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Major False Claims Act Settlement Snags New York’s Independent Health

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Manage episode 460946771 series 2288292
Content provided by RACmonitor. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by RACmonitor or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://staging.podcastplayer.com/legal.

New York health insurer Independent Health and its former executive reached a settlement that will amount to up to $100 million with the U.S. Department of Justice (DOJ) and a whistleblower over False Claims Act allegations that they made Medicare members appear sicker than they really were to get more money from the government, a practice known as risk adjustment fraud.

Betsy Gaffney, former CEO of now-defunct vendor DxID, agreed to pay $2 million to resolve allegations she helped DxID mine patients’ medical records for diagnoses that risk-adjust, nudging doctors to approve them up to a year after the patient visits, all while pocketing up to 20 percent of the additional revenue generated for Independent Health by these unsupported diagnoses.

Reporting the lead story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm Whistleblower Partners.
More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – except here and in RACmonitor.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on current healthcare legislation.

Register now to listen to this exclusive news edition of Monitor Mondays; all this and more will be coming up at 10 a.m. EST on Jan. 13, 2024.

  continue reading

Chapters

1. Major False Claims Act Settlement Snags New York’s Independent Health (00:00:00)

2. Ronald Hirsch, MD (00:01:20)

3. Knicole Emanuel, Esq (00:05:41)

4. RACmontior Commercial (00:10:54)

5. David Glaser, Esq (00:11:38)

6. Cate Brantley, JD (00:15:36)

7. RACmontior Commercial (00:19:47)

8. Mary Inman, Esq (00:20:40)

9. Q&A With David Glaser (00:25:52)

10. Closing (00:29:53)

355 episodes

Artwork
iconShare
 
Manage episode 460946771 series 2288292
Content provided by RACmonitor. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by RACmonitor or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://staging.podcastplayer.com/legal.

New York health insurer Independent Health and its former executive reached a settlement that will amount to up to $100 million with the U.S. Department of Justice (DOJ) and a whistleblower over False Claims Act allegations that they made Medicare members appear sicker than they really were to get more money from the government, a practice known as risk adjustment fraud.

Betsy Gaffney, former CEO of now-defunct vendor DxID, agreed to pay $2 million to resolve allegations she helped DxID mine patients’ medical records for diagnoses that risk-adjust, nudging doctors to approve them up to a year after the patient visits, all while pocketing up to 20 percent of the additional revenue generated for Independent Health by these unsupported diagnoses.

Reporting the lead story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm Whistleblower Partners.
More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – except here and in RACmonitor.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on current healthcare legislation.

Register now to listen to this exclusive news edition of Monitor Mondays; all this and more will be coming up at 10 a.m. EST on Jan. 13, 2024.

  continue reading

Chapters

1. Major False Claims Act Settlement Snags New York’s Independent Health (00:00:00)

2. Ronald Hirsch, MD (00:01:20)

3. Knicole Emanuel, Esq (00:05:41)

4. RACmontior Commercial (00:10:54)

5. David Glaser, Esq (00:11:38)

6. Cate Brantley, JD (00:15:36)

7. RACmontior Commercial (00:19:47)

8. Mary Inman, Esq (00:20:40)

9. Q&A With David Glaser (00:25:52)

10. Closing (00:29:53)

355 episodes

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