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
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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.

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.

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