She Wrote the Compliance Book. Then She Ran a $136M Fraud Scheme.
There is a sentence in the DOJ’s press release about Jean Wilson that deserves to be read twice. After her…
Category: Business View
$5.7 Trillion and Climbing: What America’s Health Spending Surge Actually Signals
The number itself is almost too large to process. U.S. healthcare spending reached $5.7 trillion in 2025 — a 7.3%…
When Your Provider Is Abroad: The Hidden Compliance Trap in Cross-Border Telehealth
By Elena Pak, Credentialing Department, WCH Telehealth has made geography feel irrelevant. A physician in Portugal, a therapist in Thailand,…
Criminalizing Coverage Denials?
What Pennsylvania’s New Bill Reveals About the Growing Backlash Against Health Insurers By Elena Pak, Credentialing Department, WCH When Pennsylvania…
Deny First, Approve Later?
New Federal Findings Raise Questions About Whether Medicare Advantage Prior Authorization Is Functioning as a Clinical Safeguard—or a Cost-Control Tool…
One in Five Patients Denied Care: Why This Matters to Every Medical Practice
By Elena Pak, Credentialing Department, WCH A new survey from the Commonwealth Fund found that one in five privately insured…
Medical Necessity Under the Microscope: What a $6.73 Million DOJ Settlement Means for Procedural Practices
The Department of Justice recently announced that a California vascular practice and its owner physician agreed to pay more than…
NCCI: Your Billing Compliance Ally — Not Your Enemy
A practical guide for providers navigating Medicare’s coding edit system By Shogher Nikoghosyan, Billing Department, WCH Few billing workflows are…
