by Advize Admin | Jul 28, 2023 | FWA, Medical Record Auditing
There is absolutely nothing in this report that should be interesting, shocking, or otherwise reflective of surprise. $784 million in improper payments is estimated to have been made to providers as it relates to COVID-19. Claims were submitted to the uninsured...
by Advize Admin | Jul 7, 2023 | FWA, Medical Record Auditing
Newly approved procedure codes, devices and DME are like the watering holes on the Serengeti. They are gathering spots for fraudsters and great hunting grounds for those looking to identify and stop the FWA. As a fraud hunter, you must follow the data trends to...
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 | 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 | Aug 27, 2021 | Medical Record Auditing
A little background, one of areas where Advize provides consulting services is in the medical record review space. We have been providing this service to clients for over 20 years, both proactively, and reactively. Our CEO, Jeanmarie Loria, was actually a...
by Advize Admin | May 20, 2021 | Compliance, Medical Record Auditing
As new technologies progress more and more payers are actively deploying AI capable systems. This shift is now producing more audits of physicians than ever before and directly contributing to higher rates of denials. Audits take time and...
by Advize Admin | Dec 9, 2020 | Fraud, FWA, Healthcare, Medical Record Auditing
Healthcare providers have a lot on their minds. Between daily rounds, patient care, and an ongoing global pandemic – it’s not easy to stay on top of administrative tasks like documentation and medical record maintenance. Even so, medical record review is a critical...
by Advize Admin | Oct 9, 2020 | Dental, Fraud, FWA, Medical Record Auditing
Even more than money … what about the standard of care? This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud...
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