Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Medicare Beneficiaries

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Several weeks ago, I wrote a blog post about a case that I…

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Podcast: Medicare For All

Our very own Eric Rubenstein (Director of Litigation, Fraud, Waste, and Abuse Support) will be sitting down with progressive democrat Ron Rivers to discuss the divisive concept of Medicare For All in an upcoming podcast. Rivers will lead the discussion by exploring the social implications and infrastructure needed with such an expansion. Rubenstein will then…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Unconventional Kickbacks

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. In my blog posts the past few weeks, I discussed those instances when…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Genetic Testing

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Fraud. It is everywhere; mortgage applications and loans, credit cards, you name it….

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Posted and filed under Healthcare, Payers.

HEDIS Season: The Home Stretch

As we approach the month of June, we also begin our downward slide towards the end of HEDIS season. HEDIS season, in all its glory, stretches through about 3 calendar seasons – and requires hard work from providers, chart reviewers, and record collection companies from December through October – depending on program enrollment, measures, and…

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

What Do You Hate Most About Healthcare?

Last night, Advize Health had the opportunity to present before one of the largest chapters of its kind in the United States. The audience, comprised largely of credentialed medical coders and billers who assemble to discuss their professional and issues within the industry, were given the opportunity to explore healthcare fraud from two different perspective….

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Posted and filed under Compliance, Payers.

Meet Your New MBI

If you’re covered by Medicare, or if your patients are covered by it – you’re about to start feeling more of the effects of The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Most organizations have been preparing for MACRA’s ripple effects for years, so this wave of change may just be another to…

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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, Medical Record Auditing.

Sign, Seal, Deliver: Provider Signature Requirements

To a physician, providing authentication may appear as yet another inconvenience or hindrance to productivity in the midst of the already chaotic audit process – but it’s the difference between being reimbursed and having your claims denied. For the purpose of a medical record audit, Medicare requires that any services provided be authenticated within the…

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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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