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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Posted and filed under FWA.

Fraud, Waste and Abuse Fact: September

Affordable Care Act Fraud Criminals Facing Tougher Sentences Due to the Affordable Care Act, criminals convicted of fraud now face tougher sentences and more jail time. Criminals will receive 20 to 50 percent longer sentences for crimes that involve more than $1 million in losses. “The government’s successes in prosecuting and winning health care fraud…

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Posted and filed under FWA.

Fraud Waste and Abuse Fact: August

DOJ and HHS Annual Report Highlights $3.3 Billion in Settlements and Judgments in FY 2014 “On March 19, 2015, the Department of Justice (DOJ) and Department of Health and Human Services (HHS) issued their annual Health Care Fraud and Abuse Control (HCFAC) Program report highlighting that the HCFAC Program obtained $3.3 billion in health care…

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Posted and filed under FWA, Healthcare.
Gavel and Stethescope

12 Healthcare Fraud, Waste, & Abuse Facts

Fraud accounts for 19% of the $600 to $800B in waste in the U.S. healthcare system annually, including everything from bogus Medicare claims to kickbacks for worthless treatments and other services. 57% of insurers expect to see an increase in fraud losses this year on personal insurance lines (mainly auto and home insurance), while only 5% of…

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