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 | Dec 2, 2022 | Coding, FWA, Medical Record Auditing
Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some plans overbilling the government more than $1,000 per patient a year on average. Summaries of the 90 audits, which...
by Advize Admin | Nov 11, 2022 | FWA, Healthcare
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 expect the case would grow into a national bellwether. A ruling against her could strip millions of vulnerable Americans of...
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 | Sep 23, 2022 | FWA, Healthcare
Health insurance giant Centene Corp. has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. It’s the biggest known payout by the nation’s largest Medicaid insurer over its drug pricing...
by Advize Admin | Sep 8, 2022 | FWA, OIG Files
Open enrollment will be upon us in the coming month. With it will come a slew of fraud complaints as it relates to managed care enrollment. Brokers work to enroll eligible members into plans that are supposed to be the best suited for the member. ...
by Advize Admin | Aug 5, 2022 | Commentary, FWA
This week our very own Eric Rubenstein, Sr. Director of FWA and I, flew out to Dallas to present to the Texas Office of the Attorney General Medicaid Fraud Control Unit. The topic was for auditors and was Data Analytics for the Analyst. They shared...
by Advize Admin | Jul 8, 2022 | FWA, Healthcare, Medical Record Auditing
Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Witnesses sharply criticized...
by Advize Admin | May 20, 2022 | FWA, Healthcare
RaDonda Vaught, a former Tennessee nurse convicted of two felonies for a fatal drug error, whose trial became a rallying cry for nurses fearful of the criminalization of medical mistakes, will not be required to spend any time in prison. Davidson County...
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