FWA Briefs

Examining the difference between diagnosis codes that are applied correctly for reimbursements or was done with the intent to increase the amount they are paid. We review some of the more common coding errors that are typically identified.

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.

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 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.

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.