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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.
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Medicare and Maine Medicaid Healthcare Fraud Settlement Case

  • May 17, 2023
  • Blog

A Maine family practitioner used false claims billed to Medicare and Medicaid for services that were either not provided or not medically necessary, which provides reasons for the need of Fraud, Waste, and Abuse (FWA) protection.

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Dental Fraud in Medicaid

  • May 9, 2023
  • Blog

A multi-million dollar dental fraud scheme provides an example to the benefits of having fraud, waste, and abuse (FWA) protection. Click to learn more.

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Why Fraud Analytics Are Important to You

  • October 17, 2022
  • Blog

by John Danza The U.S. Department of Justice recently issued a press release about guilty pleas for people involved in…

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Evaluation and Management with Psychotherapy

  • September 26, 2022
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Per CPT1, “Psychotherapy is the treatment of mental illness and behavioral disturbances in which…

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CMS Adds and Updates Place of Service Telemedicine Codes

  • February 11, 2022
  • Blog

by Steve Nesnidal, MD, CPC, AHFI On January 1, 2022, CMS’s Place of Service (POS) Workgroup added new POS code…

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The Latest Three COVID-19 Vaccine Codes from the AMA

  • February 2, 2022
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Throughout the course of the COVID-19 pandemic, the AMA has released many COVID-19 related…

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Impact of Policy Adjustments on Telehealth Fraud

  • September 10, 2021
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Early in the Coronavirus pandemic, telehealth restrictions were significantly relaxed by federal and most major commercial payers.  This enabled more…

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Audits of Telehealth Services During COVID-19

  • June 29, 2021
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Starting January 27, 2020, in response to the Novel Coronavirus pandemic, the Department of…

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Fighting Fraud in Medical Nutrition Therapy

  • April 27, 2021
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Nutrition can play a key role in many diseases. The role of nutrition in…

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Impact of the COVID-19 Pandemic on Healthcare Fraud

  • April 7, 2021
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Even before the COVID-19 pandemic, healthcare fraud, waste and abuse (FWA) was already a…

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Janssen Single-Dose COVID-19 Vaccine is Pending FDA Emergency Use Authorization

  • February 23, 2021
  • Blog

by Steve Nesnidal, MD, CPC, AHFI UPDATE: FDA Grants EUA for Janssen COVID-19 Vaccine On February 27, 2021, the FDA…

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Effective dates now known for Pfizer and Moderna vaccines, AstraZeneca vaccine coming

  • December 24, 2020
  • Blog

by Steve Nesnidal, MD, CPC, AHFI The FDA has authorized these first two COVID-19 vaccines (produced by Pfizer and Moderna)…

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