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

3 Common Healthcare Fraud Schemes

Scroll through any law enforcement or OIG newsroom, and you’ll quickly learn that healthcare fraud comes in many shapes and sizes. There is no one-size-fits-all fraud scheme adopted by those looking to exploit the system for a buck (or a few million). This is what makes healthcare fraud such a persistent problem. Fraud examiners, enforcement…

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Posted and filed under Medical Record Auditing.

The Importance of Medical Necessity in Medical Coding

Medical necessity documentation, or lack of it, is one of the most common reasons for claim denials. For a service to be considered medically necessary, it must be reasonable and necessary to diagnosis or treat a patient’s medical condition. When submitting claims for payment, it is the diagnosis codes reported with the service that tells…

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