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Find news and solutions for healthcare payers and providers. Recognize and avoid potential fraud, waste, and abuse scenarios. Real-time clinical claim editing are analyzed to maximize provider reimbursements.

Impact of Policy Adjustments on Telehealth Fraud

  • Steve Nesnidal, MD, CPC, AHFI
  • Sep 10, 2021
  • Comments
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On May 19, 2021, the Medicare Payment Advisory Commission (MedPac) provided feedback to Congress regarding their opinions on the effectiveness of the overwhelming 200 healthcare policy changes that Congress and CMS instituted during the interval of January through July 2020, in response to the coronavirus public health emergency. Aside from the obvious and necessary benefits of these changes in response to the pandemic, MedPac raises concerns about the detrimental impact in the realm of fraud in healthcare: “…not all actors in the healthcare system are well-intentioned”.

Audits of Telehealth Services During COVID-19

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 29, 2021
  • Comments
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Relaxed telehealth restrictions is a necessary step to limit potential COVID-19 exposure in physician offices in the emergency period. With this change, unfortunately, the US Justice Department estimates telehealth-related fraud has expanded significantly since early 2020 – approximated at 4.5 billion dollars.

Fighting Fraud in Medical Nutrition Therapy

  • Steve Nesnidal, MD, CPC, AHFI
  • Apr 27, 2021
  • Comments
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The role of nutrition in chronic disease management is especially crucial, as it is a modifiable risk factor for many conditions such as chronic renal failure (CRF), diabetes mellitus (DM), obesity and coronary artery disease (CAD). Payers who bear significant long-term healthcare utilization burdens due to obesity and cardiovascular risk factors may determine that Medical Nutrition Therapy (MNT) preventive coverage is a cost-effective policy approach for their beneficiaries.

Impact of the COVID-19 Pandemic on Healthcare Fraud

  • Steve Nesnidal, MD, CPC, AHFI
  • Apr 07, 2021
  • Comments
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During the pandemic, healthcare claim fraud prevails as new fraud schemes develop and adapt to the changes in healthcare guidelines enacted, so providers can continue to treat patients. Two major areas of FWA expansion during the pandemic include Telehealth and COVID-19-related laboratory testing add-on services.

Janssen Single-Dose COVID-19 Vaccine is Pending FDA Emergency Use Authorization

  • Steve Nesnidal, MD, CPC, AHFI
  • Feb 23, 2021
  • Comments
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UPDATED AS OF 6/9/2021. Janssen Biotech, Inc. applied to the FDA for Emergency Use Authorization (EUA) of its single-dose COVID-19 vaccine, which may be a highly desirable weapon used to fight the virus based on characteristics and efficacy data.

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