Medicare Hospice TPE Basics and Update

Within the last few weeks, I’ve had the opportunity to discuss and review, the ongoing Medicare TPE program with a number of hospices and hospice folks. Suffice to say, there are more than a few questions and resultant (still) confusion over the audit process and claims denial in general. I hope this post provides some … Read more

Humana, United Health: Class Action Suits over AI use in Coverage Determination

It was only a matter of time before litigation came forward regarding the use of Artificial Intelligence (AI) in primarily, Medicare Advantage plans, where coverage denials/determinations are at issue. This week, a class action suit dropped in the U.S. Circuit Court of Western Kentucky against Humana. A link to the suit is here: https://www.scribd.com/document/692182281/Humana-AI-NaviHealth-MA-lawsuit In … Read more