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...
by Advize Admin | Jul 1, 2022 | Compliance, Events, Healthcare, Technology
Recently we presented to New York State Adult Day Services Association (NYSADSA) on this very topic. For those of you who do not know, NYSADSA is comprised of individuals, single-site programs, multiple-site programs, professional organizations, and supporters...
by Advize Admin | Mar 25, 2022 | Compliance
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 performed, and a bill (claim) goes to the health insurance plan (payor/issuer) for reimbursement for those services that...
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