August 2016
Our e-newsletter for Enterprise Risk Management, Claim Settlement and Healthcare Solutions.
Enterprise Risk Management (ERM)
On July 28, 2016, the Chief Financial Officers Council (CFOC) and the Performance Improvement Council (PIC) released a document entitled Playbook: Enterprise Risk Management (ERM) for the U.S. Federal Government. The tools are designed to provide high-level key concepts for consideration when establishing a comprehensive and effective ERM program to meet the requirements of the revised Office of Management and Budget Circular A -123. To learn more about how this document may affect your operations, please click here >>
Claim Settlement, Medicare, and Medicare Set Asides
On July 22, 2016, the owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician’s assistant were charged with conspiracy, obstruction, money laundering and health care fraud in connection with a $1 billion scheme involving numerous Miami-based health care providers.
Additionally on June 22, 2016, Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts. The efforts of the Strike Force resulted in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. For more information about these announcements, please click here >>
Healthcare
In a July 15, 2016 speech to the National Governors Association, HHS Secretary Sylvia Mathews Burwell announced a series of AHRQ grants to support rural primary care practices in delivering medication-assisted treatment for people addicted to opioids.
The grants will also seek to study how to overcome barriers to access treatment. The treatment is an evidence-based therapy for assisting people with opioid addiction and involves using both medications and behavioral support to empower people to manage their addiction. For more about how these key initiatives may be utilized in your risk and claim practices in the future, please click here >>