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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Posted and filed under Compliance, Cybersecurity.

Something Smells Phishy

Phishing is a common fraudulent practice that involves, “sending emails purporting to be from reputable companies in order to induce individuals to reveal personal information, such as passwords and credit card numbers”. Phishing is an example of deceptive social engineering, one that exploits cybersecurity weaknesses held across most industries, including healthcare. Phishing attempts are typically…

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

Your Data Will Be Stolen

This article is a continuation of Risky Retrievals. Walk-Ins Welcome Our medical record specialists are required to arrive at each facility with their equipment, as well as their ID badges and driver’s licenses. This is to ensure that their identities can be verified by office staff and reporting in the event of an incident. What…

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Posted and filed under Compliance, Fraud, FWA, Healthcare, Medical Record Auditing.

Risky Retrievals

For years, whenever we began launching a medical record review project, clients and physicians alike would ask us the same question: Why can’t you come onsite to pick up the requested records? The easy answer would have been to say that we simply hadn’t performed record retrievals before, but we had vested interest in doing…

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Posted and filed under Compliance, Healthcare, Payers.

The Road to Compliance

The road to compliance is long and bumpy, but a trip we must all take in 2018. In January 2017, compliance professionals from the Department of Health and Human Services (HHS), Office of Inspector General (OIG) held an assembly in which they discussed how to measure the efficacy of Compliance Programs. From this roundtable came…

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Posted and filed under Compliance, Fraud, FWA.

Don’t Get Ghosted by Your DME Supplier

Medicare fraud maintains its position among the fastest growing crimes in the United States. The government loses nearly $75 billion a year to Medicare fraud; which has led to the conception of several anti-fraud initiatives, including the OIG’s Operation Whack-A-Mole (WAM). Medicare fraud comes in many shapes and forms, with the three most popular including:…

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