FWA Briefs

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.

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.

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.

The Office of Inspector General (OIG) Work Plan for Fiscal Year 2017 provides useful guidance for healthcare providers and payers to monitor their claims for potential fraud and quality of care concerns. The Work Plan (at https://oig.hhs.gov/reports-and-publications/workplan/) details areas where OIG will focus their review efforts by type of provider.