Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. The OIG applies published criteria to assess future risk and places each party to an FCA settlement into one of five categories on a risk spectrum. Excluded individuals and entities are listed in the OIG’s exclusions database.

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Fraud Compliance Medicare Medicare 59

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse.

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Fraud Compliance Medicare Medicare 52

Healthcare IT Today

FEBRUARY 2, 2023

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. Target audits highlight areas for provider education. To that end, the agency doubled its budget for audits in 2022.

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Medicare Medicare Medicaid Medicaid 60

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. The Medicare Fee-for-Service Compliance programs prevent, reduce, and measure improper payments in FFS Medicare through medical review.

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Medicare Medicare Compliance Governance 52