Posted and filed under Healthcare.
Posted and filed under Healthcare.
Posted and filed under OIG Files.

OIG Files: The Mixing Bowl of Medication

In 2012, the National Council on Prescription Drug Programs (NCPDP) made a change to the manner in which a compounded medication should be submitted to a Pharmacy Benefit Manager (PBM) for reimbursement.  Previously, the requirement was to only list the most expensive ingredient, with reimbursement being made based on that line item.  With the change,…

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Posted and filed under FWA, Healthcare.
Posted and filed under Fraud, Healthcare.
Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Detecting & Investigating FWA during COVID-19

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. We hopefully are seeing the beginning of the end with COVID-19, but we will certainly not see…

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Posted and filed under Community, Fraud, FWA, Healthcare.

Fraud Spotlight: Year in Review

The year 2020 was ripe with unprecedented challenges. Between a global pandemic, civil unrest, and rampant socio-political uncertainty…there was a lot to deal with. The healthcare industry was thrust into the spotlight, first for its heroes on the frontlines, then for its billing practices. COVID-19 put medical documentation under a microscope, examining everything from cause…

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

Legal Violations Against Physical Therapists: Part II

It’s more than money when your license is on the line.  This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud experts. This article continues a multi-part series that will be covering the top ten violations…

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Posted and filed under Fraud, FWA, Healthcare, Medical Record Auditing.

3 Quick Tips to Avoid an Audit

Healthcare providers have a lot on their minds. Between daily rounds, patient care, and an ongoing global pandemic – it’s not easy to stay on top of administrative tasks like documentation and medical record maintenance. Even so, medical record review is a critical function of the healthcare ecosystem. The reality is that there are a lot…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: The OIG, Speaker Programs & Kickbacks

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. A couple of weeks ago, the OIG issued a Special Fraud Alert regarding the use of speaker…

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