Uncovering Healthcare Profitability

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Aetna and Humana call off $34 billion merger

Aetna and Humana are calling off their $34 billion health care merger. A federal judge blocked the deal last month on antitrust grounds, siding with the Justice Department. Aetna said Tuesday it will pay Humana a $1 billion breakup fee. The deal’s end casts a pall over an even larger merger proposal between two health insurance giants. […]

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Payers increasing scrutiny of coding compliance

In September 2014, the U.S. Dept. of Health and Human Services’ Office of the Inspector General (OIG) published its audit of Tulare Regional Medical Center, an acute care hospital in California. In its findings, federal investigators determined the “hospital did not comply with Medicare billing requirements for all 10 of the outpatient surgery claims we […]

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Outpatient surgery options expanding under new regs

By Gerry Tuoti Wicked Local Newsbank Editor Max Bowen mbowen@wickedlocal.com THE ISSUE: New state regulations allow ambulatory surgery centers to expand. LOCAL IMPACT: The independent centers may perform certain surgeries for less money than hospital outpatient departments. Under the new regulations, patients could have more options. More patients in Massachusetts could soon have surgery outside […]

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After DOJ denial, Mylan close to closing $465M settlement: 3 things to know

Even though Canonsburg, Pa.-based Mylan Pharmaceuticals agreed in October to pay $465 million to settle a U.S. Department of Justice investigation into EpiPen, the company is still working on finalizing the settlement, Fortune reports. Here’s what you need to know. 1. The U.S. Justice Department and other agencies have not confirmed the settlement. 2. Mylan […]

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