Don’t Be Taken for a Ride with Non-Emergency Medical Transportation Fraud
In a recent fraud indictment case, a provider was charged with over $3 million dollars1 in billing fraudulent claims for…
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The Cancer in Health Care Fraud: Genetic Testing
In a 2019, one of the largest Health Care Fraud schemes ever charged, federal investigations and prosecutions resulted in charges…
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Context 4 Healthcare, Inc. announces over 30 years of Usual, Customary, & Reasonable (UCR) Leadership
NAPERVILLE, Ill, (February 13, 2025) – Context4 Healthcare is proud to announce today the successful completion of the 30th year…
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The Graft is On in Skin Graft Billing Fraud
In a recent healthcare fraud case, from a short timeframe of November 2022 through May 2024, over $1.2 billion dollars…
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Bad Coding: A Fine Line Between Error And FWA
by Steve Nesnidal, MD, CPC, AHFI Medical coding provides several important functions in healthcare. One of the main functions is…
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Potential Overpayment Patterns: Non-Physician Assistant at Surgery
by Steve Nesnidal, MD, CPC, AHFI A non-physician assistant at surgery–physician’s assistant (PA), nurse practitioner (NP), or clinical nurse specialist…
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The Federal Hospice Fraud Problem in the United States
by Steve Nesnidal, MD, CPC, AHFI Fraud, Waste and Abuse (FWA) in Hospice is a significant US Healthcare problem. CMS…
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Medicare Reference-based Pricing RAND Study
by John Danza As a leader in the Medicare reference-based pricing (RBP) space, Context is frequently asked two questions: Our…
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Overutilized High-level Drug Testing: Small Fees, Large Overpayments
by Steve Nesnidal, MD, CPC, AHFI Dr. Steve Nesnidal of Context4 Healthcare, Inc. presented at the 2023 NHCAA Annual Training…
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Monitor Potential FWA: Overutilization of High-Level Codes
by Steve Nesnidal, MD, CPC, AHFI A common Fraud, Waste and Abuse (FWA) pattern detection involves monitoring for and analyzing…
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Mole Removal Claim Fraud Nets Jail and Fines
by Steve Nesnidal, MD, CPC, AHFI A suburban Chicago doctor will spend 6 months in jail and pay a $1…
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NPI Guidance Can Help Your FWA Detection
by John Danza CMS recently released a guidance letter concerning if HIPAA rules would prohibit a health plan from requiring…
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