Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

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Fraud Medicare Medicare Overpayments 62

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

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US Department of Health and Human Services Compliance Officers Compliance Fraud 52

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. This is the final article in a 3-part series on denials and appeals management. Only appeal claims when you have evidence and supporting documentation to substantiate your right to payment.

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Fraud Compliance Medicare Medicare 52

HIPAA Journal

MARCH 30, 2022

Articles discussing the 3 major things addressed in the HIPAA law often tend to focus on the Administrative, Physical, and Technical Safeguards of the Security Rule. Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors.

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HIPAA Fraud Health Insurance Health Care Reform 119

Healthcare IT Today

FEBRUARY 2, 2023

The following is a guest article by Rebecca Darnall, R isk Adjustment Leader at Episource. It has given every indication that it intends to investigate fraud, waste, and abuse more robustly in the foreseeable future. The Justice Department has joined the fraud case against one large national insurer.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

MARCH 28, 2022

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. This information is not all-inclusive and the article is a truncated version of Lesson 3 from our Certified Outpatient Clinical Appeals Specialist (COCAS SM ) training program.

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Medicare Medicare Compliance Governance 52