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…
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…
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…
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…
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…
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…
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…
A study conducted by three universities has revealed a fatal flaw in the healthcare industry’s cyber security operations – lack of cohesion between cyber security protocol and the proper execution of such procedures. Healthcare organizations are vulnerable to data breaches because cyber security efforts are perceived as an interruption of clinical workflow, rather than as…
Whistleblower Lawsuit Leads to Record Setting Settlement for Adventist Health System Adventist Health System will pay $118.7 million to the federal government and four states to settle a whistleblower lawsuit filed in December 2012. The lawsuit alleged that Adventist paid doctors excessive compensation for patient referrals to Adventist-owned health care facilities, including hospitals, clinics and…