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The Cancer in Health Care Fraud: Genetic Testing

  • February 28, 2025
  • Blog

In a 2019, one of the largest Health Care Fraud schemes ever charged, federal investigations and prosecutions resulted in charges…

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The Graft is On in Skin Graft Billing Fraud

  • February 14, 2025
  • Blog

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

  • September 17, 2024
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Medical coding provides several important functions in healthcare. One of the main functions is…

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The Federal Hospice Fraud Problem in the United States

  • June 25, 2024
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Fraud, Waste and Abuse (FWA) in Hospice is a significant US Healthcare problem. CMS…

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Overutilized High-level Drug Testing: Small Fees, Large Overpayments

  • November 17, 2023
  • Blog

by Steve Nesnidal, MD, CPC, AHFI Dr. Steve Nesnidal of Context4 Healthcare, Inc. presented at the 2023 NHCAA Annual Training…

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Mole Removal Claim Fraud Nets Jail and Fines

  • August 3, 2023
  • Blog

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

  • July 24, 2023
  • Blog

by John Danza CMS recently released a guidance letter concerning if HIPAA rules would prohibit a health plan from requiring…

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Fraud Spotlight: Why Modifier 25 FWA Continues

  • June 7, 2023
  • Blog

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.

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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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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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fake doctor, quack or charlatan in hospital office. medical crime, illegal health care, insurance fraud, negligence, treatment error or malpractice.

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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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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Recent Posts

  • Inappropriate Anesthesia Billing During Spinal Pain Management (SPM) Procedures
  • Don’t Be Taken for a Ride with Non-Emergency Medical Transportation Fraud
  • The Cancer in Health Care Fraud: Genetic Testing
  • Context 4 Healthcare, Inc. announces over 30 years of Usual, Customary, & Reasonable (UCR) Leadership
  • The Graft is On in Skin Graft Billing Fraud
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  • (800) 783-3378
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      • Advanced Medical Coding Software – CodeLink®
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