Posted and filed under Coding, FWA, Medical Record Auditing.

How Much Are Your Policies Costing You?

A medical record audit can reveal over-payments for up-coding, incorrect numbers of units billed, and the abuse of modifiers – just to list a few. Given the popularity of such indiscretions, what is being done after the money is recovered? Do you intend on data mining again in six months, hoping that the provider will…

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Posted and filed under FWA, Healthcare.

Whistle Blower Costs NJ Hospital $450,000 In Recent Settlement

On May 31, 2016 the US Attorney’s Office for the District of New Jersey published a press release regarding the latest settlement for health care fraud in the state involving Saint Michael’s Medical Center and four individual physicians who submitted false claims for procedures that were not deemed medically necessary. These allegations come from a…

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Posted and filed under Dental, FWA.

Is Dental Fraud the New Normal?

As an auditing firm, we are well aware that dental fraud is alive and well in the American healthcare system. With so many American children covered by Medicaid, dentists have taken it upon themselves to begin offering unnecessary and Al-La-Carte services in order to maximize profits. Many offices justify this unethical practice by mentioning that…

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Posted and filed under Compliance, FWA.

Clinical Labs Under Heavy Scrutiny After Cigna Lawsuit

A tidal wave of fraud has been approaching our shores for quite some time, and it’s finally broken land. The scheme, gaining popularity in clinical labs and pathology groups involves waiving patient fees and copays in order to send payer groups inflated claims fees. While these billing tactics might seem innocuous, they are fraudulent because…

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Posted and filed under Coding, FWA, Payers.

Vision vs. Medical Coverage Making You Bleary-Eyed?

Billing issues, to an extent, are expected in any physician or healthcare provider office. Most patients are in possession of both medical and vision benefits coverage, and this duality often causes confusion in ophthalmology offices. Certain procedures that are performed in an ophthalmology office should be billed as medical procedures, and do not apply to…

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Posted and filed under FWA.

Could Healthcare Fraud Occur in my Backyard?

Many members of the Advize Health staff call Winter Park, Florida their home.  Winter Park is a historic city populated by private colleges such as Rollins College, boutique hotels with enviable veranda views, picturesque canopies of Spanish moss, and a small number of country clubs.  If you’re picturing a painted sky illuminating a boat launch…

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Posted and filed under FWA.

Does Incident-To Have You Perplexed?

Stringent billing guidelines and regulations are often instituted to limit the incidence of fraud, waste, and abuse (FWA). Specificity increases annually, providing a well-developed outline for physicians and billers. Revisions to billing procedures are designed to help all facets of the healthcare industry. An example is incident-to billing, which was introduced to address the trend…

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Posted and filed under FWA.
Posted and filed under FWA.

Top Recent Regulatory Activities by the US Government

Recently, the U.S. Government has been undertaking regulatory activities to drive down healthcare costs and improve patient outcomes. It is crucial to keep an eye on published regulations. One of the Centers for Medicare and Medicaid Services’ (CMS) key goals is to pay claims right the first time. This means paying the right amount to…

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Posted and filed under Fraud, FWA.

Fraud Waste and Abuse Fact – October

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…

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