by Advize Admin | Sep 11, 2024
OIG Roundtable (Formerly Retro Fraud) Episode 94: Is Adding a Diagnoses to a Medicare Advantage Patient FWA or a Positive Step in Social Determinants of Health (SDOH) Play Episode Pause Episode 1x 00:00 / 30:09 Subscribe Share Spotify RSS Feed Share Link Embed...
by Chia Gemmato | Oct 27, 2023 | Healthcare, Healthcare Law, OIG Files
After glancing at the Halloween-themed graphic, I was tempted to rename this blog “The ‘Fraid’ Hunter” because that picture is horrifying. However, it did inspire me to discuss a healthcare horror tragedy. In this story, there are no bad guys,...
by Advize Admin | Sep 1, 2023 | Compliance, Providers
Providers, are you aware that the Affordable Care Act (ACA), often referred to as “Obamacare,” mandates a compliance plan for those participating in Medicare and Medicaid? It’s surprising how many providers lack such a plan. This isn’t a...
by Advize Admin | Aug 4, 2023 | Community, FWA
On a recent trip to South Florida, I came across some very interesting sights that gave me pause. The first was the combination of an Adult Day Care/Auto Garage, as pictured. The second was a similar combo of Home Health Care in the same storefront as a Guns/Ammo...
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 | Jul 7, 2023
OIG Roundtable (Formerly Retro Fraud) Episode 38: Interviewing & the Importance of Consistency Play Episode Pause Episode 1x 00:00 / 23:57 Subscribe Share Spotify RSS Feed Share Link Embed <blockquote class="wp-embedded-content"...
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 | May 5, 2023
OIG Roundtable (Formerly Retro Fraud) Episode 31: Challenges of Managing an SIU Play Episode Pause Episode 1x 00:00 / 33:20 Subscribe Share Spotify RSS Feed Share Link Embed <blockquote class="wp-embedded-content"...
by Advize Admin | Mar 10, 2023
OIG Roundtable (Formerly Retro Fraud) Episode 24: Quick Hello from the ABA Health Law Emerging Issues in Healthcare Law Conference Play Episode Pause Episode 1x 00:00 / 12:44 Subscribe Share Spotify RSS Feed Share Link Embed <blockquote...
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