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A pharmacist takes a 30-day prescription and inputs it as four weekly prescriptions – quadrupling the Medicaid dispensing fee.
A fraud ring obtains a list of Medicare patients who recently underwent hospital outpatient procedures and starts submitting phony claims, threatening the lives of parties who expose the scheme.
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The health and welfare leader and 2026 Excellence in Benefits honoree is guiding the bank in navigating them all.
As the scope of gene therapy grows, understanding their impact and cost can help organizations decide how to cover them through their healthcare plans.
As more Americans turn to GLP-1 medications for weight loss, employers are weighing the benefits of coverage against rising healthcare expenses and long-term costs.
A growing share of employers are rethinking coverage of the weight-loss drugs as costs rise and early expectations of lower obesity rates and surgical needs have yet to surface in claims data.
Latest point solutions help health plan members understand their coverage, uncover billing errors on claims and offer business intelligence on what's driving costs.
