by Advize Admin | Sep 1, 2023 | Compliance, Providers
Providers, are you aware that the Affordable Care Act (ACA), often referred to as “Obamacare,” mandates a compliance plan for those participating in Medicare and Medicaid? It’s surprising how many providers lack such a plan. This isn’t a...
by Advize Admin | Aug 11, 2023 | Compliance, FWA
The biggest mistake a healthcare investigator can make is to forget what their mission is. It is not to solve a crime; it is to follow the facts to determine if a crime has been committed. Healthcare fraud investigative work is the opposite of detective work. A...
by Advize Admin | Jul 21, 2023 | Compliance, OIG Files
Every investigator knows that keeping your focus on the allegation is the key to efficiently conducting your investigation. There are times, however, when keeping those blinders on will result in the investigator not seeing the bigger picture. While investigating what...
by Advize Admin | Mar 3, 2023 | Compliance, Providers
BUTTE, Mont. — Jennifer Mitchell remembered getting a call nearly two years ago that her 69-year-old husband, Bill, had crashed his car and had been committed to the Montana State Hospital, the state-run psychiatric hospital for adults about 20 miles from their home...
by Advize Admin | Mar 3, 2023 | Compliance, Healthcare
MIAMI — In hindsight, Nikki Ruston said, she should have recognized the red flags. The office in Miami where she scheduled what’s known as a Brazilian butt lift had closed and transferred her records to a different facility, she said. The price she was quoted — and...
by Advize Admin | Jan 27, 2023 | Compliance, FWA, Medical Record Auditing
Today, KHN has released details of 90 previously secret government audits that reveal millions of dollars in overpayments to Medicare Advantage health plans for seniors. The audits, which cover billings from 2011 through 2013, are the most recent financial reviews...
by Advize Admin | Dec 2, 2022 | Compliance, FWA, Medical Record Auditing, OIG Files
When you first open this article, the most glaring of things is the time frame from which the audit was derived. 2011-2013 data is at this point so aged, the calculation of $1,000 per patient enrolled in a Medicare Advantage (MA) as the overcharged amount is simply...
by Advize Admin | Oct 21, 2022 | Advize News, Compliance, Events
This week two of Advize Health’s own former HHS-OIG experts, Matt Kochanski and Wade McFaul presented a conversational webinar on Organized Fraud. Matt and Wade discussed their experiences with the types of fraud and various ways they investigated these cases. ...
by Advize Admin | Sep 30, 2022 | Compliance, FWA
Massachusetts has become the latest state to settle with health insurance giant Centene Corp. over allegations that it overbilled the state’s Medicaid program for pharmacy services, KHN has learned. Centene, the nation’s largest Medicaid managed-care insurer, will pay...
by Advize Admin | Aug 19, 2022 | Compliance, Healthcare
Kyle Kopec, Braden Health’s chief compliance officer, holds up a sample of diagnostic images left behind at a Tennessee hospital. As the company takes over abandoned hospitals, a major task is figuring out what to do with old medical records stacked in...
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