When fraud causes patient harm, and how to find it before it does

  • Cindy Gallee, JD, RHIA, CHC
  • Apr 17, 2018
  • Comments
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It’s been called the most sinister, the most egregious, the worst kind of health care fraud – providers performing medically unnecessary procedures. When this type of fraud makes the headlines, it is indeed sensational.

FWA, Fraud, Waste and Abuse, Payers, Potential Fraud Scenarios, program integrity, payment integrity, SIU, Fraud Prevention,

EHR systems can’t protect you from the False Claims Act

  • John Danza
  • Aug 11, 2017
  • Comments
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The recent Department of Justice (DOJ) $155 million False Claims Act settlement with eClinicalWorks highlights a problem that has existed in the EHR software industry for a long time.  Any EHR system that attests to do everything for the integrated health system can’t possibly provide the highest possible level of all aspects of functionality.  Some parts of the system will be concentrated upon while others will get just enough attention so the vendor can say they have the ...

FWA, program integrity, EHR coding, payment integrity, Billing Integrity,

RAC Ramp Up for 2017

  • Margaret Klasa DC, APN BC
  • Feb 27, 2017
  • Comments

The five regional Recovery Audit Contractors (RACs) are ramping up their automated and complex reviews starting this month. The Centers for Medicare & Medicaid (CMS) Medicare Fee for Service (FFS) audit program awarded contracts in October 31, 2016 ....

healthcare, rac audit, healthcare compliance, program integrity, CMS audit, medicare, medicaid, FFS, FFS audit,

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