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Jack Kilmer plays a junkie attempting to get clean in the health insurance scam thriller "Body Brokers," written and directed by John Swab.
In California, this move was echoed as insurance agencies and health plans were enabled to perform "peer review." This combination of events ended the ability of physicians to conduct peer review of themselves, and "peer review" of physicians became transformed into "performance appraisal" done by physicians and non-physicians alike.
A 2004 Journal of the Medical Library Association review noted that "approximately half of the [laboratory test results] reports indicate the date the review was posted". [17] For a fee, ConsumerLab.com offers a voluntary certification program. Products that pass the certification can use the "CL Seal of Approval" for which there is a licensing ...
Forms of fraud by health insurance companies include the wrongful denial of claims, wrongful cancellation of coverage, and underpayment of hospitals and physicians. [2] [3] When detected, health insurance fraud can result in civil liability as well as criminal penalties, and potential action against a healthcare provider's license. [35] [36]
The Founder and Publisher is Gary Schwitzer, a health care journalist for more than four decades who is now an Adjunct Associate Professor in the University of Minnesota School of Public Health. The project's 10-point grading scale includes whether a story gives information about its sources and their competing interests, quantifies the ...
The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The National Committee for Quality Assurance operates on a formula of measure ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
Their data has impact: a nurses' union's 2011 public statements cited Becker's data to justify their demands. [7] Becker's reports on how data is used (or abused) [8] and they cite, review and analyze [9] surveys and rankings, [10] including how various subgroups of medical practitioners are affected. [11]