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

ICYMI: 2018 OIG Work Plan Webinar

Advize Health’s first webinar of the new year will be broadcasting live today from 2:00PM EST until 3:30pm EST. The program will break down the 2018 OIG Work Plan and provide an in-depth examination at the OIG (Office of Inspector General) and their efforts in the fight against fraud. From mandatory requirements, to laws and…

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Posted and filed under Compliance, Fraud, FWA.

Don’t Get Ghosted by Your DME Supplier

Medicare fraud maintains its position among the fastest growing crimes in the United States. The government loses nearly $75 billion a year to Medicare fraud; which has led to the conception of several anti-fraud initiatives, including the OIG’s Operation Whack-A-Mole (WAM). Medicare fraud comes in many shapes and forms, with the three most popular including:…

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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 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 Coding, FWA.

Investigating Health Plan Overpayments

Picture yourself balancing on top of a fence with vast expanses of land, each with their own set of governance, visible to you from both sides. You’re straddling the fence, your legs occupying each of the divided spaces. Where do you stand? It depends on which way the wind blows. Such is the case with…

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Posted and filed under Community, FWA.
nhcaa booth

What We Learned at Our $500 Conference Booth

Advize Health had the honor of attending NHCAA’s Annual Training Conference (ATC) in Atlanta, GA earlier this month. The ATC is widely-regarded as the most important assembly against healthcare fraud, where attendees explore fraud schemes, trends, and best practices for identification, investigation, and prosecution of fraud-related offenses. The conference, which was in operation over the…

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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 FWA.

Back to Reality: Takeaways from NAMPI 2016

Last week, Advize Health returned to Florida after fighting fraud in Baltimore during NAMPI 2016. This annual National Association for Medicaid Program Integrity took place from August 28-31st, and was held at the Baltimore Marriott Waterfront Hotel. This conference offered more than waterfront views and famous Baltimore cuisine. Jeanmarie Loria, Advize Health’s Managing Director and…

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Advize Health’s Prepayment and Postpayment Reviews Webinar

Advize Health will take you step by step through several real life audit example from data selection to extrapolations and recoveries. Find out common pitfalls and areas of your policies and procedures that could be tighten up to guard against FWA. We will present the differences between a postpayment audit and a prepayment audit and…

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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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