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...
Compliance Articles
Shaved Costs, High Risk, Maximum Profits: Regulators Worry About Florida’s Butt Lift Boom
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...
Did Your Health Plan Rip Off Medicare?
Today, KHN has released details of 90 previously secret government audits that reveal millions of dollars in overpayments to Medicare Advantage...
MA and Risk-Scoring, We Can Do Better (and Advize does)
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...
Kochanski and McFaul Take on Organized Fraud
This week two of Advize Health’s own former HHS-OIG experts, Matt Kochanski and Wade McFaul presented a conversational webinar on Organized Fraud....
Centene Agrees to Pay Massachusetts $14 Million Over Medicaid Prescription Claims
Massachusetts has become the latest state to settle with health insurance giant Centene Corp. over allegations that it overbilled the state’s...
Some Rural Hospitals Are in Such Bad Shape, Local Governments Are Practically Giving Them Away
Kyle Kopec, Braden Health’s chief compliance officer, holds up a sample of diagnostic images left behind at a Tennessee hospital. As the company...
Cybersecurity for Mom and Pop Compliance Shops
Recently we presented to New York State Adult Day Services Association (NYSADSA) on this very topic. For those of you who do not know,...
How Providers are Paid is Different from How Health Plans (Issuers) are Funded
Providers are most often paid in Fee-For-Service (FFS) models for visits AFTER they occur. The patient sees a provider, a service or procedure is...
What is Risk Adjustment?
Risk adjustment is a newer payment methodology that is designed to allow for a proactive approach to managing healthcare. It does not seek to...
The Importance of Getting Risk Adjustment Right
Background Anyone who has taken the CRC™ (Certified Risk Adjustment Coder) curriculum can tell you that risk adjustment was first utilized in the...
Independent Review Organizations (IRO): A Necessary Evil
Providers who are lucky enough to have their fraud, waste, and abuse matters resolved through a civil settlement (either via the US Attorney’s...
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