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

Pre-Litigation Considerations

Law firms have been known to enlist the help of a third-party when dealing with healthcare fraud cases. This is because in addition to investigating the allegations against one party, there is a myriad of additional pre-litigation considerations. In multi-faceted cases in which health plan overpayments are being pursued within the judicial system an audit…

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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, 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.

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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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 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 Community, Events.

Recap of NHCAA Annual Training Conference 2015

This past week, Advize Health had the pleasure of attending and hosting a booth at the NHCAA Annual Training Conference 2015. This was a great opportunity to network with old and new friends. At our booth we held our signature, “Guess the Fraud Scheme”, in which one of our artistic employees drew out some Fraud…

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