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.

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
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.

Fighting Fraud in Medical Nutrition Therapy

  • Steve Nesnidal, MD, CPC, AHFI
  • Apr 27, 2021
  • Comments
Nutrition

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
Stop Fraud Image - Large

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.

CMS Adds New HCPCS COVID-19 Lab Code

  • Steve Nesnidal, MD, CPC, AHFI
  • Oct 21, 2020
  • Comments
COVID Test Neg

CMS is adjusting its payment policy for COVID-19 laboratory tests starting in Jan 1, 2021 in order to incentivize high throughput COVID-19 laboratory test results and ensure turnaround of results are provided in a clinically meaningful timeframe.

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