Posted and filed under Coding, Compliance, Fraud, FWA, Healthcare.

Fraud Spotlight: Provider Awareness & Compliant Billing

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. This past week, I had the pleasure of presenting a webinar to approximately…

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Posted and filed under Compliance, Fraud, Healthcare.

Fraud Spotlight: Fraud Fighters Love Data

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Recently, there has been an unbelievable amount of bandwidth spent discussing telemedicine as…

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Posted and filed under Compliance, Fraud, FWA, Healthcare.

3 Common Healthcare Fraud Schemes

Scroll through any law enforcement or OIG newsroom, and you’ll quickly learn that healthcare fraud comes in many shapes and sizes. There is no one-size-fits-all fraud scheme adopted by those looking to exploit the system for a buck (or a few million). This is what makes healthcare fraud such a persistent problem. Fraud examiners, enforcement…

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Posted and filed under Compliance, Fraud, FWA, Healthcare.

Fraud Spotlight: Self-Disclosure Protocol

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. I am surprised sometimes at the number of people in the healthcare field…

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Posted and filed under Compliance, Fraud, FWA, Healthcare.

Examining The Fraud Triangle

Federal healthcare fraud recoveries totaled upwards of $2.3B in the 2018 fiscal year. This staggering sum is proof enough that healthcare fraud is here to stay as an unfortunate reality of the industry. Providers, patients, and insurers alike have all been complicit in various scams and schemes – which brings to mind the question: why…

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Posted and filed under Compliance, Healthcare.

OIG Medi-Cal Audit Reveals $70M in Incorrect Payments

Earlier this month, the Office of Inspector General released a 29-page audit report of an investigation conducted on the California Department of Health Care Services. The audit, which covered the review of more than 112,000 Medicaid capitation payments amounting to nearly $74 million dollars was initiated to determine whether California had made capitation payments on…

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Posted and filed under Compliance, Fraud, FWA, Healthcare.

What Do You Hate Most About Healthcare?

Last night, Advize Health had the opportunity to present before one of the largest chapters of its kind in the United States. The audience, comprised largely of credentialed medical coders and billers who assemble to discuss their professional and issues within the industry, were given the opportunity to explore healthcare fraud from two different perspective….

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Posted and filed under Compliance, Healthcare.

Medical Record Retrievals: Why Outsource?

Medical records can be requested for several reasons, with the most common being a) for litigation purposes, and b) for medical record reviews. These highly coveted bundles of documentation are the focal point of many insurance related trials, and of course, documentation reviews sanctioned by the Centers for Medicare and Medicaid Services (CMS) and various…

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Posted and filed under Compliance, Cybersecurity.

What’s Up With These Updated Privacy Policies?

We’ve updated our privacy policy. Does this sentence look familiar? If you’re an active user of the Internet, then it should. Inboxes around the globe are being inundated with updated privacy policies, a verbose consequence of the European Union’s new set of privacy protections. The European Union’s General Data Protection Regulation (GDPR) went into effect…

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Posted and filed under Compliance, Payers.

Meet Your New MBI

If you’re covered by Medicare, or if your patients are covered by it – you’re about to start feeling more of the effects of The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Most organizations have been preparing for MACRA’s ripple effects for years, so this wave of change may just be another to…

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