Monitor Potential FWA: Overutilization of High-Level Codes
In our latest blog, we discuss a recent OIG report that found Medicare could have saved millions of dollars by monitoring providers who billed the highest reimbursable codes. It shows how certain code descriptions were miscounted by providers, causing higher reimbursements that weren't owed. Click below to learn and read more.
Mole Removal Claim Fraud Nets Jail and Fines
A recent fraud event involving a Chicagoland doctor will cost over $1 million and jail time from a mole removal scheme. The doctor submitted false claims for mole removals that were billed on multiple, separate dates of service, which allowed this doctor to receive larger reimbursements.
NPI Guidance Can Help Your FWA Detection
The Centers for Medicare & Medicaid Services (CMS) recently released new guidance that may affect certain providers wanting to obtain an NPI if they don’t already have one. These guidelines are important for you and your health plan to have protection against fraud, waste, or abuse (FWA) in your claims.
Fraud Spotlight: Why Modifier 25 FWA Continues
A pain management practice will pay $625k from a False Claims Act violation. Similar cases give an importance to Fraud, Waste, and Abuse (FWA) protection, and the use of E/M codes would have detected an abnormality on similar claims. Read more to find out how.
Medicare and Maine Medicaid Healthcare Fraud Settlement Case
A Maine family practitioner used false claims billed to Medicare and Medicaid for services that were either not provided or not medically necessary, which provides reasons for the need of Fraud, Waste, and Abuse (FWA) protection.