Tag: Closed claims cases

States take aim at outpatient facility fees driving higher commercial health costs

Editor's Note States are sharpening their focus on outpatient facility fees, using new data and reporting mandates to expose how these charges inflate commercial healthcare spending, HealthAffairs October 6 reports. Specifically, Colorado, Maine, Connecticut, and Washington have launched varied but increasingly sophisticated efforts to monitor when and where hospitals bill…

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By: Tarsilla Moura
October 15, 2025
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Study finds Medicare paid nearly $2 billion for unnecessary back surgeries

Editor's Note More than 200,000 older Americans underwent back surgeries they likely did need, costing Medicare and Medicare Advantage a combined $1.9 billion, Axios October 9 reports. The findings, based on an analysis by the Lown Institute, raise new concerns about overuse of high-cost procedures with limited benefit, as federal…

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By: Tarsilla Moura
October 10, 2025
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Largest US healthcare fraud case reveals billions in false Medicare, Medicaid claims and vast schemes nationwide

Editor's Note The US Department of Justice (DOJ) has conducted the largest healthcare fraud takedown in US history, charging 324 individuals, including 96 licensed medical professionals, in schemes totaling more than $14.6 billion, HealthCare Business News July 8 reports. The nationwide crackdown involved 50 federal districts and 12 state attorneys…

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By: Tarsilla Moura
August 19, 2025
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Closed claims analysis identifies wrong-site surgery risks

Editor's Note This study, published in The Joint Commission Journal on Quality and Patient Safety, analyzes 68 closed claims cases on wrong-site surgery from 2013 to 2020. The services most frequently responsible for these cases were: Orthopedics (35.3%) Neurosurgery (22.1%) Urology (8.8%). The most common types of procedures involving wrong-site…

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By: Judy Mathias
April 26, 2023
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