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Audits Insurance Claims

Orrick, Herrington & Sutcliffe LLP

Who Is Accountable for AI?

Orrick’s John Bautista sat down with Rune Kvist, founder and CEO of Artificial Intelligence Underwriting Company, to explore accountability in AI and how creating auditable standards and insurance products could unlock...more

Polsinelli

Delaware Department of Insurance Launches Exams of Third Party Administrators

Polsinelli on

Key Takeaways - The Delaware Department of Insurance (Department) is conducting targeted market conduct exams of Third Party Administrators (TPAs) for compliance with state insurance laws and regulations....more

J.S. Held

Inside the Healthcare Industry: The Critical Role of Medical Coding, Billing & Nurse Review

J.S. Held on

In what is already a highly regulated industry, it is becoming increasingly difficult for healthcare organizations to navigate the growing volume, complexity and enforcement of laws, regulations and guidance that surround...more

Kerr Russell

The Difference Between ‘Non-Covered’ vs. ‘Disallowed’ Services

Kerr Russell on

Question: I have had several colleagues describe their experience with dental plan audits. All of them have had to pay something back. Sometimes they say this is due to a service being deemed a “noncovered service.” Other...more

Nelson Mullins Riley & Scarborough LLP

Medicaid Overpayment Audits: What Medical Providers Need to Know

The Audit Process - While Medicaid audits are meant to ensure integrity and efficiency of the Medicaid Program, they can often be incredibly cumbersome and challenging for medical providers to navigate. During an audit,...more

Kerr Russell

Did I Commit Fraud?

Kerr Russell on

Question: I am under audit by a dental plan I participate with. The audit has identified a few issues in connection with how my billing employees have been submitting claims for payment. For example, the name of the treating...more

King & Spalding

Big Data and Bigger Disputes? How New Data Technologies Impact Construction Disputes

King & Spalding on

The last decade has seen the emergence of Big Data platforms allowing parties to major construction projects to digitize and integrate more and more of the engineering, design and build phase of their projects. Such...more

Skadden, Arps, Slate, Meagher & Flom LLP

Recurring Issues in Accounting for Litigation Contingencies

Certain questions seem to recur when it comes to outside counsel’s communications with a company’s auditors about potential exposures as a result of litigation or regulatory/enforcement matters and the underlying accounting...more

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