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

Examining The Fraud Triangle

Federal healthcare fraud recoveries totaled upwards of $2B in the first half 2017’s 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…

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Posted and filed under Community, Fraud.

Keep Your Holiday Season Fraud-Free

As the holiday season nears its zenith it can become extremely difficult to maintain your defenses against the myriad of fraud schemes that plague our capitalistic society. Luckily, Florida Attorney General Pam Bondi has your back! In her presentation, “2017 Holiday Consumer Protection Guide”, she outlines a number of safety precautions, product safety information, and…

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Posted and filed under Compliance, Fraud, FWA.

Advize Returns From NHCAA 2017

Last year we had the ONE AND ONLY cheapest.booth.ever featured at NHCAA’s Annual Training Conference. This year Advize brought guacamole and cookies to the table at the Even Cheaper Cheapest Booth Ever. Advize Health had the honor of speaking with some of NHCAA’s Annual Training Conference (ATC) attendees right in our backyard. The ATC is widely-regarded…

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Posted and filed under Dental, Fraud, FWA.

Fraud Round-Up

If you read the news, you know that health care fraud is just as prevalent as ever. During any given time, you will be able to find a headline about a provider or care giver defrauding patients, insurance companies, or CMS in every state across the nation. This month we’ve seen quite a few colorful…

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Posted and filed under Coding, Cybersecurity, Events, Fraud, FWA.

From ECC to IASIU

Advize Health kicked off the month of April by diving headfirst into Conference Season, and attending the Eastern Claims Conference in Boston, MA. The Eastern Claims Conference, recently relocated from New York to Massachusetts was an impressive assembly of insurance professionals. Catering to life, disability, medical, legal, and insurance claims; the Eastern Claims Conference has…

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

Safeguard Your EHR

If healthcare was a chemical solution, and relevant technologies were solutes – the mixture would quickly become a fragmented clump of, well…various technologies. The healthcare market is over-saturated with technology designed to “fix” the present problems plaguing the ecosystem. Of course, in a paradoxical twist of fate, these solutions come with a new set of…

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Posted and filed under Coding, Compliance, Fraud.

Upcoding vs. Downcoding

Physicians and their billing/coding staff have an established history with, and an acute awareness of upcoding and overpayments. In fact, unless they’re operating within a fraudulent billing scheme, they’re avoiding the practice of upcoding all together. Upcoding is arguably the most common red flag in both audit selections and audit results, making it a serious…

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Posted and filed under Fraud, Healthcare.

Are Your Eyes Deceiving You?

Are you being used by your doctor? Do you ever go to your optometrist for a routine eye exam and unknowingly leave with a medical condition? Were you asked for your medical insurance card at your visit? Why is that? Routine eye exams are covered by your vision plan. Most people go for an eye…

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Posted and filed under Coding, Fraud.
pain-management

Chiropractic Billing Red Flags

All insurance payers are obligated to perform routine reviews of claims submitted by providers who operate under their plans. In recent years these claims examinations have gotten more rigorous, with antifraud initiatives being pushed by private health plans and those operating under the umbrella of CMS. The prevalence of insurance fraud has created a hypervigilant…

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Posted and filed under Fraud, Healthcare.

Bad Reputation: Big Pharma’s Eventful Year

Thinking back to late 2015, the pharmaceutical industry was shaken by a tsunami of criticism and vitriol, all thanks to the rapacity of Big Pharma “bad boy” Martin Shkreli. You may recall Shkreli’s ill-received decision to jack up the price of Daraprim from $13.50 a pill, to an inconceivable $750 per pill only one month…

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