There is absolutely nothing in this report that should be interesting, shocking, or otherwise reflective of surprise. $784 million in improper...
FWA Articles
Fraud Hunters: Claim Determinations
Self doubt is a necessary part of the process when making claim determinations. As a reviewer, you have the ultimate decision-making authority as...
Fraud Hunters: One Hit “Wonders”
Newly approved procedure codes, devices and DME are like the watering holes on the Serengeti. They are gathering spots for fraudsters and great...
Moral Injuries
If you are an avid reader of our newsletter or blogs, you know that we focus on payment integrity, program integrity, fraud waste and abuse, and...
Is Ozempic the new Solaraze?
For those that remember Solaraze, it is one of the name brands for Diclofenac. Diclofenac is commonly known today as Voltaren. In 2018, the OIG...
Modifier 25, the Itch that Keeps Needing a Scratching
Within the past few weeks, we have seen at least two of the large payors seek to institute policies that would require providers to submit their...
Watch: Emergency Room Turns Simple Injury Into a Big Bill
Leigh Fava wound up in the emergency room after injuring her thumb at her New Orleans home. She said she received a tetanus shot and a badly...
Nursing Home Owners Drained Cash During Pandemic While Residents Deteriorated
After the nursing home where Leann Sample worked was bought by private investors, it started falling apart. Literally. Part of a ceiling collapsed...
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...
Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges
Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some...
Supreme Court to Hear Nursing Home Case That Could Affect Millions
When Susie Talevski sued the agency that managed her elderly father’s care before he died, she hoped to get justice for her family. She did not...
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