Posted and filed under Healthcare.
Posted and filed under Compliance.

Targeted Probe and Educate (TPE) is Back

The tagline from the CMS Website is “When Medicare Claims are submitted accurately, everyone benefits.” First – TPE why do we even care?  Well, simple answer, it is a lovely little gift from CMS designed to help reduce claim denials and appeals through one-on-one help.  As we can attest thorough masses of audits of provider…

Read the full article

Posted and filed under Healthcare.
Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Understanding the OIG’s Key Operating Divisions

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. When we speak to various people in our space looking to engage us in work that…

Read the full article

Posted and filed under Compliance, FWA, Healthcare, Payers.

MSP 101: A Brief Overview

Friend of Advize and healthcare payer expert Dino Kasdagly put together a helpful resource for healthcare professionals looking to quickly refresh their knowledge on Medicare as a Secondary Payer practices. Below you will find several popular instances in which Medicare benefits are secondary to Group Health Plan (GHP) benefits.  If the documented employer has more…

Read the full article

Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: COVID-19 Fraud Schemes & Paradigm Shifts

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. With every single social media post out there is about Coronavirus (and just…

Read the full article

Posted and filed under Fraud, FWA, Healthcare.

COVID-19’s Impact on Telemedicine & Reimbursements

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Under Medicare rules, telemedicine, or telehealth as it is also commonly known, required…

Read the full article

Posted and filed under Coding, Compliance, Fraud, FWA, Medical Record Auditing.

Fraud Spotlight: Understanding the 3 Types of BLS Transport

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Previously, I wrote a couple of blogs about the continued fraud in the…

Read the full article

Posted and filed under Community, Fraud, FWA, Healthcare.

Fraud Spotlight: Prevention Through Medicare Literacy

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. With the New Year will come an increase in Medicare premiums for those…

Read the full article

Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Human vs Machine

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. This past week I attended a CMS “listening session” hosted by the Center…

Read the full article