FWA Briefs

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.

The Federal Hospice Fraud Problem in the United States

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 25, 2024
  • Comments

Addressing and diving into the issue of hospice fraud in the United States, specifically with claims submitted for those who don't qualify for hospice or those who didn't receive hospice.

Medicare Reference-based Pricing RAND Study

  • John Danza
  • Jun 11, 2024
  • Comments

Using the RAND Corporation's newest study to understand payer questions involving Medicare Reference-based Pricing.

Overutilized High-level Drug Testing: Small Fees, Large Overpayments

  • Steve Nesnidal, MD, CPC, AHFI
  • Nov 17, 2023
  • Comments

Dr. Steve Nesnidal of Context 4 Healthcare, Inc. presented at the 2023 NHCAA Annual Training Conference on Overutilized High-level Drug Testing, focused on Small Fees with Large Overpayments. Dr. Nesnidal goes into depth about specific cases where aberrant providers intentionally billed a higher amount of the higher-level codes.

Monitor Potential FWA: Overutilization of High-Level Codes

  • Steve Nesnidal, MD, CPC, AHFI
  • Sep 13, 2023
  • Comments
Monitoring Claims for Fraud-canstockphoto25652629

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

  • Steve Nesnidal, MD, CPC, AHFI
  • Aug 03, 2023
  • Comments
Stop Fraud Image - Large

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.

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