Posted and filed under Coding, Fraud, FWA.

Fraud Spotlight: Providers & The “Impossible Day”

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. When a provider commits healthcare fraud, and they hit all the “goodies,” we just have to…

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Posted and filed under Coding, Dental, Fraud, FWA.

Dental Fraud: Isolated or a Pattern?

This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column next week for more examples of dental fraud from real cases! This article points out some basics of dental misconduct – fraud.  A dentist who bills for services not performed is committing fraud.  For example, billing for the…

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Posted and filed under Careers, Coding, Community.

Celebrating National Medical Coder Day

May 23rd  is  National Medical Coder Day to celebrate YOU and your unrelenting dedication to the field and endless hard work.  From educating providers to helping keep protected health information safe and secure — YOU are a compliance warrior!  YOU are an essential front line worker! Do you feel like you aren’t treated as such? We’re…

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Posted and filed under Coding, Compliance, Fraud, FWA, Medical Record Auditing.

Fraud Spotlight: Understanding the 3 Types of BLS Transport

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. Previously, I wrote a couple of blogs about the continued fraud in the…

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

Fraud Spotlight: The Use & Abuse of Modifier 25

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.  Modifier 25.  It has been the bane of existence for fraud, waste and…

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

Fraud Spotlight: Providers & Deferred Prosecution Agreements

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. Over the past few weeks, I have been discussing the investigative process.  From…

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

Fraud Spotlight: Economic Healthcare Fraud Perspectives

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.  This past week, while having lunch with a friend who knew about my…

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

Fraud Spotlight: Another Ophthalmologist Fraud Bust

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. This past week, the US Attorney’s Office in the Southern District of NY…

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

Fraud Spotlight: Provider Awareness & Compliant Billing

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. This past week, I had the pleasure of presenting a webinar to approximately…

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Posted and filed under Coding.

6 Ways to Drop Your “A”

You did it. You put in the hours. You’ve tabbed your code books until they couldn’t be tabbed anymore. You completed practice questions ad nauseum. You’ve even passed your Certified Professional Coder exam. But you’re not there yet. The “CPC” credential you were promised is accompanied by an uninvited guest. The kind of visitor who…

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