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.

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.

NPI Guidance Can Help Your FWA Detection

  • John Danza
  • Jul 24, 2023
  • Comments
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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.

Medicare and Maine Medicaid Healthcare Fraud Settlement Case

  • Steve Nesnidal, MD, CPC, AHFI
  • May 17, 2023
  • Comments
Stop Fraud Image - Large

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.

Why Fraud Analytics Are Important to You

  • John Danza
  • Oct 17, 2022
  • Comments
Man Working on Computer

A multi-million dollar scheme serves as a prime example to the benefits of Fraud, Waste, and Abuse (FWA) protection. The story of a doctor performing an alarmingly high amount of surgeries not typically conducted by their specialty is awakening to the need for robust safeguarding solutions.

Audits of Telehealth Services During COVID-19

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 29, 2021
  • Comments
telehealth

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.

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