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

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

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.

Fraud Spotlight: Why Modifier 25 FWA Continues

  • Steve Nesnidal, MD, CPC, AHFI
  • Jun 07, 2023
  • Comments
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A pain management practice will pay $625k from a False Claims Act violation. Similar cases give an importance to Fraud, Waste, and Abuse (FWA) protection, and the use of E/M codes would have detected an abnormality on similar claims. Read more to find out how.

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