, Tom Price, M.D., are threatening to cut off funding for seven million low income ACA insured. If that happens, to quote Trump, “Obamacare is gone. Just gone.” It’s crunch time for insurers and the ACA.

HCAHPS Report Card: A+ or C-?

Source: Wikimedia Commons and Rhoda Baer

Millions of patients have evaluated their hospital, physician and nurse experience by way of the HCAHPS survey. Patients seem happy. But CMS isn’t. And poorer hospitals are calling foul. We checked with the expert about all this and read a handful of new studies. Conclusion: HCAHPS is a very good, albeit not perfect, thing.


Florida Orthopedic Group Settles False Claims Lawsuit

Sources: Public Domain

A $4.5 million settlement was reached between Southeast Orthopedic Specialists (SOS) and the Department of Justice (DOJ). “Patients are getting billed as though they’ve seen a doctor when in reality they’re being seen by technicians who aren’t necessarily being supervised, ” says Prosecuting Attorney Jason Mehta.


Untwisting the Obamacare Rubik’s Cube

Photo creation by RRY Publications, LLC / Source: Flickr

Orthopedic surgeon Dr. Tom Price is in charge of implementing President-elect Trump’s promise to repeal and replace Obamacare. He faces a 2, 000 page long law and a Rubik’s Cube of rules and regulations. But he is the right guy for the job having led the Republican effort over the last couple of years to design an alternative plan. Can Obamacare be untwisted? What does it mean for orthopedics? We find out.


The Cost of Donaldcare – Update

Photo creation by RRY Publications, LLC and

Donald Trump wants to repeal and replace Obamacare. “We have to take care of the people in our country. We can’t let them die on the sidewalks of New York or the sidewalks of Iowa or anywhere else.” Sounds good. Except his plan costs the public purse almost $500 billion over ten years and removes over 20 million people from insurance coverage. What’s in the plan? Read it here.