by Chia Gemmato | Oct 27, 2023 | Advize News
Advize Health is thrilled to welcome Ashlee Heath to the Advize team as Director, Program Integrity. Ashlee is a passionate and experienced leader with more than a decade of healthcare experience in coding compliance and fraud, waste and abuse prevention, detection,...
by Advize Admin | Oct 20, 2023 | FWA, SIU
As someone who has retired twice already but is still working, I may not be the best person to answer this question but I am aiming this query more at the fraud hunt than the job hunt. A hunter or fisherman answers this question all the time. Do we quit when it gets...
by Advize Admin | Aug 2, 2023 | Advize News
Scottsdale was hot AF (Hot As Fraud) – temperatures were way over 105, and hot Medicaid Fraud topics were discussed. The National Association for Medicaid Program Integrity (NAMPI) has an annual training conference. This conference brings together the public and...
by Advize Admin | Jul 14, 2023 | FWA
Self doubt is a necessary part of the process when making claim determinations. As a reviewer, you have the ultimate decision-making authority as to whether a re-opened claim should be denied and the money recouped. You should be asking yourself whether the...
by Advize Admin | Jun 16, 2023 | FWA, Healthcare
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 conducted a study that reflected that there were some strong fraud indicators on the off-label use of Diclofenac (under...
by Advize Admin | May 26, 2023 | Coding, FWA
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 medical records when an Evaluation and Management (E&M) is appended with Modifier 25. While not having a discussion on...
by Advize Admin | Mar 3, 2023 | Compliance, Healthcare
MIAMI — In hindsight, Nikki Ruston said, she should have recognized the red flags. The office in Miami where she scheduled what’s known as a Brazilian butt lift had closed and transferred her records to a different facility, she said. The price she was quoted — and...
by Advize Admin | Feb 10, 2023 | Healthcare Facepalm, Technology
In early 2020, as they tried to fight covid-19 across two rural counties in North Carolina, the staff of Granville Vance Public Health was stymied, relying on outdated technology to track a fast-moving pandemic. Lisa Macon Harrison, the agency’s health...
by Advize Admin | Jan 20, 2023
OIG Roundtable (Formerly Retro Fraud) Episode 18: Trials & Tribulations of Trials & Tribulations with Sean "The Compliance Guy" Weiss Play Episode Pause Episode Mute/Unmute Episode Rewind 10 Seconds 1x Fast Forward 30 seconds 00:00 / 52:16 Subscribe Share...
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...
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