Our Insights

CMS has released an updated version of the NGHP Section 111 User Guide, introducing critical clarifications and new requirements that impact reporting. Staying ahead of these changes is essential to avoid compliance risks and potential penalties. Below is a summary of the most significant updates that require your immediate attention.   Key Highlights from the […]

In a recent Medicare conditional payments case involving a 1999 asbestos settlement, Allan Koba Compliance Solutions successfully navigated a series of legal and procedural challenges to deliver over $54,000 in savings to the client. Case Facts Claimant sustained work-related exposure to asbestos in 1993.  The workers’ compensation claim settled in 1999.  Twenty-six years later, Medicare’s […]

In a pivotal ruling from the Eastern District of Pennsylvania, CVS Caremark finds itself in hot water, facing significant repercussions for allegedly manipulating prescription drug pricing. (See:  United States of America ex rel. Sarah Behnke v. CVS Caremark Corporation, No. 14‑cv-824 (E.D. Pa. June 25, 2025)  This high-stakes case, initiated by former Aetna actuary Sarah […]

Life Care Planning: Bringing Clarity to Life’s Toughest Moments When a catastrophic injury or chronic illness turns life upside down, navigating the future can feel overwhelming. That’s where Life Care Planning steps in—with compassion, clarity, and expert guidance. At Allan Koba, our Certified Life Care Planners are experienced medical professionals who work hand-in-hand with attorneys, […]

If medical records feel like a foreign language or opposing experts sound like they’re reciting Latin, you’re not alone. Legal Nurse Consultants (LNCs) are the missing link—registered nurses with legal savvy who decode healthcare data into actionable legal strategy.   Why Legal Teams and Insurance Carriers Trust LNCs   1. Medical Record Forensics   No […]

🚨 The Case of the Unnecessary Transplant Picture this: A middle-aged woman with post-COVID cardiac complications. A shocking recommendation for a heart transplant buried in her records. A price tag of millions added to her Medicare Set-Aside (MSA). But here’s the twist: the suggestion came from an internist, not a cardiologist—and it was about to […]