by Advize Admin | Jul 28, 2023 | Healthcare, Healthcare Law
The only government program that I can think of that did not authorize price negotiations for prescription medications was the Medicare Part D program. In its inception in 2006, price negotiations were not part of the law, and drug manufacturers were essentially at...
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 | Sep 16, 2022 | Commentary
This week’s topic is patient advocacy. As the season of enrollment is upon us, we think about what makes this difficult-to-understand process easier for everyone. Google could potentially be making it easier for enrolling in Medicare and/or Medicaid. ...
by Advize Admin | Aug 26, 2022 | Commentary, OIG Files
A phrase that does not often come up is “medical loss ratio,” or MLR. As an OIG Agent, I spent very little time looking at the OIG Workplan (I’ve blogged and spoken about how OIG Agents follow the current frauds, and how the plan is very much used to direct the work...
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