DEFINING CONVENER Health starts in our homes, continues in our communities, and is largely impacted by our day-to-day choices and interactions. The interconnectedness of life demonstrates why providing holistic healthcare that delivers long term results is hindered by a primarily…

WHO IS AT RISK The federal government has indicated that it is still investigating, and could ultimately join a false claims whistleblower qui tam action against Aetna, Inc., Humana, Inc., Cigna, Inc. (through its Bravo Health unit) and Health Net,…

In a court decision last year in Swoben v. United Healthcare, the United States Court of Appeals for the Ninth Circuit held that an allegation—that a Medicare Advantage Plan performed a “biased” HCC-RAF retrospective medical review designed only to identify…