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HEALTHCARE | Medical Facilities & Services
carecorenational.com

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Stage

Merger | Merged

About CareCore National

CareCore National provides healthcare solutions that contain costs while improving the quality of care. The company's programs address a wide array of healthcare services including cardiology, medical oncology, radiation oncology, sleep apnea, musculoskeletal care, pain management, physical therapy, radiology and lab services that touch the lives of over 41.5 million insured across more than 35 Commercial, Medicare Advantage, Managed Medicaid health plans, ACO's and Self-insured entities. CareCore solutions utilize the most innovative technologies in healthcare underpinned by partnerships with Cisco, VMWare, EMC2 and GemFire combined with clinical expertise from academic and community physicians from across the country.

CareCore National Headquarter Location

400 Buckwalter Place Blvd

Bluffton, South Carolina, 29910,

United States

800-420-3471

Latest CareCore National News

CareCore pays $54 million to settle CMS billing suit

May 12, 2017

By Maria Castellucci  | May 12, 2017 CareCore National, a healthcare utilization management company, has agreed to pay $54 million to settle allegations it fraudulently billed the CMS. The lawsuit, filed by attorneys general from 21 states, claims that CareCore engaged in a fraud scheme from 2005 to 2013 that involved routinely billing the CMS for more than 200,000 medical diagnostic procedures without proving they were medical necessary. The suit alleges CareCore developed a system that involved its clinical reviewers improperly approving prior authorization requests even without approval or review from physicians. As part of the settlement, CareCore admitted it improperly approved prior authorization requests paid for with Medicare Part C and Medicaid funds. Of the $54 million settlement, $18 million will be paid to states' Medicaid programs. CareCore, which is now part of healthcare management company eviCore, determines medical necessity for states' Medicaid managed-care organizations. New York, one of the plaintiffs in the suit, will recover $7.6 million. "Companies that overbill Medicaid are undermining efforts to help some of our neediest citizens," said New York Attorney General Eric Schneiderman. CareCore didn't respond to a request for comment on Friday afternoon. Related content

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Expert Collections containing CareCore National

Expert Collections are analyst-curated lists that highlight the companies you need to know in the most important technology spaces.

CareCore National is included in 3 Expert Collections, including Portfolio Company Matchmaking M&A.

P

Portfolio Company Matchmaking M&A

389 items

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C

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