Atlanta, GA – Ventiv Technology, Inc., a provider of risk, claims and safety software, recently announced that it has acquired DAVID Corporation, a proven leader in claims and policy administration software. As a combined company, Ventiv Technology® will have more than 625 clients, 390,000 users and 450 colleagues with offices in nine countries. Specific terms… [Read more]
Claims, Legal, & Compliance News
HealthSmart Rebrands Casualty Claims Division as SmartCasualtyClaims
Irving, TX -(BusinessWire)- HealthSmart, one of the nation’s largest independent third party administrators of health plans for self-funded employers, recently announced it is rebranding its Casualty Claims Solutions division to SmartCasualtyClaims™. SmartCasualtyClaims provides third-party claims and administrative services for Workers’ Compensation, liability and disability with flexible, client-specific solutions, outcome-focused technology and experienced, licensed adjusters. “Our… [Read more]
ODG by MCG Announces Release of ODG Job Profiler Powered by MyAbilities
Austin, TX – ODG, an MCG Health company, recently announced a partnership with MyAbilities Technologies to incorporate a unique new product option, the ODG Job Profiler, into its industry-leading medical treatment and return-to-work (RTW) guidelines. The ODG Job Profiler is a software platform powered by MyAbilities™ which will be made available as an add-on to… [Read more]
York Appoints Dennis Duchene as EVP, Managed Care
Jersey City, NJ – York recently announced that Dennis Duchene has been appointed Executive Vice President, Managed Care. Duchene will oversee and manage all aspects of York’s Managed Care solutions, reporting to Chairman and CEO Thomas Warsop. With more than 20 years of experience in managed care and finance, Dennis most recently served as president… [Read more]
CA Office Manager Convicted on 51 Felony Counts in Massive Patient Referral Scam
San Diego, CA – San Diego County District Attorney Summer Stephan recently announced that a jury has convicted Gonzalo Paredes of 51 felony counts of paying illegal kickbacks to a doctor for patient referrals and fraudulently billing workers’ compensation insurance companies in the California workers’ compensation system. The jury reached their verdict on Thursday, November… [Read more]
Former Virginia Physician Pleads Guilty to Operating an Oxy Pill Mill
Alexandria, VA – A former physician recently pleaded guilty to operating a pill mill that illegally distributed over 600,000 oxycodone pills out of a pain management clinic in Woodbridge. According to court documents, Shriharsh Laxman Pole was a physician who voluntarily surrendered his medical license in 2009, and again in 2013. In both instances, Pole… [Read more]
Mitchell Launches Revamped ReviewStat Solution for Utilization Management
San Diego, CA – Mitchell International, Inc. recently announced the launch of the Mitchell ReviewStat® solution, its newly upgraded medical management software for the workers’ compensation industry. Following the 2017 acquisition of UniMed Direct, Mitchell focused on the core of UniMed’s legacy ReviewStat product, making enhancements to deliver more robust capabilities. Mitchell’s ReviewStat medical management… [Read more]
CIRMA Selects Guidewire InsurancePlatform for Claims Management, Data and Analytics, and Digital Engagement
Foster City, CA – The Connecticut Interlocal Risk Management Agency (CIRMA), a leading member-owned municipal insurance provider in Connecticut, and Guidewire Software, Inc. (NYSE: GWRE) recently announced that CIRMA has selected Guidewire InsurancePlatform™ to replace its existing systems and modernize the way it does business. Guidewire PartnerConnect™ Select Consulting Partner, Blackcomb Consultants, will be leading… [Read more]
WCRI: Payments for Surgeries in ASCs Lower Than in Hospital Outpatient Departments, with Few Exceptions
Cambridge, MA – The payments for similar knee and shoulder surgeries performed in ambulatory surgery centers (ASCs) were lower compared with hospital outpatient departments in many study states, with few exceptions, according to a new FlashReport from the Workers Compensation Research Institute (WCRI). “Some studies indicate that ASCs provide care that is less expensive than… [Read more]
URAC Awards Nexus Reaccreditation for Workers’ Compensation Utilization Review
New Braunfels, TX – Independent clinical review provider Nexus recently announced that it has earned URAC reaccreditation in Workers’ Compensation Utilization Management. URAC is the independent leader in promoting healthcare quality through accreditation, certification and measurement. By achieving this status, Nexus has demonstrated a comprehensive commitment to quality care, improved processes and better patient outcomes.… [Read more]